Pod deactivated frustration

Yesterday I went to a trade show with a friend. We planned to attend the show for a few hours in the late morning and then have lunch. My pod was not due to expire until 3:45 p.m. and I had enough insulin in the pod to cover my lunch needs and comfortably get me to the pod change sometime around 3:45 p.m.



When we sat down for lunch, I used the PDM to deliver both an extended bolus and an immediate bolus. Following the second beep-beep confirmation that my bolus was delivering, I placed my PDM back into its usual spot in my day pack.



When I was getting into my car after lunch I heard a long continuous tone - I think it was coming from the pod. I fished the PDM out of my pack and when it awoke it reported “pod deactivated.” Not only that but it also told me that neither of my lunch boluses was delivered!



Needless to say, I was irritated and frustrated with this Omnipod-caused hyperglycemia that I knew would follow. All insulin had been stopped for about 30 minutes when I finally discovered that the Omnipod had quit.



I immediately injected some insulin via a syringe to cover for the missing insulin but I knew that I could not recover the 30 minutes in time. I decided to drop my friend off at his home before I returned home myself and place new pod. I guess I could have changed to a new pod in the car with my friend in the passenger seat. But that would have been socially awkward to me.



Once I had the new pod in place, I called Insulet customer service to see if I could figure out what happened and hopefully avoid a similar thing from happening again. The customer service rep took down my report and had me look up the alarm history and tell her the alarm code that was store in my PDM. I asked her what that number meant. She said that she had no idea but would report it to engineering. I told her that I would like to know what’s going on but she said that engineering does not communicate with customers. Bottom line: I would not find out why my pod deactivated.



The customer service rep politely told me that I would receive a replacement pod. I told her that I appreciated that but at this point I was more interested in what actually happened than I was in getting a free replacement. She apologized and said that there was nothing more that she could do. I expressed that this was not her fault but I wanted more transparent info. I said that living with the normal challenges of T1 diabetes was hard enough without having to fight the vagaries of a treatment system like the Omnipod. She apologized again. I told her that I know she has a hard job and does not have the authority or knowledge to answer my questions.



The call ended amiably but I am not happy with pods deactivating like this. I have worn insulin pumps since 1987 and I have rarely experienced this level of unreliability. It’s ironic that Insulet’s commitment is to make “diabetes a smaller part of our lives” but when there’s trouble they holds us at arm’s length using polite, yet deliberately ignorant, customer service reps.



I’ve been on the Omnipod system since July and was hoping to be a long term customer. This incident and a few others makes me think that “living without tubing” isn’t all that great. I may be forced to go back to a tubed pump for another 4 years. Well, if I do that, at least I can say that I gave Omnipod a fair trial.

This is basically why I found a new pack that would allow me to carry not only the PDM and BG testing supplies like the provided pack does, but also an unused pod and other supplies if ever needed. I wish the provided pack was a bit more roomy for all needed supplies and such. I've not had to use them in this way yet, and have yet to have such a failure. I do believe they are actually rare. Sorry it happened to you Terry, hope you have better luck in the future.

I had deactivation and occlusion issues when I started too! I think we all do. My endo prescribed me a 2 day pod change so my insurance would cover more pods a month. That means I don’t stress waiting on replacement pods. It helps a lot. Also as I got more used to the system I found errors (occlusion failed error ect) came less often. I went into Omni with my “eyes wide open” to its flaws. It’s benifits (to me) out weighed its risks (flaws). That being said, they usually can’t tell you why, they just send you replacements. I keep a syringe just in case, a pod just in case, and I’ve alarmed in classes, at my kids school events ect. I just fix it. My life is so much simpler now. I have a toddler so I’m happy to not have tubes. Nothing to yank at, no buttons to push on mommy, easily swim with my son ect. If you can’t say these are my reasons for THIS management system, maybe it’s the wrong one for you? Not that it’s you by any means, but if the pros don’t out weigh the cons then maybe there might be a better system for you?

Also if you want a reason behind an error ask your pump rep. Mine is available to me via email or text and almost always has an answer for me. Customer service is just there to send my replacement pods :slight_smile:

Scott - Thanks for the reply. I'm glad to hear that you've not experienced a pod deactivation failure before. What I didn't mention in my post is that I this is my second failure of this type. I had another pod deactivation failure on November 3.

I've been trying to hold back a rush to judgment on the Omnipod system. While yesterday was a setback, I will wait and see. As of now, I'm leaning toward going back to the Animas Ping with the Contact Detach stainless steel cannula infusion sets. My next opportunity to reorder infusion sets is January 1.

Alison - Thanks for the tip about contacting my pump rep. I also have a prescription to change pods every two days. I'm reluctant to do that now since I've been dealing with figuring out how to preempt post pod change hyperglycemia. I was having 8-12 hours of highs when I changed pods. Once I got my BG down, the last thing I wanted to do was change again at 48 hours.

Luckily, I've found that using a syringe bolus at pod change time seems to be limiting the post pod change highs. I need a few more pod changes to verify.

Did you know that both Apidra and Novolog insulin package inserts recommend infusion site changes at 48 hours?

Terry, like you I have been on the Omnipod system since last July. In general it works great for me. However, sometimes an unexplainable thing happens. I am afraid we have to live with this. Unfortunately there is no such thing as an ideal world. Sofar I am happy with the Omnipod - better BG, less insulin - and every problem is solved adequately by the European distributor of Insulet.

Actually my endo said the pods work better in his experience with certain insulin (I’m not saying which because I’m not a doctor)! So yeah I knew that some insulin “expires” (not goes bad but loses efficacy) in pods supposedly. I don’t know that this is true or false or just my endos observation but I have found that I’ve had better “luck” with my pod than a lot of other new users and I really think a lot of it comes down to my care team being really knowledgable about the systems flaws (including my rep who was open and honest even when “selling” me the pod). I think Omni users are less pumpers and more a breed of their own in terms of pumping we are more “poder’s” and we have different new issues with a different new management system.

barend - I realize we live in a less than ideal world. I get that. I also know that things can get better and the way to make them better is to reach for the ideal. While perfect is unattainable, better can usually be achieved.

I don't speak out and register discontent simply to blow off steam. I believe speaking up on forums like this and creating sentiment for improvements will, over time, have an influence on companies like Insulet.

I'm glad you're happy with the Omnipod system. Anything that makes the lives of diabetics easier is a good thing!

Terry - I fully agree with you.I always inform the Insulet distributor in Europe when I encounter a problem. Let's keep them sharp and come up with better products. BTW I can't wait to start with the recently received new pods. They are much smaller!

My information is that it is Apidra and Humalog that recommend that their insulins not be in a pump reservoir more than 48 hours and that Novolog oks up to 6 days. I've been using Omnipods since Oct. of 2008. I used Apidra until January of 2012. I have had much greater success with the Novolog. On Apidra, the last 18 hours of the 72 hours of a pod, the BG would rise significantly. I actually am getting 80 hours of effective use out of most pods now. Also after I put on a new pod, I inject 1 unit as a "primer" dose, check the BG in one hour and make any corrections. (I also check the BG before I change and dose accordingly.) If my BG was low I cut back on the primer dose.

the previous 2 pods I used, have done that to me as well when I had a couple of hours left. I started to think the box of pods was a lemon. it's annoying, but I have just changed the pod and bolused again. I have never called to find out why, I just change the pod. but it would be intresting to know why. I think I shall fire off an e-mail to my rep and seee what he has to say. if I do get any useful info I will let you know.

Hi jla - Your comment about which insulin brands recommend 48 hour limits for insulin pumps sent me back into research mode. Here's what I found:

Apidra -
Source
"Based on in vitro studies which have shown loss of the preservative, metacresol and insulin degradation, APIDRA in the reservoir should be changed at least every 48 hours."

Novolog -

I initially found this FDA link that lead me to believe that the manufacturer recommended changing the infusion set/site every 48 hours. Looking at it more closely I realized that this was 2006 info.

Source
"In-vitro studies have shown that pump malfunction, loss of
cresol, and insulin degradation, may occur when NovoLog is maintained in a pump system for more than 48 hours. Reservoirs and infusion sets should be changed at least every 48 hours."

Here's the current recommendation from Novo_Nordisk:
Source
"NovoLog® is the first fast-acting insulin that can be used for up to 6 days in a pump before it needs to be changed. The table below shows how often to change NovoLog® in a pump. Please be sure to check the instructions that came with your pump.
Pump component Time frame
Reservoir Up to 6 days
Infusion set and infusion set insertion site Up to 3 days"

Humalog -
Source
"Based on the updated label, people with type 1 diabetes using Humalog for pump therapy can use the insulin in the pump reservoir for up to seven days and should change the infusion set and infusion set insertion site at least every three days. The previous label indicated that Humalog in the external insulin pump reservoir should be replaced and a new infusion site selected every 48 hours or less."

While Novolog says that 6 days is OK with insulin in a pump reservoir, it does say to change the set/site every three days. For me though, this is a moot point, as I found that I am allergic to Novolog. I developed "pump bumps," red and swollen tissue at the pump infusion site.

It's interesting that you found absorption problems with Apidra in the last 18 hours of a three day period. I'm not sure what to attribute that to but it is consistent with the problems I've personally observed.

Thanks for relating your experience.

Did you happen to run out of insulin before the 72 hours was up because I believe that will make the pod deactivate too.

Ok - your question made me go back and re-examine the insulin amount status that day. I had a low reservoir alarm at 8:16 a.m. That means I had 20 units onboard at that time. The pod deactivated alarm occurred at 12:43 p.m. Between those two alarms I used 3.6 units for basal and 8.55 units for breakfast, which leaves me 7.85 units for lunch.

My carb history shows that I dosed for 15 grams of carbs for that meal. (Interesting that the carb history is intact yet insulin delivery for that meal is missing.) Fifteen grams of carbs = 2.5 units for me. That leaves 5.35 units. I usually take an extended bolus to cover protein and fat anywhere from 2.8 units over 2.5 hours to 3.6 units over 3 hours. Even if I took 3.6 units, that would have left 1.75 at the end of 3 hours.

The alarm went off soon after I finished eating. I calculate that I had more than 5 units in the reservoir when the pod deactivate alarm went off.

If I had run out of insulin, I also think that the pump alarm would have been an "out of insulin" alarm instead of a cryptic "pod deactivated." Don't you think so?

I should have gone through this exercise sooner. Thanks for asking a good question!

Meh - It’s always good to know I’m not alone in this. I would be very interested to learn what you discover.

I recently have had times when I would swear I have taken insulin but there's no record of it but my PDM is old and seems to be getting sticky. I would have to go back and check the manual to see if there's a level of insulin at which the pod deactivates and what message one is supposed to get when you run out of insulin. It appears that you were very close. I've had T1 for 46 years and, as imperfect as they are, the Omnipod and my DexCom are the best tools I've ever had. My A1c's are not great but still better. I'm pretty active and am 67 with no major complications.

When the incident in question happened, the PDM informed me that the boluses were canceled. That's what prompted me to immediately take some insulin via a syringe. Yeah, one of the major benefits that a pump has over MDI is the fact that it remembers much better than I can!

Good for you that you've managed T1 well enough to avoid any complications.

Hi Terry, just wondering what alarm code you got when your pod did this.

Mine was 19-000-0000-00064.

I spoke to my rep on the phone yesterday, he is also a omnipod user.

he advised that he doesn`t know what causes this, but as this has happend to him as well and his thoughts are that it`s possibly too much air in the resevior, as it always seems to happen at the end of the pods life.

again this is just his thoughts as a user, he has no official word on the subject.

meh - The alarm code was 19-000-0000-00051. I did have another pod deactivate alarm on November 3. It was the -00064 code that you noted.

Every pod that I've dismantled (about 5 or so) had a rather large air bubble in it. Not sure how that happens as I'm careful about not injecting any air when I load insulin.

I'd love to know what the alarm codes mean.

At least your experience and your rep's experience confirms that what happened to me was not a solitary incident. Thank you for your feedback.