I consistently experienced post change highs with the larger pods towards the end. I was thrilled when I did not experience post change highs with my first 4 boxes of small pods. Unfortunately though, it did not last. My latest shipment of pods has brought back the post change highs. The site doesn't matter. I can set my watch by it. I change the pod. The first hour is stable because I am still benefiting from my previous pod. Next my blood sugar starts to climb. At 6 hours from pod change it starts to fall. It falls for approx. 2 hours. I feel like all of the insulin, boluses and basal is hitting me all at one time. I have been injecting boluses now, during the 6 hour period, because that turns into a lot of insulin when I finally get it.
Am I the only one having this problem? I hope it is just this lot number. Lot L40419.
For me post change highs are hit or miss. Maybe a little less frequent with the smaller pods. I always bolus extra in anticipation of a high. If it does not happen then I get to eat an extra snack. I am looking forward to extra snacks.
I bolus 0.6 when I change pods.
I was going to post a similar question because I have found the similar post pod change highs with the smaller pods that I had with the larger pods. I am just following the same procedure I had with the larger pods (bolus extra 1 unit with old pod and 1-1.5 units with new pod). Helmut sums up my feelings exactly-extra snack if I don’t need the added insulin-huge bonus!
Thank you for your replies! I don't understand, "why the extra bolus?" Does the extra bolus get the insulin into your system faster?
I make sure that I am good and low when I change the pod...80's approx. Then I change it. That keeps me ok for at least 1 hour. My basal is approx. 1.2 units of insulin per hour around noon....so in 6 hours, I have a 'fake bolus' of 1.2 X 6 plus any 'real boluses' coming in. If I took any 'real boluses', my BG can drop over 300 points (with no bolus) starting at 6 hours after the pod change. It drops from approx. 6 hours to 8-9 hours after the pod change. It has been 'saving up'. I guess I am scared that if I turn up my basal to 1.3 for example....I will have 1.3 X 6 to deal with at the end of 6 hours. I thought I needed to actually turn the basal down so I don't have soo much cooped up insulin to deal with at the end of 6 hours. I have been injecting boluses now so I am not dealing with them anymore at the end of 6 hours, and I haven't been going as high because of that. It hasn't made any difference in the 6 hour drop. Basically my new pod doesn't work for 6 hours.
Before I realized this....I would take a bolus....nothing....take another bolus.....nothing again. At the end of 6 hours....here it all comes, and I am chasing it for approx. 3 hours.
When you inject with a syringe or a pen, you normally wait a second before withdrawing to ensure it’s all delivered. With a pump, you infuse small amounts of insulin constantly. When you remove the pod, all the insulin in the old cannula is removed & it takes a while for the insulin on the first hour of basal to enter our bodies.
Insulin's reaction on the body is a very tough nut to crack. Lots of things like stress and certain foods, and timing of pod changes can affect it in ways we won't necessarily understand each time it occurs. One small possibility is the timing on your pod change. For example, do you change it now before a meal rather than after or visa-versa? As Belinda stated, there is a hour of time that may cause your BG to fluctuate due to the pod change's need for the new insulin to start it's work from the old pod's insulin. If that timing is at certain points of the day, it could be more dramatic than other times of the day. There are other factors too, so consider them all and be prepared to bolus or not bolus if and when needed. We are so lucky to have the tools at our disposal today to control our needs, much unlike the past.
MyLife & my DSN have always advised me to change before meals. As I cook dinner & have porridge for breakfast. I prefer to change 20 - 30 mins before, so I have my mini-bolus, then my meal bolus. After an occlusion (rare as they are) my mini-bolus is even more important. Trial & error is the best way to work out how much you need.
I change it at approx. 10 am...after my walk. Now, on the day of a pod change, I usually only have a piece of fruit for lunch...and I inject the bolus, because I don't benefit from a pod bolus until the 6 hours is up. The weird thing is that my first 40+ small pods didn't do this.
I was always scared to eat right away after a pod change, for fear of a pod change high. Thanks Belinda and Scott. I have been consistent with my timing of a pod change, because I wanted to give the pod time to kick in when I was paying attention. That is also the time of day when I am the most insulin resistant, so my timing may be playing a role in this. I think I do mostly trial and error, so it is helpful to hear recommendations heard from a pro. Belinda...can I ask, do you know why changing before meals was recommended?
I will change my pod change timing and see if that makes a difference. Once the pod starts to flow, most of the time it works like a champ.
Yes, I do! The bolus clears out any tissue in / around the cannula & flushes things out. You bolus with meals, so that solves one problem. The other problem (the insulin in the removed cannula) is solved by the mini-bolus & is in my case approx 40mins of basal.
This is different from the behavior that most (but maybe not all) other users of the new pod have reported.
For me things seem to have got better with the new pods. I frequently had a high a few hours after the change of the old pods however bolusing 1IU after the pod change fixed this. Most other people seem to have similar experiences that are fixed by up to 1.5IU on pod change.
What you have sounds like a magnified version of the problem - rather than 1IU to get the pod to work you need at least 7IU. If it is the same problem, and it just requires an appropriately large bolus to start working, you could try suspending your basal after a pod change and bolusing 7IU immediately, then watch what happens for a few hours (watch for the low) but first I'd make sure that a 1IU (or so) bolus immediately after the change doesn't have any effect.
A second explanation is that you are seeing an effect I sometimes see when I go very high (>250mg/dl) and my blood sugar 'sticks'. No amount of bolus will bring it down. It takes several hours to reset after an event like that and if I bolus too much to get it down I experience low blood sugar when it does eventually drop. If this is the problem you are seeing a larger bolus after pod change might avoid the high and allow your blood sugar to behave more like mine. 7IU would probably be too much if this is what is happening, hence my suggestion that you test carefully with a lower amount first.
Regardless of what happens it sounds like a good question for Insulet. Clearly you shouldn't be able to bolus/basal more than 7IU of insulin and not see any effect for six hours.
Humalog insulin *should* start work within 30 minutes of injection. If it didn't we wouldn't be able to eat meals with any significant amount of carbohydrate. Of course we still see highs for maybe 2 hours after eating, but the insulin and carbohydrate match up after that.
John Bowler
As to *why* the pod change bolus is required by some people sometimes it's possible to come up with any number of explanations, such as bubbles in the pod, but none of them are easily testable and none of them seem to be quite right.
By definition we know that the priming process is incomplete, because if it were complete the insulin bloused after the pod change would invariably cause a low blood sugar.
It might be that the pod is not delivering insulin into the skin after the change, but I find that very unlikely. Bubbles in the pod reservoir are really small - much less than 1IU, which is 1/100 ml, so the same size as a bubble 2.6mm in diameter!
Apparently, for some people/sites, insulin delivery does not commence at a significant rate until up to 1.5IU have been injected into the skin. The insulin has to go somewhere and it clearly isn't getting into our blood stream. The 20 minute delay before subcutaneously injected Humalog starts to enter the blood stream isn't enough to explain this, particularly as there is still insulin being adsorbed from the old pod.
Apparently a bubble of insulin up to 3mm in diameter is sitting somewhere not being adsorbed. Maybe that's the explanation? Maybe some of us need a little bubble of insulin of about this diameter before adsorption really starts?
John Bowler
I said nothing about bubbles. The cannula theory makes the most sense. If I bolus 0.6u before a pod change my blood sugars stay flat. If what I’m saying sounds crazy, look at the cannula you remove & tell me that it’s empty.
I was responding to the original question by Nevada. Many people have felt that bubbles in the reservoir might be the problem.
The cannula is full both before and after insertion. It's 23 gauge and it would contain about 0.6IU, however the whole point of the priming process is to fill it before it is inserted. Anyway, many people report needing 1.5IU and Nevada seems to need 7 or more IU.
The fact that the behavior and amount of insulin varies by person surely indicates that it is not simply a function of pod misbehavior.
John Bowler
I think this picture from my CGM explains it. I changed the pod approx. 10am during a low. I ate a normal lunch and bolused a 5 at approx. 11:30. I knew I had enough insulin in me, so I waited. I finally injected approx 4 units (correction bolus - but where would you start?) in the afternoon. 6 hours after I changed the pod, all of the insulin caught up and started to come. If I had 'primed' the pod, I would have seen that extra insulin also.
I am definitely going to try and change it at a different time and see if that helps.
Maybe you should do a pod change & basal test. Test when you wake up, skip breakfast & see what happens.
Thank you for responding again. My basal is solid. Good idea though. I didn't have these problems with my first batch.
I just spoke with Insulet and told them about the pod errors (3 of the last 4 of these pods have failed) and the 6 hour problem. They want the pods, said that they are trying to work out the kinks and they are sending out replacements and an envelope so they can look at these. Who knows?
I think that my posting was for 2 reasons....1)I appreciate the suggestions (I will use them.) and 2)The low at the end of 6 hours can be a pistol to overcome, and too much over-correction with these pods can create quite a low. Insulet and the FDA must have come across some proof of pod-change highs or they wouldn't make us pay attention to the PDM at the 1.5 hour mark.
Sorry, I’m not querying the basal. If you don’t eat & your blood sugars spike when you change pods, the pod change is messing up the basal.
A spike after a meal, that rectifies itself, isn’t abnormal. That, plus pod change, makes it harder to separate the two out & fix what needs fixing.
Once I knew, I needed 0.6u when I changed pods, I could go back to changing shortly before meals.
How long do your G4 sensors last?
I have always had a new pod high…old pods and new smaller ones. I just add an extra bolus with old pod before I put on the new pod and keep a higher basal for two hours. Works every time but it took alittle trial and error to find the perfect amount.
I usually change the G4 sensors approx. every 10 days. By that time, I have re-glued them and they don't seem as accurate. Also, I was told from a Dexcom rep that 10 days or less creates less risk of infection/sensor staying in the skin...that kind of thing. I don't see ??? yet at that point, but I rely on them, and don't push them.
You are absolutely right....if I am not eating and my blood sugar is spiking...my basal has a problem, but I see both the basal and bolus at the end of the 6 hours - and it is relentless and drops and drops for hours.