Tell Me Your Lessons Learned for Transition

Diabetes Technology Insulin Pumps
1

Soon to be a new OmniPodder! Just waiting now for endo to send medical notes for final approval. I've read many of the helpful tips from the users here and thank you all for that. I am hoping that you will give me the benefit of your experience if you had to do the transition from MDI to OmniPod over again.

I'm excited but a bit nervous because I'm afraid that the training I receive may be minimal from my CDE. The OmniPod rep for our area is also really new so I'm not sure how much support I will have locally. I'm trying to educate myself as much as I can to make this go as smooth as possible.

My story in a nutshell: Type 1 for almost 25 years on MDI of Lantus (1x 29u) and Humalog. Using Dexcom since November - this has allowed me to eliminate almost all lows and highs over 180 so I'm hoping that the OmniPod's ability to dose in smaller increments will help me even more. Eating low carb since I got the Dex and saw what was "really happening" with my trends. A little nervous about the transition messing with my numbers that I've worked so hard to get more in line.

Questions:
(1) I understand that many endos will start basals low for safety reasons, causing many to run high until levels are appropriately set. Would you take off a few days from work when starting initially or is that a bad idea because the activity level not at work vs at work is different and would affect basal requirements? I work a desk job but worry if I'm up at night with blood glucose issues that I might struggle during the day at work.

(2) Will I need to check blood glucose every 2 to 3 hours around the clock to get levels straight? My Dex is great but if I go high during this transition, that's when my Dex isn't as trustworthy so I'm wondering if it's typical to do around the clock testing at first?

(3) I've read that different pumps calculate IOB differently and the OmniPod calculates IOB using only correction doses and not carb doses and that could cause problems with stacking insulin if you don't manually calculate. The info where I read this was dated. Do you find that to be the case now? Do you trust the pod suggestion or do you check the math to see if you agree? How do you deal with this?

(4) With MDI I wait 3 to 4 hours before I give a correction with IOB because I've had some really fast, hard lows from stacking too close in the past. How often do you correct with OmniPod without having to backfill and do you trust the wizard when doing so?

(5) Does the OmniPod show you if there's too much IOB for a correction?

(6) Are unfilled pods affected by heat? As in could I leave spares in my car as back up even when it's hot outside (like 90+ degrees) so I don't have to tote them everywhere?

(7) Based on your experience, what else should I know to best prepare me for the first week?

Thank you so much for your support and for any wise advice you can give me as to what would have made your experience an easier one. Or maybe I'm just overthinking this (as I tend to do) and it will be a piece of cake!

2

Wish you luck in this process!
1. I personally wouldn't take off from work--just keep extra supplies and glucose on hand in case something went awry--but it's definitely a personal preference. I think the doc should have it fairly dialed in initially so you shouldn't have too many crazy highs or lows, just a few tweaks to figure out how your basal rates fluctuate throughout the day.

2. In an ideal world, sure, checking every 2-3 hours would give you lots of good info. Depending on what you and your doc decide, maybe just a few days of this constant checking and then cut back to maybe 1 in the middle of the night and then throughout the day as needed to finish w/ the tweaking?

3. Yes IOB is only calculated based off of the glucose values you put in and any bolus you give for carbs is not factored in...so if you're a good carb guesser, you'll be fine. But we all know in the real world this is sometimes not the case (unless you do the same thing and eat the exact same thing every day at the same time...and then it would of course be less of a factor :)
While I would prefer it the other way (so I could see at a quick glance how much total insulin I actually have on board), the current method works fine too so long as I don't get bolus crazy w/ a big/heavy/fatty meal. I trust the pdm as a guide for the most part. If I test an hour after I've eaten a main meal b/c I'm about to eat some dessert and it says I'm 186 (w/ my target of 120) it will tell me to give a much larger bolus than I know is correct, b/c I know I still have insulin that's dealing w/ the food and it will (assuming I've carb guessed correctly) be coming down soon. So in that instance, I wouldn't likely give the recommended dose. For me it's about timing and just keeping in mind when my last bolus was for food.

4. Kind of relates to Q3. Not sure what else to add other than saying it might be a best practice to continue w/ your current strategy and then adjust as needed (correcting sooner) in the future?

5. I don't think so...only b/c I think this question relates to the way other pumps factor IOB.

6. I carry spare pods around in the center console of my truck and occasionally switch them out for fresh ones just so they never reach their expiration...I haven't noticed them be affected by the heat (although I'm sure if you read the fine print there is probably an acceptable temp range at which they should be kept and 130* inside a truck in the summer is likely not w/ in that range :)

7. I came from another pump when switching to the pods, so it's been a while for me to recall anything particularly useful to keep in mind for MDI to pump. I know there are plenty of other great folks in this group that will probably have lots to say though.

3

smileandnod- Great name! Is this (as one would expect) a name brought about by reactions to your giving yourself shots and the public's curiousity? IN any case, welcome to the group of "podders"! I hope your experiences with the Pod go better than mine, As I just got off the phone with Insulet reporting another "bad" pod. I find the rate of unusable and "bad" pods to be unacceptable at 20% or every 2 in a box of 10. From what I've read and heard that is pretty common, and I grew tired of it and switched to Anamis last month, but found the tubing on the Anamis pumps to be too big an adjustment. Also I find the Insulet billing dept to be very backward to the point that I truly wonder if they use computers. Other than those concerns the whole premise of the pod is great, No tubing good delivery system, however there is NO IOB option or function, so one needs to do the calculations themselves just as you do with MDI. Actually I agree with B
radford and the way he suggests you handle it. One great thing about the pod is the "adjustment bolus" calculator...at least my endo and I have come up with the best correction ratio for me. I find that is the REAL KEY to making the pod work for you! MAKE SURE you put the necessary work into coming up with a truly accurate "correction ratio" or "carb to insulin' ratio with your CDE or endo, and the pod will work better for you. I am sorry if this is coming accross as negative but like I said...I am fresh off the phone with Insulet and that always aggravates me!

4

Thanks so much for the words of wisdom Bradford! I think you're right about continuing to wait for corrections at first until I'm more comfortable and have the settings in sync.

5

Thanks for your comments Steve. I understand the frustration as I have had similar experience with my Dexcom and sensor failures...I like to say I have a love/hate relationship with my Dex. For me, it's the OmniPod or MDI right now. I just don't think I want to deal with tubing...that's really why I've never gone to a pump before now. I'm not one who really minds the injections so it's not like I hate MDI, I just want the ability to dose in smaller increments.

I hear you about accurate I:C ratios and correction factor and I've been working hard to try to figure that out on MDI. All my ratios have changed over the last few months and I've even found that a difference in 1 hour of eating lunch late can make a difference in my I:C needs so I'm trying to nail that down. I've also been suspecting lately that my correction factor is too much insulin as I seem to continue to drift very slowly down after a correction instead of stopping where I think it should. Thanks for pointing this out because I need to re-read that part of Pumping Insulin and try to test my correction factor.

6

Oh and yes, "smileandnod" comes from the uninformed (aka insensitive, stupid) comments that people make about diabetes. One day at work I was taking a shot at my desk and one of my co-workers started to walk in and then backed up when he saw what I was doing. I told him "that's okay, come on in, not a big deal, I'm used to it" and his response was "well I'm not" and he walked out....

Another day I'm testing my blood sugar with my Accucheck and one of my co-workers started to walk in my office and said "Wait what are you doing?". He knows I'm diabetic and when I told him I was testing, he said I thought you were using a cellphone to do it!

I have a million of these stories but yes, I just smile and nod and laugh because what else are you gonna do? :)

7

I understand the frustration with the Dex also....I have gone through the same! i guess when someone (like us) goes for the latest in technology (the Pod and the Dex) we should expect frustrations....but I must admit I am impatient and expect everything to work perfectly at the outset. I am learning to be more patient, although the pod is seeing some improvements out there and I am anxious to try the new pump called the "Solo" .... which is essentially the pod with a few improvements....I think it is being prepared to US launch in early 2012 by the company Roche medical, so I feel I just need to be patient and try it out when it is available (and then I need to expect some deficiencies). Good Luck!

8

Oh yeah, every one of us has one millon stories....there was a discussion last yeat on TU about the rude comments some ignorant people make and how we have handled it.....I cant recall the title of the thread but it is an entertaining way to spend some time!

9

Steve, not sure if you made a typo but US launch of Solo is likely to be early 2013. No way to know until it rolls out if it will fail less often than Omnipod but that is my hope. Of your 20% fail rate, were most reimbursed?

10

Thank you Don, and Yes, Insulet does replace essentilly 100% of the "bad" pods, but i have an issue with having to "call in" every few days to report another faulty pod. Yes also, that WAS a typo on the launch date of the Solo, just off by a full year, no big deal!