Sorry, but I have another question. When does the Pod deliver your basal insulin? We were frantically trying to complete a Pod change before the top of the hour so that we didn't miss the beginning of a basal delivery. I could't remember if it is a slow-release over the entire hour or a one-time thing. I even Googled it and looked in the book/manual with no luck. Thanks again ... you guys are great! :)
Basal is continuous. It always delivers. There is no hourly sync of delivery. Change the pod when the alarm goes off, unless you need to change earlier due to scheduling of activities. After a while you'll be able to pin point to 10 or 15 minutes when the alarm will sound. Also remember, you can usually do well without a pod attached for up to 1 hour according to Insulet, though the shorter the time the better.
Hi the basal rate is delivered slow release so over the hour rather than a one-off delivery. Don’t panic about when you have to change a pod, it should only take a few minutes so you won’t miss much insulin at all.
One thing you will have to observe though, and you’ll probably see lots of comments on the forum about this, is that people’s levels can increase a bit whilst the new pod “settles in”. Everyone is different, but what works for me is a bolus of 0.5 once the new pod is on, and then I have a temp basal rate increase of 25% for 3 hours. But like I say everyone is different and so you will just have to try and find what works for you.
slow release over the hour.
So if you were on 1 u/hr basal, it would deliver a that evenly over 60 minutes (so every 6 minutes you'd get 0.1 u, or if you had it set to 0.05 you'd get it every 3 minutes?...if I did that math right!).
That's why temporary basal rates can be so effective--b/c it's a fluid change over time, not an all or none thing.
If it was delivered once and you missed it by 5 minutes and then edited the basal, it would effectively double up the basal (or at least stack the insulin)...so again thankfully that is not how it operates.
No need to be frantic :)
I'm 90% certain that basal is delivered "continuously" at a frequency determined by your basal rate. In other words, if your basal rate is .6 units/hour, it would deliver .1 unit every 10 minutes or .05 unit every 5 minutes (I'm not sure what is the smallest amount of insulin it can deliver at one time, but I think it's 0.05 unit). If you listen carefully, you can hear the tiny little "tick" sound of the pod as it delivers basal every few minutes; the same "tick" sound you hear lots of when delivering a bolus.
The click is actually the motor moving through it's protective gears (without getting too technical), not when it's actually moving as compared to not moving. It moves constantly, without stopping.
The smallest amount the Pod can dispense is 0.05 units. Let's say basal is set at 0.5 units per hour. I expect the Pod to dispense 0.05 units every 6 minutes. I have never heard anything about once-per-hour on-the-hour. I remember an observation posted here that in the above example the first dispense would be after 6 minutes, not right away.
That doesn't make sense to me. When a bolus is being delivered, you can hear it throughout the duration of the bolus, then it stops when the bolus delivery is complete. Once I actually counted the clicks and it corresponded to the bolus size and the setting I had for minimum delivery (0.1 or 0.05 unit); in other words, I heard a number of clicks that was equal to my bolus units divided by 0.1 or 0.05.
You actually have 8 hours AFTER the 3x24 hour expiration alarm to change the pod before it actually does REALLY stop pumping or bolusing, so you have alot more flexibility concerning the response to the three day alarm.
Amen to reminding us that we can live without a pod for an hour or so! I think a lot of new podders forget that and try to micro-manage too much. Remember that stressing out over pod changes is bound to raise BG, so my advice is to relax and get it done as soon as possible without letting it stress you out.
I think this pod video might help. Near the 1:45 mark in the vid.
I don't want to mis-speak, but I think (?) the wire is being heated (or an electrical charge is being applied to each side, which shortens/lengthens it, respectively) and that causes the mechanism under the scroll wheel to "wobble", so to speak, and that causes the actuation of the wheel to actually scroll. This is on a rod that is threaded and it pushes on the reservoir with each movement down the threaded rod.
I would think you're hearing the click and simultaneously being given the insulin (whether you have it set for 0.05 or 0.1)? But that's just my understanding from the vid.
OK, so I can relax. We didn't miss much then. His pre-Pod change BG was 134 and post-Pod change (1 1/2 hours later) was 145 so I think we did pretty good. I hope we do that well each time and he'll be one of the lucky ones to not have those dreaded post pod change highs!
Thanks again for all of your replies. :)
I called Insulet and had a detailed discussion with their R&D team about this, since my toddler son frequently only takes .05 or .10 basal for an entire hour. Like Helmut said, the smallest increment is .05 units. Basal insulin always starts delivery at the top of the hour and then is spread out over the hour. So if it's 1PM and you have a .05 basal set, then it delivers that basal at 1:00PM. If you have a .10 basal set, then it delivers a .05 at 1:00PM and 1:30PM. .15 basal delivers .05 units at 1:00PM, 1:20PM, 1:40PM. If you miss a basal it does not make up for it - I used to think that - say I change pump at 1:01PM and have a .05 basal for that hour you will not get any basal until 2PM.
Something else interesting - if you change a pump at 1:45PM your hour for basal on that first day actually starts at 1:45PM. So that first day your basal will be at 1:45PM, 2:45PM, 3:45PM. It resets itself on the hour at midnight. Any discrepancies in basal (say you were owed another .05 for 15 minutes of an hour not taken) it will actually short you that basal at midnight.
Wow! So, it actually would benefit you to do your Pod change before the top of the hour, right? Because by the 3rd day (by the next day even) it would have reset itself at midnight on/to the hour. So, I wasn't being all frantic for nothing then! LOL Thanks SO much for sharing that information. :)
Well, keep in mind that this only matters for quite low basal rates. For small children I imagine that's not uncommon, but I suppose most patients have enough basal that it's spread out more evenly over each hour.
Eric and Bradford are right. It only moves when a pulse is delivered (0.05 U) and that's when it makes the "tick" noise. Gil.
Agree, agree, agree.
Also a point about delivery that was very important to Caleb when his TDD was about 2 u per day and and had basals set at .05 per hour - the delivery happens at the end of the time interval, in a conservative manner. So if Caleb's basal was .05 per hour, that basal was delivered at the end of the hour. If it was .15 per hour .05 was delivered at the 20 minute mark, .05 at the 40 minute mark and .05 at the 60 minute mark. If my memory is correct, the hour starts on the minute that you initiate the Pod, not at the top of a chronological hour. This is not a big deal now that his insulin needs are much greater bc this all gets lost "in rounding", but it was paramount for a period of time.
I used to stress out about missing basal during a pod change as well, because I wanted to make sure he got his basal on a "working" pod. I was always uncomfortable with people saying "oh, just give him some extra like a half unit or whole unit to make up for pump change high." When your child gets so little insulin to begin with, anything extra can have severe consequences.
So I now just make up for extra insulin that would be missed during a pump change. Since it can take me up to 15 minutes to chase my little one down and pop a new pod on him, I just figure out what basal he will miss during pod change and pre-bolus off the old pod. So - my pod change procedure - take blood sugar; correct off old pod; bolus for any upcoming missing basal by saying no for correction, no for food, and then just giving him an extra .10 (basal he would miss on pod change); change pod; prebolus for food (pod won't really work for us before getting a meal bolus). This is obviously for dealing with little ones and low doses - adults wouldn't have these kinds of issues due to much bigger doses.
So...I have read this discussion and I now have a question. :-) Is the 'bolus increment' setting a comfort preference, set based on basal size, bolus size or ?? On average, I take about 1 unit of insulin per hour (basal), and I have it set at .05 u. I turned it up to .50 for a while (before I knew that I could listen for the beep and then walk away during a basal delivery) because I was impatient when taking a bolus and thought I could 'move on' with my life quicker.
Can anyone shed some light on this for me? Any better insulin sensitivity with a different bolus increment setting based on basal rates?
bolus increment would be set based on insulin sensitivity, and how small you want to get with the micromanaging of a bolus amount (to put it in simple terms).
Compare MDI (needles) to a pump. You can deliver (for the most part) only in whole units in a needle, right? So if your bolus amount (based on your carbs) really added up to you needing 7.3 units of insulin, with MDI would you take 7 and know you're going to be a bit higher later, or would you take 8 knowing that's too much and you'll need a snack later...?
Same situation, only smaller differences in bolus amounts, with a pump set to 0.05 vs. 0.1. You can make more fine-tuned adjustments. For some it may not amount ot that much difference. For a small child with a high insulin sensitivity (like has been described above w/ 0.05 u/hr basal), that 0.05 difference in a food bolus could make all the difference in the world :)