Pod Advice

[Lindy]

For those of us having "higher numbers" after a pod change - here are some things we learned this past week that may help some others - or are things you can maybe try..... the following is my response to a pm about the same..


we just saw Cooper's endo on Tuesday and discussed this very issue. I see this happening probably 75-80% of the time and get very frustrated with it! One thing that she (endo) told us was that this was NOT specific to Omnipod but kids using other pumps also experience this..... interesting because I haven't really noticed others on CWD using different pumps chiming in with these kind of problems!

So here are a few suggestions:

Warm the area that you will be placing the pod on. This brings blood to the area and after insertion the theory is that there will be better and quicker absorbtion of the insulin.

Keep the other pod on for a few hours... so they'll be wearing 2 pods for awhile. When a pod or any infusion set is on - it develops a small deposit of insulin around the site. When you pull the old pod - you lose that small deposit and the new pod may take some time to develop this little deposit.

She said we could do a temp basal also - but would run the risk of running him low for the pods that work "right" from the start. But - it is an option!

So Wednesday night we had a pod change - we gave him a bath before pod change - did the pod change and we kept the "old" pod on until the next morning. So we did the both things she suggested and we were smooth sailing! Everything worked just like it should!

Hope that helps! Good Luck! Keep me posted if your endo has some suggestions too!

[Kirsten]

That's interesting. We normally do pod change after a warm bath and rarely have the problem of running high after pod change. I NEVER would have connected the two.

Kirsten

[twodoor2]

We should have a forum on "pumping tips." There is so much interesting and innovative advice people have.:D

Thanks for providing these tips.

[saxmaniac]

Keep the other pod on for a few hours... so they'll be wearing 2 pods for awhile. When a pod or any infusion set is on - it develops a small deposit of insulin around the site. When you pull the old pod - you lose that small deposit and the new pod may take some time to develop this little deposit.

Good points! I will keep this in mind!

You know, we used to leave the old pod on because it was just one less stressing thing during a site change. As we got "better" with our technique, we started removing them earlier. I figured out how to detach the pod from the adhesive and Alex doesn't mind so much. Maybe this is contributing to the problem. And we used to do it after tubs, but I hated battling these highs at 3am so we started doing them more during the day.

I sent this to taximom last night:

If he's in range, we need to bolus .5 to 1u before the change, with no food. If it goes down too fast we'll give some juice. The problem is if he goes high he will be stuck there.

If he's high before the change, we haven't had much luck with that. I suspect we need the correction dose plus the above .5 to 1u. I would delay until he's in range.

On top of that we need a temp basal otherwise it won't stick, at least +20%. Sometimes it's 50% and sometimes we need to do +99%! Other times, I have to make the +20% permanent for a day or two, so I have an alternate basal profile which is .05 higher for every "step".

We check hourly and if it goes up, dial in a full correction -- look at the IOB and add it back in -- and goose up the basal even more.

I won't back off the basal increases until I see a very steep drop, or a lowish number around 80 or lower. Sometimes the higher basal profile sticks for the entire pod.

It's almost like his body goes haywire as soon as there is even a tiny bit less basal than it needs. How can .05/hr basal cause us to need 2-4u of corrections that don't stick? It doesn't add up, I don't understand it, but it's what happens!

[Rick]

Do your total daily doses follow a three day pattern?

[taximom]

Nicki & Scott..

Thanks for your help. I just gave up on last night's "new pod". Kept DS home from school today (he's lovin' it), because right before he was about to leave he shot back up to 385 w/ small ketones :eek:. I gave a good correction w/ a syringe, warm bath,(came down to 250 after 1 hr, trace ketones) warmed-up new site on arm and activated a new pod, but still have the old one on. So I think I'm doing everything right...:rolleyes:. So we shall see.

[brownkkeb]

Just this morning did my first pod change since going live with insulin, and for what it's worth, we saw some numbers approaching 300 this morning, but after lunch things have returned to normal.

I asked my Insulet rep about highs, and also the APRN in my endo's office and got a similar response about it not being only Omnipod kids that see highs after site changes. They both suggested not doing changes before going to bed because you wouldn't have the ability to see if the new pod is working as readily as you would during the day.

Also, the Insulet rep suggested changing the pod right before a meal. She was going to investigate the reasoning behind that, but she's only been with Insulet for about 3 months and is still learning some things too. She basically says that giving a big bolus for a meal is going to get things working faster than the tiny basal increments. Reading Lindy's comments about the deposit of insulin building after a change, it makes a bit of sense that a larger bolus is going to help with that.

I guess we'll see.

Kathy

[Ali]

I am an adult but see that pattern with my Minimed sets-I use the steel short Sure t (straight in type) but used to use the short straight in teflon sets-all the tips help. Leaving the old set in for a bit, putting it in right before a meal, bolusing a bit extra at set change or increasing the basal for a few hours. Putting the new set on early in the day is great cause you can more easily spot issues and aggressively treat. I change every 48 to 60 hours and try to do it pre break. or lunch. But if it happens to work best to change in mid afternoon I go ahead and just get some more insulin in there via basal or bolus. Leaving an extra pod on might be a pain so figuring out how to give a bit more basal or extra bolus to compensate might work well. Good luck. Ali P.S. Putting in a new set near exercise time also seems to help speed up the absorption-sounds like the same idea of the bath or rubbing the site tips.

[saxmaniac]

Ali, thanks for your input.

We just tried all of your suggestions at once, hopefully it will stick!

1. Had a warm tub.
2. Bolused .6 units with the old pod.
3. Left old pod on (will do so for 4 hours)
4. He's still on his higher basal.

Alex was very good, we decorated the pod with stickers, so no "stress hormones". At this point LMX seems to be mostly a placebo, but if it makes him happy, why not!

[Lizzy731]

Well...I actually have been saying this for months about Bethany. She has had an absorption issue from day 1 and I have managed it quite well. I like the idea of warming the site area first...never tried that before. Here are my tips:

1.) I always change her in the AM when her basal is the lowest (.05)...this way she won't go too high.
2.) When I change her, I give her a small bolus to get it going (like .10) with no food or like 2 grams of slow acting carbs.
3.) I do not give her food that needs a bolus for at least 2 hours after a site change...I usually change her right after BF.
4.) I find that giving her her first meal bolus after the change as an extended bolus also helps the site to get absorbed more quickly.

Hope that helps!

[saxmaniac]

Quick update: he dropped from 180 just before the change, to 80 about one hour after. That's pretty steep but we're checking enough to head it off with some tabs and juice. Seems to be working so far.

[Darryl]

For what it's worth... We've been using the pod with our daughter (9) for more than a year and never saw high's after insertion.... in fact, we usually get low's due to the pod priming (clicking) up to 7 times after insertion.

Each click is 0.05u, or 10 points of BG. Usually we have her eat 1 carb for each post-insertion clock, and she ends up near where she started.

In case anyone else has noticed, the pod clicks 9 times during the insertion process. The needle goes in somewhere between 2 clicks and 7 clicks. That is a lot of variability for kids with high insulin sensitivity (ours in 200:1). I've talked to Omnipod about that and they acknowlege it.

[Ali]

Scott
Good luck with figuring it out. I usually only do one of the suggested tips depending on what is going on and time of day. Usually I opt for a snack bolus and then eat half the amount I bolused for. But...I am an adult, do not mind lots of checks of fingers if needed and have no problem eating glucose tabs. With a child it is hard plus the fact that sometimes the sites seem to kick in right away. After about of month of watching and tying different things I figured out how much extra to bolus for to help the absorption and can catch the 20 percent times when the extra bolus was not needed and eat more to avoid lows. The temp. basal increase alone for a few hours might do the trick with a kid and reduce the risk of a fast low coming on. :cwds:Good luck. Ali P.S. I had been pumping for three years before I figured out the site issue and no one had alerted me to this possibility. If you do not have super stable numbers these issues can be hard to spot.:o

[sugarmonkey]

We use the animas pump. Phillip usually leaves the old site in after a change, mainly because he forgets to take it off i think. the few times he's not (because its fallen off for some reason) he has gone high right after. I'll have to remember this.

[saxmaniac]

Lizzy: I know you've mentioned it, sorry to seem if I was ignoring you. We just had to experience it ourselves before we knew it was a problem. The first few site changes went fine, but over time they started getting worse.

Darryl: I never knew that it was actually delivering extra insulin after insertion. I will count the post-insert clicks next time. How can they do this and not tell us!?

Ali: this time the site did kick in right away, but I'd rather fend off a low than a high. At least then I know the site is good.

Last night was a good night. No highs at all. He actually kept dropping slightly, but I let it be, and fed him some yogurt.

[Lizzy731]

Lizzy: I know you've mentioned it, sorry to seem if I was ignoring you. We just had to experience it ourselves before we knew it was a problem. The first few site changes went fine, but over time they started getting worse.


No problem...I remember how frustrated I was when I was in your position. I thought I would tell you my experience as your situation sounded exactly like mine. Btw, sometimes Bethany doesn't have a problem either and she ends up going too low because of my tricks. But this rarely happens...so it's the luck of the draw. Now that we have a cgm we can catch highs and lows before they get severe.

GL.

[saxmaniac]

That's why I'm just going to blabber on and on about all of this, so the next time someone has it, it's easy to find in a Google search. (Really, there's a point to me running my mouth all the time!)

[Lizzy731]

That's why I'm just going to blabber on and on about all of this, so the next time someone has it, it's easy to find in a Google search. (Really, there's a point to me running my mouth all the time!)

And another thing....I was always thinking we had "bad sites" like you and it turned out to be an absorption issue. I don't think we really ever had a bad site. Only highs after a site change...but since I fixed this problem, as I said no "bad sites".

[saxmaniac]

Thinking back to all of our changed-out pods, I think one or two really did have a bent cannula. But we've gotten better pinching it the right way. I really wish the trainers would've have shown it to us and stressed how important it is. Likewise, a heads up on absorption issues, and strategies on how to deal with it, would have saved a lot of pain and suffering!

[taximom]

Oh good...I'm glad you guys are still "talking" about this.

We had a very smooth pod change :) (after the disasterous one:mad:) yesterday.

1. warm bath
2. also warmed site (arm), just before applying new pod.
3. After breakfast, around snack time
4. New vial of insulin

We've been in range ever since (80-130)...yay!

I also called Insulet last night and had a nice discussion with a customer support woman, whose son has been on the pod for quite awhile. They have experienced highs after a pod change as well (nice to hear that she went through it as well). They always give their DS an extra bolus (w/out food) before a pod change. She always changes during the day, like right after school. Her DS prefers his arm (2 sites per arm), but after a few months, they convince him to use the belly for awhile. The pre-pod-change bolus did the trick for their DS and now they do it every time.

My endo also suggested an increase temp basal of 10% for 3 hrs ( a little conervative, if you ask me).

So bottom line...I guess we just have to figure out what "trick" or combo of them works best for our kids.

[saxmaniac]

My endo also suggested an increase temp basal of 10% for 3 hrs ( a little conervative, if you ask me).

Our CDE says the same thing, but doesn't seem to realize it's under the minimum amount.

Alex's day basal is .2u, so +10% isn't enough to get up to a .05 increment, so it would do nothing. +25% is the minimum here.

[taximom]

For what it's worth... We've been using the pod with our daughter (9) for more than a year and never saw high's after insertion.... in fact, we usually get low's due to the pod priming (clicking) up to 7 times after insertion.

Each click is 0.05u, or 10 points of BG. Usually we have her eat 1 carb for each post-insertion clock, and she ends up near where she started.

In case anyone else has noticed, the pod clicks 9 times during the insertion process. The needle goes in somewhere between 2 clicks and 7 clicks. That is a lot of variability for kids with high insulin sensitivity (ours in 200:1). I've talked to Omnipod about that and they acknowlege it.

I didn't even know it clicked after the cannula insertion. :confused: I only hear the clicking prior to it. Now....I'm really confused about these highs.

Oh another thing the Insulet woman told me.....
If you think you have a "bad pod" (that's not delivering inulin) or you are not sure if it's a bad site. She said to remove the pod before you deactivate and watch the cannula and give it a big bolus (like 10u) and see if the insulin comes out. ......just for piece of mind....if you wanted to know if it was a pod issue.

[taximom]

Our CDE says the same thing, but doesn't seem to realize it's under the minimum amount.

Alex's day basal is .2u, so +10% isn't enough to get up to a .05 increment, so it would do nothing. +25% is the minimum here.

I know...same here. Ryan's is .25 or .3u. Even if it could do that amount, it probably wouldn't make any difference.

[saxmaniac]

I didn't even know it clicked after the cannula insertion. :confused: I only hear the clicking prior to it. Now....I'm really confused about these highs.

Me too. We do the priming when it's on the counter, click click click click. Remove the cap. THEN put the pod on, press Go, and wait a few seconds for insertion. One big chunk for insertion. I'll have to listen more closely afterwards.

[Lizzy731]

I don't know if I am reading some replies incorrectly but you are DEFINITELY NOT supposed to prime the pod while it is on your child. The clicks that you hear during the insertion process are inconsistent. Sometimes the cannula comes out right away, sometimes it takes a bit longer. So I don't think the clicks are consistent with any insulin being delivered during the insertion process.

[Lizzy731]

Our CDE says the same thing, but doesn't seem to realize it's under the minimum amount.

Alex's day basal is .2u, so +10% isn't enough to get up to a .05 increment, so it would do nothing. +25% is the minimum here.

Just change the temp basal option to units instead of % (in the settings screen). This way you can add .05 or .10 or whatever to the basal for the hour after you change him.

[saxmaniac]

Just change the temp basal option to units instead of % (in the settings screen). This way you can add .05 or .10 or whatever to the basal for the hour after you change him.

I'm still trying to work out which is easier.

I've tried that, but I think is easier to do a %, since it tracks the existing basal program. Otherwise I have to change it whenever the basal changes (4x a day). As long as I know the minimum number (25% or 33%) I can from start there.

[Lizzy731]

I'm still trying to work out which is easier.

I've tried that, but I think is easier to do a %, since it tracks the existing basal program. Otherwise I have to change it whenever the basal changes (4x a day). As long as I know the minimum number (25% or 33%) I can from start there.

Yes...I know it is easier to keep it on %. Especially since Bethany's basal program changes almost every hour (sometimes I think a cgm is too much info!). Just figure out the math of what percentage you need to get it higher.

[Adinsmom]

In case anyone else has noticed, the pod clicks 9 times during the insertion process. The needle goes in somewhere between 2 clicks and 7 clicks. That is a lot of variability for kids with high insulin sensitivity (ours in 200:1). I've talked to Omnipod about that and they acknowlege it.

I heard the clicks. Anyone else listen for the clicks? I primed like usual, attached the pod activated the insertion and listened to some very faint clicks.

[saxmaniac]

I heard the clicks. Anyone else listen for the clicks? I primed like usual, attached the pod activated the insertion and listened to some very faint clicks.

I would if Alex would stop talking for 13 seconds. Which never happens.

[taximom]

I heard the clicks. Anyone else listen for the clicks? I primed like usual, attached the pod activated the insertion and listened to some very faint clicks.

I didn't hear any clicks after "the big click". I'll check again tomorrow.

[Kirsten]

I didn't hear any clicks after "the big click". I'll check again tomorrow.

I DID hear the clicks, but if those clicks represented insulin being delivered Griffin would have dropped like a rock.

Kirsten

[taximom]

I DID hear the clicks, but if those clicks represented insulin being delivered Griffin would have dropped like a rock.

Kirsten

Yeah...I think our trainer would have told us about this, if it were true. How would we know how much was going in, if those "clicks" were actually delivering insulin?

[etringali]

I changed Alex pod this AM. Didn't notice any additional clicks after the BIG BANG. I do hear clicks when I do boluses. I worry if I don't hear em since I know the clicks are the mechanism delivering some insulin.

[Lizzy731]

The clicks come before the cannula is inserted so even if insulin is being delivered, it's not actually going in.

[taximom]

The clicks come before the cannula is inserted so even if insulin is being delivered, it's not actually going in.

Back on page #2...Darryl mentioned clicks after the cannula goes in. Not really sure what he's talking about.:confused:

[Adinsmom]

For what it's worth... We've been using the pod with our daughter (9) for more than a year and never saw high's after insertion.... in fact, we usually get low's due to the pod priming (clicking) up to 7 times after insertion.

Each click is 0.05u, or 10 points of BG. Usually we have her eat 1 carb for each post-insertion clock, and she ends up near where she started.

In case anyone else has noticed, the pod clicks 9 times during the insertion process. The needle goes in somewhere between 2 clicks and 7 clicks. That is a lot of variability for kids with high insulin sensitivity (ours in 200:1). I've talked to Omnipod about that and they acknowlege it.


Has anyone else asked Omnipod about this? Adin is very insulin sensitive. If he were to get .05 for every click, well he too would drop like a rock. But...still it could explain some of the wonkiness in after pod changes that are reported. Or it could be an urban legend.

[Lizzy731]

Back on page #2...Darryl mentioned clicks after the cannula goes in. Not really sure what he's talking about.:confused:

I'll have to pay attention the next time I change her!:p

[Tripper]

I heard it!

[taximom]

I have a question ....trying not to hijack the thread.
But since all you podders are looking at this thread anyways:

Do you know how long the pod will last after the expiration time? Is it 8 hours? I can't find it anywhere in the manual. Our last pod change was unxpected at 930AM. I do not really want to change DS's pod and then send him off to school tomorrow. I'd rather change it after school. So will it REALLY expire 8 hours later? like at 5:30PM?

[Tripper]

8 hours on top of the stated 72. But it will beep every hour, so sending him to school will cause disruptions.

[taximom]

8 hours on top of the stated 72. But it will beep every hour, so sending him to school will cause disruptions.

Oh crap. I forgot about that part.

[Tripper]

I was at an OmniPod function tonight and spoke to a territory manager.

Concerning the ticking noises AFTER the big boom (when the canulla inserts). He says that the clicks after insertion are the insertion needle being withdrawn. Not related at all to priming noises, which sound exactly the same. :rolleyes:

There is a new PDM on the way. Gonna be way cooler. :cool:

Got to hear Jay Hewitt. http://www.jayhewitt.com/
Awesome guy.

[saxmaniac]

There is a new PDM on the way. Gonna be way cooler. :cool:

Dig??? Speak up!!

[Darryl]

To clarify my earlier post... When the pod is sent the insertion command, it clicks 9 times. Each click is 0.05u. The mechanism that triggers the insertion is mechanically tied to the first 9 clicks, however this is not precise, so the insertion happens at a random position in the click cycle.

Practically, this means that you might hear 5 clicks pre-insertion, then 4 clicks post-insertion. We've used more than 150 pods - and I count every time - and have had some that click 2 times after insertion, others click 7 times after insertion. I have confirmed from Omnipod that these clicks do deliver insulin at 0.05u per click.

We have observed, especially at those times where there are 6 or 7 post-insertion clicks, that it is good to turn off the basal (Temp Basal off) for an hour after insertion, or her BG goes low (based on her basal being 0.2u/hour).

On the other hand, there are valid observations made by some people that even if an extra 0.3u or so is delivered at insertion, that it might not matter - perhaps because the first 0.3u is not readily absorbed, and also, because by the time you get the new pod on, the old one's been off for a little while and some basal has been missed that needs to be made up anyway.

So, no reason to be overly concerned about this issue - the pod does continue to prime a *little* bit after insertion - but it's good to at least understand what the post-insertion clicks mean and that they *might* need to be taken into account for kids with very high insulin correction ratios.

For those who don't use the pod, this is a very minor issue in an otherwise fabulous design.

[Darryl]

I was at an OmniPod function tonight and spoke to a territory manager.

Concerning the ticking noises AFTER the big boom (when the canulla inserts). He says that the clicks after insertion are the insertion needle being withdrawn. Not related at all to priming noises, which sound exactly the same. :rolleyes:


I would definitely take issue with that. Watch the cannula insert. It's in and out in a flash - not retracted by the clicks. I spoke to a tech. person at Omnipod last year who confirmed that there is only one reason a pod clicks, and that is when the insulin chamber gear advances a click.

[Rick]

Practically, this means that you might hear 5 clicks pre-insertion, then 4 clicks post-insertion. We've used more than 150 pods - and I count every time - and have had some that click 2 times after insertion, others click 7 times after insertion. I have confirmed from Omnipod that these clicks do deliver insulin at 0.05u per click.
The cannula insertion is accomplished with two springs and a trip lever. The first few clicks release the trip lever, one spring inserts the cannula and the second spring retracts the needle to its original position. The insertion process lengthens the path from the insulin vial to the end of the cannula by approximately 10mm. I assume the “clicks” heard after insertion are priming the additional volume of the lengthened tubing / cannula.
The way the trip lever is released I’m surprised that the number of clicks before insertion is so variable. My guy walks away when he does the insertion so I never hear the insertion clicks.

[Tripper]

What you are describing makes sense. It is very hard to get accurate technical info from support and sales people.

On that topic, what is code 19-00000-00064
Customer support won't give me any info on codes. Lord knows I've read them a bunch of codes.

Any description of the new PDM by me would be mere internet chatter, and you know not to trust what you read on the internet. :cool:

[Adinsmom]

To clarify my earlier post... When the pod is sent the insertion command, it clicks 9 times. Each click is 0.05u. The mechanism that triggers the insertion is mechanically tied to the first 9 clicks, however this is not precise, so the insertion happens at a random position in the click cycle.

Practically, this means that you might hear 5 clicks pre-insertion, then 4 clicks post-insertion. We've used more than 150 pods - and I count every time - and have had some that click 2 times after insertion, others click 7 times after insertion. I have confirmed from Omnipod that these clicks do deliver insulin at 0.05u per click.

We have observed, especially at those times where there are 6 or 7 post-insertion clicks, that it is good to turn off the basal (Temp Basal off) for an hour after insertion, or her BG goes low (based on her basal being 0.2u/hour).

On the other hand, there are valid observations made by some people that even if an extra 0.3u or so is delivered at insertion, that it might not matter - perhaps because the first 0.3u is not readily absorbed, and also, because by the time you get the new pod on, the old one's been off for a little while and some basal has been missed that needs to be made up anyway.

So, no reason to be overly concerned about this issue - the pod does continue to prime a *little* bit after insertion - but it's good to at least understand what the post-insertion clicks mean and that they *might* need to be taken into account for kids with very high insulin correction ratios.

For those who don't use the pod, this is a very minor issue in an otherwise fabulous design.

Thanks for clarifying your post.

[vettechmomof2]

What you are describing makes sense. It is very hard to get accurate technical info from support and sales people.

On that topic, what is code 19-00000-00064
Customer support won't give me any info on codes. Lord knows I've read them a bunch of codes.

Any description of the new PDM by me would be mere internet chatter, and you know not to trust what you read on the internet. :cool:

no idea on that code, sorry but comeon give us the interent chatter...
please. come on everyone lets give some peer pressure.:p
Allene

[Lizzy731]

There is a new PDM on the way. Gonna be way cooler. :cool:



Well.....you KNOW you can't just say "way cooler" without explaning in GREAT detail what you mean by that! Come on now!!!

[vettechmomof2]

bumping for internet "facts".
:rolleyes::D:rolleyes: