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Meal spikes with new Omnipod

Discussion in 'Parents of Children with Type 1' started by Manuel, Dec 14, 2016.

  1. Manuel

    Manuel Approved members

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    Hi! We have started with Omnipod one week ago. We have worked hard to get the basal right, and I think they are ok (some small changes needed, but ok in general). But we are having big problems with meal spikes. For example, with MDI, for the breakfast my son usually started at 100, spiked to 160-180 and it ended around 90-100 in around 1.5 - 2 hours, with a smooth up and down. But with the omnipod, starting at 100, he spikes to 220-240 (with two arrows up), and it ends around 160-180 and it takes like 3 - 3.5 hours. The dose of insulin is the same. And is happening with every meal.

    With MDI we give him the shot 10 min before in the buttocks, and with Omnipod we are giving him the bolus 20 min before in his leg.
    Why is this happening? Is the leg such a bad site? I can't try yet the buttocks with omnipod because he still uses diapers. But is going the make such a big difference in the absorption?

    I am seriously thinking to come back to MDI. I don't want it, because my son was very happy that the shots ended, but I feel this is not working and I hate to see those spikes all day.

    ---------------------------------
    Benjamin born 04/2014 DX 05/2016
    DEXCOM G5 + OMNIPOD
     
  2. rgcainmd

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    You might want to consider adjusting the I:C and prebolusing 30 minutes before meals.
     
  3. Manuel

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    But the I:C change with a pump? Or it is because of the site?. The dose is the same, but the effect is much more less with the Omnipod.
     
  4. rgcainmd

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    Another possibility is that your son is growing and his I:C (and/or ISF, basal rates, etc.) may have coincidentally changed at the same time that he started pumping. Lots of people end up with different parameters when they switch from MDI to a pump. You need to adjust (and continue adjusting) to achieve optimal BG management.
     
  5. MomofSweetOne

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    I agree with Rose that it sounds like your settings need adjusted. It's easy to forget to change I:C ratios, but they do change often in the early months of diabetes. I noticed that your child was diagnosed seven months ago. Usually around this point past dx, the kids start needing significant more insulin.

    Also, do you have different basal settings now that you're pumping? On MDI, my daughter had a significantly higher I:C ratio for lunch than she does on the pump. Her basal needs drop dramatically at lunchtime, and on MDI, we were compensating for that drop with a higher meal ratio. (I just didn't know enough in those days to know why she needed so much less insulin at lunchtime.)

    Do you have books about getting the settings adjusted? I use Think Like A Pancreas and Pumping Insulin.
     
  6. Manuel

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    Thanks, yes I think that the peaks of the levemir were compensating a I:C ratio higher than what it is in reality. We have set 1:25 for breakfast and Tea Time, and 1:50 for lunch and dinner. But I think that in reality is around 1:30 all day, because the levemir peaks use to be at the same time of lunch and dinner.

    It is correct to calculate the total Insulin (basal+bolus) at the time of the meal to use for the I:C?
     
  7. MomofSweetOne

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    I would try dropping I:C by 5 points each day for those meals until you find one that brings you back to target. That way you won't bring on bad lows by overdosing, but within a few days you'll have something that is working better for your son.
     
  8. forHisglory

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    All the above suggestions are great, and I would try to adjust settings first. However, I will say that we take "tubed" pump breaks every once in a while. The POD causes horrible post-site change highs. It's like it's not functioning properly. This does not happen at all with the Vibe. Settings are the same on both pumps. Also, towards the end of the second day (sometimes sooner) it seems our meal boluses are not delivered properly with the Pod. We've become frustrated with the Pod, but we love the tubeless feature.......when it works. I think we truly need 2 different settings using the POD vs. Vibe. The endo thinks it could be differences in the way the cannulas are positioned with each pump. MDI does seem to provide faster results.........that has to be because you are using a fresh piece of tissue each time vs. the pump site that sits there for 2-3 days. We always correct for any high above 350-400 when we're pumping.....just to be on the safe side in case it's a pump site issue.
     
  9. MomofSweetOne

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    We also see highs with pod changes and have learned to do a pod change dose to avoid them as much as possible. Leaving the old pod on for a couple of hours also helps with the spike.
     
  10. rgcainmd

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    We have learned to bolus 0.5 to 0.75 units "extra" every time we change a Pod. Post-Pod-change highs solved!
     
  11. forHisglory

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    I will try a pod change bolus but I still don't like that it does that. What's the deal? Why is it not absorbing after a site change? Makes me wonder if the design should be changed so that it primes some insulin like the tubed pumps do or perhaps it needs to "fill the cannula" like the insets. Just funky and it's like the company won't officially release this phenomenon but I know other parents (at least 1) that has the site change high as well.

    Hilarious about leaving 2 pods on? I might forget about 1!!
     

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