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post site change highs

Discussion in 'Parents of Children with Type 1' started by Debdebdebby13, Jun 12, 2013.

  1. Debdebdebby13

    Debdebdebby13 Approved members

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    Is this a something that only happens with Omnipod? DD has been going to D-camp this week and today at pick up I was talking with the CDE in charge of the whole thing and we were talking about new places to try to place pods on Molly and I mentioned pod change highs, which have been an almost constant for the last 3 months or so, and sporadic before that.

    She had never heard of it before and seemed very surprised and didn't have any experience with other pumps and site change highs. She is t1d herself and has been since her childhood so I assume she's got a really good working knowledge of pumping.

    What is your experience with site change highs?
     
  2. Traci

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    We didn't have it with Omnipod until two years in! Even then, it wasn't an every site change type thing. Now it is. We now do a one unit "push" bolus and a 30% increased basal for three hrs to offset. I believe it has something to do with the priming process.
     
  3. 3kidlets

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    Yes. Hana has been on the POD for three years and we've had them from the beginning. She will go very high if I don't give a bolus. I try to bolus on the old pod about an hour before changing pods. She needs atleast 2 units to counteract the high. She has gone in to the 400s before if we don't bolus.
    I mentioned it to our CDE at one point and she said it can happen on any pump. But it seems to be more common with the POD. I have no idea what causes it. I was hoping it would be better with the new pods buttitos not.
     
  4. sugarmonkey

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    DS is on animas and he gets them. When he first started pumping he didn't. There's the odd time he's fine, but probably 95% of them he spikes after. Funn thing is if he's a bit high before changing he doesn't go any higher, only if he's in range before.
     
  5. Debdebdebby13

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    How strange. I wonder if it's a body chemistry thing, YDMV and all that jazz. We also give .5-1.0u bolus with the new pod and then +25-30% temp basal for a while, we've yet to figure out exactly the right combo to get her to mostly stay in range without going too low.

    She thought about it with me for a while, and we didn't figure priming since the pod has such a tiny amount of tubing to prime, vs tubed pumps that have upwards of 18" of tubing to prime.

    We have to fight for up to 24 hours after a pod change to get her below 300 if we don't do the bolus and temp basal. It's crazy and I'm worried it's going to affect her a1c next week since it's happening so consistently for the last couple of months.
     
  6. hawkeyegirl

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    My unscientific observations on the board lead me to believe that it does happen with the pod more than with other pumps, but it does happen for some kids with tubed pumps as well. It did happen for us with the pod (but not every pod), and never happens for us on our tubed pump.
     
  7. Dan

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    Are you using smaller Pods or original? We always need to give 1 unit bolus or Josh goes high. I was reviewing the videos on Insulet's site since we get the smaller pods this weekend. In the training video it mentions a priming bolus after the insertion of the cannula this is a new step.
     
    Last edited: Jun 15, 2013
  8. Debdebdebby13

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    We are still using old pods, not sure when we'll get the upgrade.
     
  9. Lee

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    I think I would try a higher upfront dose...instead of .5 or 1, try 1.5 and test often.
     
  10. rachabetic

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    I'm not very familiar with the pods, but is there no fixed prime to prime the cannula after insertion? Sorry, just curious. :eek:
     
  11. Traci

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    The pod automatically primes itself before insertion. On our old pump, we had to input a prime amount (I believe it was .7) but do not do that with Omnipod. I believe the prime "amount" automatically done by the PDM/pod is not enough for some reason (possibly for just some people) and that causes post site change highs. I never have insulin dripping out of the cannula before insertion which tells me (only me, I'm not speaking for anyone else, just me) that the insulin might not be at the end of the cannula. We do a 1 unit push bolus to compensate.
     
  12. rachabetic

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    Ok....I don't use the pod, and I know it's very different from tubed pumps. But for tubed pumps, the point of priming is to fill the cannula AFTER the needle is taken out. So how would the pod priming on it's own before insertion be doing this? Wouldn't there need to be a prime after insertion to do this? Like I said....I might be way off but this confuses me. :confused::eek:
     
  13. Traci

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    With the pod, it's just an automatic process. You press a button to prime then press a button to have it auto insert the cannula once it has been placed on the site. There is no additional prime, there is no way to select a prime amount. It's just push a button to prime, push a button to insert. The cannula is inserted and the needle is withdrawn back into the pod in a very quickly motion.

    Someone here did some type of test on a pod sitting on the counter upside down to see what happens. There's probably a YouTube video of the process, too.

    It works very well...we just need an additional push bolus to get the insulin flowing. Some might not.
     
  14. virgo39

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    According to the video training for the new pod (at about 19:20), it does deliver a small priming bolus. Perhaps that is why we have not been seeing the post-pod change high BGs with the new pods.
     
  15. Dan

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    Yes this step to Prime the cannula is a new step after the insertion. I mentioned it earlier in this thread.
     
  16. Traci

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    FTR, I was referring only to the old pods. As a current Omnipod user, we have not been upgraded to the new pod system. Sounds like the push bolus many of us had been doing has been replaced by a priming step. That will be interesting to see if we ever get the new system.

    Edited to add: just got to that part in the video...it doesn't say there is an extra step (as i thought above), just that it delivers a small prime bolus. I wonder if this is in fact any different than the old process.
     
  17. hawkeyegirl

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    I would think it always filled the cannula after insertion. You can't fill it while the needle is in there. I suspect on both the old and new pods, the cannula fill is automatic after the needle is inserted. The question is then whether on the new pods there is an additional bolus given, or whether it is just telling you that the cannula is filling. ETA: Just watched the video. From her wording, I just think it now tells you that it is filling the cannula, where before it kept that little fact to itself. ;)

    ETA: When it tells you it is "priming" before insertion, I think it is just moving the piston (or whatever it is, I'm no engineer here) up to the level where you filled the pod. It can't be priming the cannula, because the needle is still in there.
     
    Last edited: Jun 15, 2013
  18. Dan

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    Nope it is a new step. I called my sales rep to confirm yesterday.
     
    Last edited: Jun 15, 2013
  19. MomofSweetOne

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    I accidentally got ahead on button-pushing last night while starting a pod and the cannula inserted while the pod still in my hand. We were able to see the prime bolus come out the cannula. We also had no new-pod spike at all without adding extra insulin.
     

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