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Pumping problems w/Omnipod-what are we doing wrong?

Discussion in 'Parents of Children with Type 1' started by virgo39, Oct 3, 2010.

  1. virgo39

    virgo39 Approved members

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    We started our pumping experience very positively and immediately noticed an improvement in DD's numbers.

    Recently, however, it seems like we've had a so many issues with crazy high numbers after pod changes that do not come down. This has been happening the last couple of weeks. We've not seen this since we started pumping (in July, though we did have a bad pod in early August).

    We changed DD's pod at 3:30 yesterday afternoon, she was fine before dinner. If we have an unexplained high, we correct by pump, but if it is still high two hours later, we give insulin by syringe and change the pod. By 11:30 p.m., we changed that pod (after first trying to correct with the pump). It seemed like the new one was working, but now I realize it was simply the injected insulin and DD's really small early a.m. basal rates. After the JDRF walk this a.m, we again gave insulin by syringe (after correction by pump seemed to have no effect) and changed the pod, using a new vial of insulin and a pod from a new box.

    Once again, DD has sky high numbers. I just did a correction through the pod, and am waiting it out for an hour or so.

    DH talked to Insulet and they mentioned to make sure we pinch the skin and press down on the pod at insertion. We had not been pinching (her sites are all on bottom and belly where amount of fat has not been an issue) or pressing (were not trained to do that, but it makes sense). DH made sure to do that with the new pod.

    This pod is from a new box.

    The insulin is fresh.

    The site otherwise looked fine ... DD has not had any skin issues or lumps or bumps, etc.

    With one or two exceptions last week, we have never gotten a pod alarm.

    The canulas have come out unbent and seem to be clear (not sure if issues would be visible).

    DD has not had ketones (though, this time, I did not wake her just now to make her use the bathroom).

    What are we doing wrong? What can we do differently? Prior to this run (of the last 11 pods, we've had this issue with 5-6 at different sites, etc.), we've not had any issues like this (bad pods have been "DOA", buzzing before we've inserted them).
     
    Last edited: Oct 4, 2010
  2. blbrocky

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    Does her BG come down when correcting with the Pod?
     
  3. virgo39

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    Sorry. No, it does not. Our practice is that if we have an unexplained high, we correct with pod, then check again in two hours.

    What we've been seeing is a high BG (300+) and, after trying to correct with pod, no real change in BG.
     
  4. coni1523

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    If her blood sugars are not coming down with the pods then I would say that maybe she is not getting the right basal or correction with the pods. I know with my son we had to find the right basal and correction and it took awhile for us to do that. If the canula is coming out straight and not bent then she should be getting the insulin. what is her correction factor? Is it the same as if you would give a shot? Like if you gave a shot for a correction is the pump giving somewhere close to that? I know the pumps can do like 5.2 where we cant with a shot. Check that and see.

    also I know with the pods they have a window where you can see the canula. Is it going under the skin? That would be a thought as well.
     
  5. virgo39

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    Sorry again. I'm just not articulating this clearly. The high BGs after pod changes have been happening lately -- of the last 11 pods, we've had this issue with 5-6 of them. We don't consistently have high BG after a pod change. The 5 or so pods that worked, worked fine -- all using the same ISF (it's 1:200), correction factor (1:35 for breakfast; 1:50 for lunch and dinner). In fact, yesterday, until after the pod change, every number had been in range.

    I've used the 1:200 correction factor to do the corrections by syringe (rounded of course) and they have been effective.

    And we are using only belly and bottom sites. We do visibly check the canula and it appears to be inserted correctly.
     
    Last edited: Oct 3, 2010
  6. coni1523

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    I would call omnipod and my dr and talk to them about it. I know when we used the pods I would fill them with insulin and they would beep and not stop so I would take them out side and beat it with a hammer. LOL but as far as your situation I really don't know unless you got a bad batch of pods.
     
  7. virgo39

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    DH did speak with Insulet this afternoon and got some advice from them (and they will be sending us some replacement pods, as well). The current pod is from a new box. I'm just trying to see if there is something else that we are overlooking/doing wrong.

    Just checked and DD's BG is lower (of course the 50 point drop is within the meter's margin of error), so I am running a temp basal for the next two hours and will check again in one hour.
     
    Last edited: Oct 3, 2010
  8. coni1523

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    To me it sounds like you are doing everything right. If you see it is under the skin and all the settings are correct, and when you do a pod change the canula is not bent then i really dont know of anything else to do. My dr has always told me to give the shot if they don't come down after 2 hrs. and you are doing that, and you said that her sites area's are good like no bumps or anything, I would not be able to add anything myself. I hate that you are having so much trouble. I wish there was something I could say to help. I know that sometimes my son seem to be were insulin will drop him like a rock and then there are days where it takes the act of congress to get him down. I hope that you find out what is causing this and if you do please let me know.
    Connie

    How is the new pod working? if you have had time to tell.
     
  9. virgo39

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    Just checked and DD's BG is lower (of course the 50 point drop is within the meter's margin of error), so I am running a temp basal for the next two hours and will check again in one hour.
     
  10. Darryl

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    We've haven't had this happen after more than 3 years using the pod, so I think it's just that the basal rate and/or ratios need to be adjusted. We don't do anything special (pinching up the skin, etc.). Also be sure to bolus for any lost basal inbetween the pod changes. Even a little lost basal can send the BG high, which in turn creates insulin resistance.
     
  11. virgo39

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    Thanks. I'm concerned about changing the basal rates and ratios in response to this issue because in the run of the last 11 pods, the ones where we've had an issue have been sprinkled among those that we've not experienced this issue with. So, when we don't have these huge post-pod change spikes, things have been working (pretty nicely, we are continuing to work on nighttine basal rates) with our current ratios, basal rates, and ISF.

    We do regularly schedule pod changes at the same time in the afternoon and I do bolus for any missed basal (I contacted Omnipod and posted the information I received about basal delivery, in 0.05 u pulses over the hour). If we do a pod change at other times, I calculate whatever bolus we've missed.

    At first, I thought it was the pods, but now I'm not so sure. I think we might be doing something wrong or that perhaps DD's body is reacting to the insertion ...

    It doesn't help that there are so many variables -- known and unknown -- only a few of which are in our control.

    For tonight, the correction bolus seems to be working, which has not been the case with a lot of other pods. I'll be checking her every couple of hours to make sure. Not sure if she went so high because of an error in carb-counting and/or high(er) fat restaurant meal, or some other reason.
     
  12. MountainJam

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    We will occasionally see a bit of a spike post pod change, generally when DS is/has not been very active. We have found that activity levels have a lot to do with how he reacts.

    Is it possible that your daughter is coming out of a honeymoon? We got a lot of weird highs a couple of months ago and did some adjusting of basal rates, which helped a bunch.
     
  13. annaluvspink

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    I agree with Daryl and the last post, for sure. Sometimes we get higher bs spikes after a pod change (when she is not active) and sometimes we don't. I do, however, give her a small bolus of .5 as soon as I put a new pod on. Just to be sure. I once read that if a youth is getting a very small amt of basal, it can take a little while for the new pod to deliver the tiny amout and if there is any missed basal, bs can go up, resulting in insulin resistance.

    Sometimes I change the pod before a meal, so I can be sure to 'push' enough insulin into her soon after insertion. IDK if that makes a difference or not--just makes me feel better.
     
  14. annaluvspink

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    She may be coming out of honeymoon, as well. If increased temp basals are working, you may want to change basal rates and, eventually, I:C ratios.
     
  15. Daniel's Mom 1993

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    We have Highs with new Pods too!

    We have highs with most new pods (not all) but more than likely if he puts one on in the late afternoon or evening he will go high - what I have found that works is..if BG is good at pod change test in an hour..if going up correct with pump and test in 1 1/2 to 2 hours if still high we do a temp basal +45% for 2 hours - this will always bring it down.If he is high when we put a new pod on for wahatever reason we will usually go ahead and do a temp basal. Not sure what it is?? if he changes in the morning he is usually fine. I think for Daniel his basal needs are highest in the evening and overnight and the pod just does not keep up.
     
  16. virgo39

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    It is definitely true that DD's basal rates are highest in the early evening to midnight time frame. I try to do her pod change soon after school, so that we can retest before dinner (to get a sense of where things are headed).

    Thanks.
     
  17. virgo39

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    Her ISF is 1:200 and it does seem to work, so I would be reluctant to give her a bolus of .5 at a pod change:eek: I do time the pod changes and bolus for missed basal but as DD's basal rate after school is only .10 u, we seldom miss a basal pulse (and if we do, I know to bolus for it).

    I appreciate the info.
     
  18. virgo39

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    I'm not sure whether she is no longer honeymooning -- her insulin needs are lower than what one would expect and she has been described as "insulin-sensitive" -- so I have been on the lookout for any changes.

    Thanks.
     
  19. deeann

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    Highs after Pod Changes

    We always have to give an extra bolus and do temp basal increase after every pod change. We didn't have to do this with the tubed infusion sets. This is a new thing for us since we started pod'ing. However, it's fairly consistent from pod to pod. Occasionally I back off the temp basal increase, especially after very active days(soccer practice, games, etc).

    We ended up with the extra bolus and temp basal based on other threads I found on this forum and lots of BG testing after pod changes.
     
  20. virgo39

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    Thanks. I'll think about doing this, maybe making sure she has snack after a pod change so I can give a bolus.
     

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