Correcting with Omnipod not working?

Type 1 & LADA
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Hi all!

I have just recently started with the Omnipod from injections and I’m honestly having a hell of a time. I had pretty good control with injections, but the pump was suggested as I was struggling with exercise (running, dancing, pilates). Now I feel like I’ve had more highs than I’ve had in my entire life, lol.

I’m in pretty constant communication with my diabetes educator and she’s awesome, but we’re both really stumped about why once my BG starts going up, it just does not want to come back down with the pod. After trying to correct with the Pod, I end up frustratedly giving an injection, to ultimate success.

We’ve tweaked my basal rates quite a bit, and I have a few things I’m going to start trying after doing some research (temporary basal, 20% higher after meals that really get me) but I’m wondering if any of you have had a similar experience and found something that worked for you?

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Hello,

It gets mentioned here sometimes by others, but Humalog in an omnipod tends to not be as effective when it gets bounced around whereas Novolog is more stable.

For me, that means on the third day I’ll do my running and jumping. Other forms of exercise have been fine though.

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Hey Mark,

Thanks for replying. I do have Novolog in the pump, but I believe I’m switching to Lyumjev next week.

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It’s not so much Omnipod -vs- MDI as much as figuring out (as you did with MDI) what the correct settings are. It’s one, or a combination of, settings that need tested and dialed in…Basal Rate, ISF, I:C, DIA they all contribute to making the system work correctly. The best I can do is recommend you really work on testing each facet of pump settings until you are no longer running into the issues. It’s something that everyone grapples with when they transition from MDI to pump…or even from pump to pump for that matter.

Welcome to FUD!

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ah ok, in that case, I like to have each hour available for basal settings and to make tiny tweaks an hour or 2 before I notice an upswing or downswing I don’t like. Over time, this has made things better although if someone was to look at how it was set it probably wouldn’t make much sense.

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Thank you!! I think that’s the biggest thing I’m learning right now…just really needing to branch out and work with all the settings.

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Welcome to FUD!

I think a lot of people get started out on basal rates that are too low. And that makes everything more difficult to manage. They start you lower because of safety concerns.

I am a big believer in having a very strong foundation of basal. As long as you can eat a little snack or something if you get low.

For exercise, just turning it off or down helps a lot.

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Thanks Eric! Yeah I definitely think I started too low. I had a high basal rate last night and it helped A LOT.

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What is your background? How long ago were you diagnosed?

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I was diagnosed when I was 8 and have been really slow to the ‘new’ diabetes technology. I got a Libre Freestyle in April of this year, and then was able to upgrade to a Dexcom a month or so ago, which was also when I got on the Omnipod. I was stoked about the upgrade, but basically since then have just been struggling to get the system to work for me. Slow and steady progress, I guess!

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@Keely, you mentioned exercise in your post. Can help you out with that if you want.

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Oh yes, mainly just that I am pretty active and my endo recommended if I really wanted to get things under control exercise wise, a pump would be best. Nothing crazy was happening, but I’d have spikes after certain types of exercise (dance, pilates, HIIT) and then be pretty stable for others (running).

Any tips on how to manage more anaerobic exercise? That seems to really spike my blood and I hate that, lol.

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@Keely I also started out with a CGM first then Omnipod. I, too, started out with a too low basal, as Eric mentioned many of us did. It took me a while to understand what my body needed insulin-wise on the pump, but especially for exercise, basal needed adjusting. Exercise was one of the reasons I switched from MDI to pump. If you are on Omnipod, you can actually prepare for exercise with a lower basal prior to beginning the activity. There are many tricks which I think Eric would be better at explaining as I learned most of what I do from him! It takes a bit of practice to understand what your body needs, but it can be mostly doable. Search on FUD for examples of what others have been able to achieve, and you’ll see it is possible.

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I did injections for 44 years before switching to a pump. The main reason was the ability to adjust basal for exercise. It definitely helps.

Do you know much about the reasons why you spike at higher intensity efforts? What I am asking is if you understand the physiology of an exercise-induced spike.

Let me start with some general questions because solutions to this are never formulaic, it really depends on each individual.

Tell me about your routine. What time of day do you exercise? Like is it before breakfast, later in the day, etc. How many hours after a meal?

Tell me a little bit about your food intake. Are you on any special diet? Roughly how many grams of carbs per day? And are you trying to lose weight?

How many times per week do you exercise, and what is your general fitness level right now?

Are you able to have carbs with you for all of your different exercise - dance, pilates, HIIT, and running?

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Thank you so much for this response! I also switched to the Omnipod mainly for exercise reasons.

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Oh man let me try to answer all of this:

  1. From my little understanding, when doing aerobic exercise your body uses more protein and carbs, whereas anaerobic uses primarily carbs as energy sources? (I may have this totally backwards…for whatever reason this really doesn’t stick in my brain…) I also understand that when you’re exercising, your cells take in glucose to keep your body fueled, which can also lead to using up some of your glycogen stores, which can cause lows. Spikes after exercise can come from refueling those glycogen stores. Please correct me if I’m wrong, which I likely am.
  2. My routine really varies seasonally. I’m in my first semester of grad school right now, but before this fall, my exercise routine in the summer was nuts (super high intensity. I was training for a lot of running races.) I’ll give you an example of what a typical week day looks like for me right now:

Breakfast around 7:30 a.m., typically 70 ish carbs. (1:9 carb ratio)
Classes/school work from around 10-4, lunch somewhere in there, usually around 50-70 carbs (1:10 carb ratio)
I typically exercise before dinner. It’s either a short run (45 mins, 3.5 miles) or a dance class (ballet, contemporary) or a pilates class
Dinner is usually around 80-90 carbs (1:9 carb ratio)

I don’t usually exercise before breakfast and I’m not on any type of diet or trying to lose weight.

I exercise 6/7 days of the week and my fitness level is pretty high.

I’m not totally sure what you mean by if I’m able to have carbs with exercise…dance/pilates/HIIT exercise tends to spike me, as I mentioned, and these are usually 45 minutes to an hour long, so I usually don’t have any carbs with these exercises. Running though, if I’m going for a higher intensity run (over an hour, any sort of significant elevation gain +700 feet or so) I’ll have an energy gel or some Honey Stingers gummies.

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Okay, so let’s start with a little bit of a background on fueling. This is not stuff that is specific to only diabetes, but is actually the way everyone’s body fuels different types of exercise. It’s helpful to just have a background understanding of it.

We have different fuel systems in the body. They are all constantly in use, in various amounts. One of the common misconceptions is that your body will use only 1 of them, and then when it is empty, it will switch to the next one. But this is not correct. Your body is constantly using all of the fuel sources, in various amounts.

The type of activity, the intensity of it, will determine which fuel systems are going to be predominately used, and which will be secondary.

To keep things very simple, we will only look at fat metabolism versus glucose metabolism.

To get an understanding of the difference, and why our body uses different fuel sources, let’s assume - just for illustration - your body could only pick one or the other.

Let’s start with something of very low intensity, like walking. Your body could fuel this activity by using fat. We have an abundance of stored fat for use as a fuel. You could walk much further with stored fat as a fuel than you could with stored carbs (stored carbs is called glycogen). Like if your could pick only one to use, stored fat would get you much farther.

For an average sized person, they could last about 50 times longer with their fat stores than their carb stores.

Sounds great. Then why doesn’t our body always use fat?

Well, let’s say you are going 10 miles, but you wanted to go very fast. You could cover 10 miles with either fat or glycogen (again, glycogen is stored carbs, in both muscles and in your liver).

But… you could go about 3 1/2 times faster if you were using stored carbs instead of stored fat!

(Again, this is just an illustration based on if you could ONLY use one or the other. In real life, we use them both.)

So those are some big differences!

  • The fat fuel tank is huge! But man is it slow.

  • The carb tank is small. But man is it fast!

So your body is like a hybrid car, constantly switching between fuel sources depending on the activity and what your body needs.

That is just a little background on fueling, overly-simplified. Make sense so far? Any questions about that stuff?

So I guess the next thing is the spikes! And then I will also discuss some of the fueling stuff and meals and carbs for lowness and things like that.

I like that you are eating sufficient carbs like that. It will definitely make things easier. :+1:

What did you run? What distances? :star_struck:
(I’ve heard there are some people on FUD who like to run. :grinning:)

A 5k is spike city for BG! A 10k is generally level to drop, depending on your IF. And then anything longer than 10k is generally a BG drop.

The reason I asked is because in order to prevent a spike, you need to take insulin. (Either that, or reduce the intensity. But who would want to reduce intensity?!?)

If you are spiking consistently, you can take insulin as a preemptive measure. But there is a risk that if you take too much, or if your body begins to adjust to the intensity and the spike is reduced, you need to make sure you have carbs in case you drop.

So my thought is - as long as I have both insulin and carbs available, I can do anything and don’t need to worry about my BG. If either of those is not available, I need to be more cautious with my approach.

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With the fueling background, I think I’m a little confused still on how that differs with aerobic/anaerobic exercise and how that then affects my spikes or no spikes?

Not any crazy distances- the longest was 18 miles! I think I experience a pretty consistent drop about 3/4 the way in a 5k ish. I honestly find a 10k to drop me at that 3/4 mark and then after I have a snack I’m pretty steady. That’s similar to what I feel like happens with anything longer than a 10k. I should say, I didn’t have. Dexcom yet over the summer.

I like what you said about having insulin and carbs available makes you worry less about your BG. That makes total sense. I think I’m going to try giving some extra bolus for those activities that spike me!

How do you feel about temp basals (up 20% or so) to counter an exercise spike?

Also holy cow thank you so much for all your time on this. Is your knowledge just from your life with T1D or are you like a dietician? :joy:

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So we have not discussed the reason for the spike yet. That is not a fueling issue, but a hormonal response to a hard effort.

I will get to that in a bit.

Okay, so tell me how your pace for a 5k compares to the HIIT effort that causes you to spike. I imagine your HIIT intervals are much shorter, so they can be faster. Is your HIIT significantly harder than your overall 5k effort?

The thing that spikes you is when your body gets to a certain level of effort, and then it cries out for help…

Intense exercise causes the release of hormones that help you fuel the activity. Well, they would help you if only your pancreas would participate like it is supposed to!

At a certain higher level of exercise intensity (or even from emotional stress like an argument or from nervousness), your body releases hormones - epinephrine (adrenaline), norepinephrine, and cortisol. Your heart rate and blood pressure increase, the amount of oxygen flowing to the tissues increases, and your liver’s glycogen stores are released to give you fuel.

You have probably heard of the “fight or flight” response.

Imagine you are running along in the woods at an easy pace. Your body is able to fuel it with glycogen, carbs from food you recently ate, and fat metabolism.

Suddenly a big bear :bear: appears and starts chasing you. :astonished:

Your body would want to make sure you had plenty of fuel to run away! (Remember the earlier conversation about how you can go much faster burning glucose than burning fat.)

Let’s make sure Keely has enough glucose to burn so she can get away from that bear! These hormones will trigger her liver to release glucose immediately. And then her pancreas will release the right amount of insulin and she can use the glucose to fuel her escape!

Great plan the body has, right? Except your pancreas just isn’t cooperating. Everything else is working the way it’s supposed to. Except your pancreas. :angry:

Ultimately what you see is an immediate rise in your blood sugar.

So there is a pace or effort or point that will trigger those hormones. It will depend on many things - your overall conditioning, your level of fatigue, the amount of training you are doing at those paces, etc. That level of effort is different for everyone.

Once you know what pace and distance causes your body to scream that it is being chased by a bear, you will know when you need to dose and how much.

(Oh, and as far as aerobic/anaerobic, you can imagine that if you were running from a bear, you would be moving toward the anaerobic area of intensity. :grinning: But it is a little more complicated than that. A 100 meter dash is almost completely anaerobic, but that wouldn’t spike you, because it is so short. Running a mile as fast as you could would be about 80% aerobic, but that WOULD spike you! So there are 2 things at play - speed and duration.)

It depends on when the spike hits you, and how predictable it is. The spike might be very quick, in which case a 20% temp is not going to do a whole lot to help you.

For me, spikes happen quickly. So I go with boluses.

It would be helpful for you to track the spike with some BG tests to see when it happens. If you are looking at your Dexcom, it might appear more gradual. But in reality, it might be very sudden.

For HIIT, you can actually do your BG tests during the rest phases. Get a real good picture of it. Much better than dealing with the Dexcom delay.

Do you have one of these?

https://www.amazon.com/Contour-Smart-Meter-Monitoring-System/dp/B06W53ZLTK/

Sorry, I threw a bunch of new things out there. Does this stuff make sense?

I’ve had a lot of practice. :grinning:

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@Eric is the best. He has helped and taught me so much too with my snorkeling!!!

I just want to add, I hate upping a (temporary) basal rate for spikes after meals. A basal should deal with what you need without eating. Although we can still vary day to day. What’s nice about a pump is we usually have different needs of our basal rate throughout the day. So I need more insulin in the morning than by night. My morning settings for a couple of hours are higher in the am. I even have a higher IC factor in the am.

But if you are having a spike, why go with a higher basal rate that is released over an half hour or hour etc? Why not just give yourself a bolus for the higher than normal level? You would get quicker results with a bolus. Unless you are eating higher fat and expect a delay in absorption, but personally an extended bolus or giving yourself another dose later is a better bet.

And they do have a tendency to give you lower basal settings at the beginning as they would rather err on the side of caution. So you usually have to figure it out.

I really like my basal to be pretty accurate…that’s not always possible because we can change easily sometimes. But here is a testing guide.

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