It has occurred to me that we are going to adopt @Millz strategy of asking for a pod change every two days. Last night, around 11 PM, we had another failure. Truthfully, it probably failed a lot earlier, as a slow leak, and we didn’t catch it.
Sounds familiar! I was running into that a lot. Boluses that are too large at any one time seem to result in what’s called tunneling, especially past the pod’s halfway mark – the insulin fails to absorb, pools at the end of the cannula, and then backs up along the cannula, resulting in a slow leak at the surface. (This may be common to tubed sets as well, I don’t know.)
I no longer bolus more than 5 units at a time; any excess bolus amount, I deliver extended over half an hour. Your limit may differ; I started with 9 U and worked my way down until I no longer had these leaks.
Sorry your early days are being so frustrating for you both!
Do you think there is a dependency on how much insulin someone takes? Like more insulin would cause an earlier failure?
Seems like a distinct possibility.
I think so, yes. Larger boluses (combined with constant basal infusion) are definitely a problem for me. I suspect if I only ever needed small boluses, I wouldn’t experience these leaks/backups. But how much the area of the body, the type and condition of tissue, and the body’s response to the foreign cannula play a role, I can’t say.
I had no idea this was a possible issue. I am wondering if this may be what we are experiencing in the long, sustained highs that we don’t seem to be able to take down since we have been on an Omnipod. I will have to experiment to figure it out.
My first problem is that I am not 100% sure that I can smell insulin. I have to do some experiments for that too
These large boluses are exactly what we are doing right now (they are not resolving these highs well, which is one of our problems). In fact, we just took the decision that we need to use pens to correct sustained peaks to eliminate the pump as a potential source of trouble.
I only read about it recently myself. It’s mentioned in various forums, usually as associated with Teflon sets and commonly Omnipods. The common remedies are to change pods every two days or give up on pods altogether, but no one seems to have thought about doing smaller boluses. I just checked my Clarity report, and since starting to reduce my boluses, I’ve had only two of those sustained, stubborn highs (far fewer than before), and coincidentally they were both nights before a scheduled pod change. And since I landed on my limit of 5U, I’ve had none, knock on wood.
Like you, I can’t smell insulin (I can rarely smell, period), and it’s sometimes difficult to feel whether the adhesive is slightly damp or just old or it’s skin dampness or what. I have to wait till my partner gets home from work and immediately says, “Oh yeah, you’re leaking.” Which may mean something else once we’re both in our 70s.
That would surprise me. It is a distinct smell, like bandaids, only stronger. If we do a pump bolus and nothing happens, one of us smells the site. If it is overpoweringly like insulin, we change the site.
I sincerely wish I couldn’t smell it. Well, at this point, I suppose I am glad I can – because I think it smells awful, so I notice it when I get close enough. I managed to spray insulin all over myself, my hair, my coat, my kitchen table, and my floor last night while I was filling up the new pod. @Aaron (I think) suggested using a pencil to press the plunger down in the cartridge and it worked great! But then I tried to evauacte an air bubble before filling and I got a little carried away. Try spraying it all over yourself and see if you recognize the odor.
After my first post on this topic, @Beacher mentioned the large bolus issue, and we immediately switched to a 5u or so initial bolus and then another extended bolus or immediate bolus a number of minutes later if it needs more than the initial. We both agree that it could be an issue to try to force a large amount into the site at once.
We’ve also update our RX today to change every 2 days so at least it’ll seem less like a major failure every time.
I am happy to report that despite being at almost 300 when we realized there was a leak around midnight last night, EH woke up at 94 and we slept through the night so that felt like a win!! (We did turn the Dex high alert up to 280 though, because after we addressed the issue we figured we might as well both just sleep it off.)
Thanks to everyone for their great suggestions. While I realize there is a long ramp up to pumping success, I feel like everybody’s help makes it more bearable.
More on the slow leak issue … Around 2 this morning I was approaching 300 (blame cream cheese frosting), so I did a correction of 6.50 units, forgetting, in my sleepiness, my 5-unit limit. Sure enough, the site leaked. I didn’t feel like changing pods at that time of night, and assumed I’d still get my basal, so I injected my correction. When I got up this morning I was 60. But as soon as I started delivering my breakfast bolus, the site began leaking again.
So … Granted I’m drawing conclusions from one incident, but it would seem once you’ve got a tunneling problem at a site, you’re stuck with it. So the object is to prevent its happening in the first place, by finding what maximum one-time bolus is safe for you. And once a site starts leaking, you can keep the pod on, since the trickle of basal still seems to get through all right, and give boluses by injection. Or, of course, put on a new pod.
Is this an individual thing, or an issue with Omnipods and/or Teflon cannulas? I know some people are allergic to the Teflon (like @Jen?) but I’m not experiencing any other allergy or irritation symptoms. @Eric, do you get leaks?
I don’t know that I answered your question. Do you mean a one-time bolus, or cumulatively per pod? Or a body in general, the tissue responding to large boluses wherever they’re given (or to the Teflon, wherever it’s placed)?
I guess it could be either? Like either a large bolus or a total amount of insulin at one site?
Since you mentioned limiting it to 5 units at a time, maybe 150 units or some other number of total units makes a difference? I don’t really know.
I’ve only had a few and it was because of the pod being in a place that got jostled around and caused it to come out.
I do think pressing it down on the skin when you activate it (until you hear the insertion “click”) helps.
Wonder what Insulet could do to reduce this from happening…or to alert the user that it is happening?
Once the insulin leaves the tip of the cannula, there isn’t much they could do to know if the insulin was leaking out. As long as there is no occlusion, they have no way of knowing.
I think something that would possibly fix it is an option of different cannula lengths. I’d love a 9mm option.
The one-size-fits-all 6mm length seems silly.
It’s dumb to think these two lumberjacks would require the same cannula…
- A bit of a thread hijack here, but just after I give a large bolus - I can actually smell the insulin preservative for a few minutes even though it is just circulating in my blood. Enough of it must come into my sinuses near the olfactory receptors.
I agree. I used to get tunneling issues, but not so much anymore. John Walsh in Pumping Insulin complains that Teflon cannulas often have tunneling issues and that these issues are generally caused by cannula movement.
As I have said elsewhere - once I figured out how to stick on the pod so that the cannula does not move at all, I have stopped having tunneling issues. Typically my worst performance is on my arms but that is because of arm movement and bashing the pod into doorframes.
This has helped me immensely - once I started this the problems I had went away.
If you are using the syringe that came with the pod, it is very difficult to get all the air bubbles out. I just try to get out the big ones and then I give the syringe a shake and turn the syringe upside down in a glass. All the bubbles rise to the top near the plunger. Then when I inject into the pod, I stop just before I hit the remaining air bubbles.
Since @eric mentioned just injecting into the pod directly from the pen, I have now been doing that and it is even easier as there are no air bubbles to deal with - although I suspect it takes a bit longer than going from cartridge to syringe and I have to count which I am not good at …
Have you tried using a syringe to just pull it out of the pen? Instead of using the pencil?
Yes I have - but the pencil method is better in my opinion when using the omnipod syringe - that is pushing is better than pulling. I find the rubber stopper in the cartridge sometimes gets stuck when using the omnipod syringe to pull out the insulin.
Using a normal insulin syringe - with the nice rubber seal on the plunger - the pencil is not really needed and you can just draw out the insulin from the cartride. The seal on the syringe plunger makes it so there is adequate force to pull down the rubber piece in the pen cartridge.
Yep, I don’t use the included omnipod syringes anymore. I use BD 100ml syringes. Much better I think.
(BTW, available with no prescription from Amazon!)
I am about to bail on my second pump in 3 days. I think it is movement-relared: the first after my physical, the next one probably due to yoga. I gotta make this work, don’t want to go back to shots.
A few things to suggest.
For sure, get them replaced by Insulet.
Put it on after a shower or bath. It will stick better to clean skin. Also wipe with an alcohol swab to make sure your skin is clean, oil free, etc.
Put it parallel to whatever bone is near it. Up-and-down on your arms or legs along the bone, or side-to-side on your stomach parallel to the ribs. It seems to last better that way.
Bunch up the tissue under it and press down when activating.
Just try to find a spot that is not stressed too much with movement or stretching. I have put them in a lot of places that are not shown in the book. Be creative.