Going to Omni Pods Monday from MDI since diagnosis

Tips, Tech & Gear Pump
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On Monday, April 23rd I will be going to Joslins for my pump/Pod training because after a little over 2 years since my T1D diagnosis I’m having major issues with spikes and ridiculous morning highs that continues through the afternoon.

I’ll start by saying up until about 3 to 4 months ago I had pretty good control over my BGs but lately no matter what I do or how much insulin I take in the morning, I spike pretty quickly and stay high for an extended period of time. For example, the other day I woke up and was 109, ok I’ll take that. I take my Basal as usual and pre bolus 6 un of Humalog because as soon as I have a cup of coffee I’m up around 150 or higher. 30 min later I have an Oikos Triple Zero yogurt (6g carbs, 15g protein and 0 fat) along with strawberries or blueberries and 10g carbs in granola. Total of 16g plus a few more for fruit so call it 20g total. I bolus another 8 un and an hour later I’m at 250 or somewhere around there and stay high until 1pm when I finally get down to 125 and can have lunch where this happens all over again. Mind you my endo set my correction ratio at 1:10 for breakfast and lunch then 1:20. If I was to take bolus based on endos recommendations I’d spike to 400+.

My endo finally believed me and says it dawn phenomenon and when I brought up Pods he said that should be a great way to control these spikes and I already did research and feel tubeless is best for me Plus my insurance covers everything as a prescription and the PDM is going to be free vs. $4500 out of pocket for another type of pump.

I brought up concerns in another thread and I’m still second guessing the decision, should I just stay MDI? Is initial setup as time consuming as I’ve heard? Am I going to be gaining more weight?

Why am I so stressed out about this?

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Hi John. Glad to see your post.

Let’s start with this. :arrow_up: Has anything changed in the last 3 or 4 months?

What is your current basal regimen? What type of basal do you take and when do you take it and how many times per day?

Just a guess here - I don’t know what basal you are on, but it sounds like your basal is not covering you through the morning (I would guess Lantus, once per day). You are waking up with no basal left in your system. When you wake your liver says, “Good morning, here is some fuel since you haven’t eaten all night…” That is all normal. But without basal, that spike is what happens.

If you wanted to work through MDI a few more weeks, we could definitely fine-tune this. But since you are going to a pump, it won’t really matter. Just an interesting exercise in problem-solving and figuring out what is happening to you in the morning.

Training is an hour or two. They will probably start you with less insulin though, for safety. :frowning: And then tell you to come back in a few weeks for adjustment. Most likely they will use a their formula to come up with your numbers, based on your total daily dose of insulin and your weight. If you are comfortable, you can adjust the basal yourself after a few days. You have access to the best diabetics in the world on this site. Feel free to ask the peeps here for help with it.

Insulin pumps don’t cause weight gain, but food does. :grinning:

Actually some people may gain weight on a pump just because they might find it easier to bolus and eat. But really, weight comes down to how much you eat, how much you burn, and how much you store.

How much exercise do you do? We might be able to scare up some exercise freaks on this site to tell you all about how good exercise is for you. :crazy_face:

If things were humming along great for you now, I’d say why switch. But since you are having some issues, seems like trying something different is a good idea. Struggling and not changing doesn’t make sense. We could tinker with the MDI, but either way, all of these things are fixable. Why not try it and see?

I don’t know! No need to stress. You are in the right place. Try it and find out.

Please ask questions.

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Our son has been using the omnipods for going on two years now. Please be aware that a pump isn’t a magical pill. It will take time, patience and a lot of testing to home things in correctly but it is certainly possible.

We chose pump after six months of MDI to spare our son so many shots each day.

If you really want to get that control this is the place to be. There are so many helpful and patient people here who will walk you step by step to help you uncover what’s causing your issues.

It’s great to have you here with us!

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Welcome to the site John!!

Has your diet changed in the last 3-4 months?

I second @Eric’s point about Lantus not lasting 24 hours. When I was on Lantus, I split my dose into two shots- one in the morning and one in the evening. You’d have much more even coverage that way. I’m not sure why endos don’t recommend this from the very beginning. It might be worth giving this a shot before your appointment on April 23rd. That way you’ll have a better idea of whether a gap in basal was the problem or dawn phenomenon.

If the gap in basal isn’t the problem, then the pods will definitely help with the dawn phenomenon because you can dial up your basal dose a little before you wake up in the morning.

Once you’ve worked out the basal, you may find the that post-meal spikes are less pronounced. When my basal is off, nothing seems to work right. A little exercise can also help me a lot with insulin sensitivity at mealtimes.

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You should try a pump because you should try everything. It’s not an either/or situation anyway, I go back and forth between the pump and MDI when I get annoyed. It’s good to be knowledgeable with both treatment regimes so you can use whatever works best for you in the moment. People say the pump is more work, but I find MDI much more complicated to maintain the same level of control I have on my pump, so it’s all what you’re used to.

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@Eric I do currently take Lantus and I take 18 un at 6am or around there. I tried to split the dose but 2 things. I didn’t notice any difference and I was late taking my 2nd does more than I was on time. it is just a huge mystery and I did basal testing about 6 months ago on a saturday morning and I stayed steady at around 150 for 6 hours. I woke took 1/2 my basal and did nothing and ate nothing for 6 + hours…

With everything I have going on I may just delay this change until I get a handle on MDI then switch, I don’t even know anymore I am getting so frustrated with this T1.

I used to go to the gym early in the morning but re injured an old back issue and was out for a couple of weeks. When I started back I was feeling like garbage every morning basically because I cannot sleep more than a couple of hours and then just stopped going. It’s been about 5 or 6 months and I HAVE to find time to get to the gym. I at the very least do everything I can to get my dog out every night for a 1 to 1.5 mile walk but that is not enough obviously since I am so heavy right now I can’t even look at myself in the mirror anymore, it makes me sick that none of my clothes fit and when I find something close to fitting it looks like a fat guy squeezed in to smaller clothes and that bothers me.

I wonder if I need some type of psychiatric sessions to get my head back in this before doing anything else. Getting diagnosed at 49 yrs old really hit me hard and I’ve been in denial for a little over 2 years so that isn’t helping me at all.

My God I am so sorry to throw all this at you all but I have no support system, no family close by and I work so much I really don’t have too many friends because I live away from where I grew up and all my roots were put down. Its just me and my dog and a wife who does nothing but try to tell me what to do when she knows nothing of this. She hears something at work and all of a sudden she’s an expert. When I first started going to Joslins she was coming with me and my Dr actually asked me to not bring her she was disrupting our conversations and when we left all she would do is argue the Dr has no idea what they are talking about, really I am not making this up.

Thank you for letting me vent, I do feel a little better which is good because I have to go see customers now and won’t be back until later today but I will reply when I do get back. THANK YOU everyone, you have no idea how helpful you all are.

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@Katers87 yes I do Lantus once a day and tried splitting but it didn’t seem to make a difference. I am hoping that the Pods with constant flow of Humalog to start with (I still have 3 bxs of pens left over I will use but sounds like Novalog is the way to go in the POD?)

My diet hasn’t changed and I do eat fairly low carb, I keep it under 100 g a day and most days under 75 g and still these issues pop up. As I mentioned in my reply to Eric I wonder if seeing and talking to someone to get my head on straight would be helpful? I am hesitant because I did that early on at Joslins but they set me up with a social worker not a psychiatric consult which is more of what I think I need right now.

I need to stop eating all together and get this damn weight off of me it is really driving me crazy.

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I am going to try it, it can’t be worse than what I am dealing with now, that’s for sure.

More work in the beginning I believe but hopefully it will level off within a few weeks and be almost on auto pilot.

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@ClaudnDaye thank you. I am finding that everyone here seems awesome and this could be the support system I need.

I do understand getting a pump dialed in will take time but I think it is time I need to invest NOW and take control of my life and body back.

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So…I’ve been trying to get up the courage to make an appointment with Dana Lehman at Integrated Diabetes Services. (I am not their advertiser, I promise, but they have and are continuing to help me so much and I have gotten great support/results with them that I want to share it as a possible resource for you.)

Dana is a T1D and a clinical psychologist who can do phone/Skype/etc appointments through IDS. Go to integrateddiabetes.com and all of their services and staff profiles are right there. Gary Scheiner recommended that I do a few sessions with Dana to address my anxiety about hypoglycemia. I haven’t worked up the courage to do so yet, but it’s staying on my radar. Maybe this is the perfect option for you! You have more on your plate than anyone should have, but we can make it better. I also understand the wardrobe issues…trying new sites is making me branch out from my standard jeans/t-shirt or dress pants/cardigan routine. I am going to have to start wearing skirts/dresses which I’m not the biggest fan of…but my health requires it so it must be done.

Hang in there. Think about setting up an appointment with Dana. I hear she’s great…and lives T1D herself!

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Hi John,
You have mentioned a lot of things. Many things to discuss, but it probably would be good to start with a few things to tackle, and do them one-by-one. You can get totally overwhelmed trying to do to many things at once and all of the advice you get will be good but it may pull you in many directions.

Let’s start with a few things you want to tackle first. Do you want to try fixing your current MDI situation, or start with the pump?

There really is a lot to do here, and you have to just take steps in the right direction and not try to take it all in at once.

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This is why this community was formed. All of us, whether we have support systems outside of the world of diabetes or not…often do NOT have support systems that understand Diabetes. We can have all the loved ones who are super intelligent, but if they don’t understand Diabetes, they’re really no help. Diabetes is not a simple concept for people who don’t live with it, to understand. Never feel like you need to apologize for throwing everything at us – this is literally what FUD is here for. :slight_smile: People helping people improve their lives and reach those goals they’re trying to achieve to live happier more fulfilling lives!

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:+1: :100: :arrow_up:

Nothing will be solved by looking at the BIG PICTURE…as @Eric indicated, you have to solve one problem at a time. Tell us what you consider your BIGGEST problem right now, let’s work through that, then work down from there. @Eric is a Diabetes Sensai/Guru, so whatever he needs from you, if you get it to him, he will help you figure out whatever it is that you need to get figured out (and the rest of us will help also whenever and however we can!).

You can do this! We all have faith in you…just take it one problem at a time. It’s like in school…we don’t think about the entire load of coursework that’s going to be required as part of the course if we want to be successful…we think about one chapter at a time, one page at a time, one assignment and test at a time, then the “big picture” will take care of itself!

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That is considerably more than nothing. That is a springboard you can use to continue on.
I would absolutely find this extremely helpful and very encouraging.

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Generally, a successful basal test means that your blood sugar remains level for the whole period of time you’re testing (e.g. 5-6 hours). It should not increase or decrease substantially. It sounds like your blood sugar level was 150 at the start and 150 at the end. Is this correct? If not, could you explain a bit more? If so, then that means your basal insulin level was correct, but you simply started at a level too high. In that case, it’d be best to investigate why it started at 150. Was there a problem with your last bolus? Maybe your insulin to carb ratio needs an adjustment?

A fast-acting insulin is needed for an insulin pump. Most people use Novolog or Humalog, but some people have started using Fiasp. Humalog and Novolog are very similar, but some people may have better experiences with one or the other.

If you eat very low carb some days, you may develop some carb sensitivity. This was discussed in another forum (linked below). I don’t think this should be a major problem at 100 grams a day though. Just something to think about.

Also, I second everyone else’s comments regarding the benefit of talking with others going through similar things. The people here have so many good suggestions and helpful insights. It’s so nice to talk with people who truly understand the disease you’re dealing with. I’ll say again, glad you joined us!! :slight_smile:

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It is common to have a blood sugar rise when you wake up. Taking that pre-bolus is likely controlling that only. Nothing to do with the coffee, unless you are adding cream and/or sugar.

You should start tracking your food in something like MyFitnessPal. You are eating more carbs than you think you are, at least with the yogurt. Undercounting carbs is very common. One at a time:

  1. On the yogurt, you are counting sugars, not carbs. The sugars are 6g, but the carbs on the Oikos Triple Zero are 14g of carbs.
  2. Are you reading the label correctly on the granola? Are you measuring your servings? 10g of carbs for granola is typically between 3 Tablespoons to .25 cup of cereal for low carb ones. Most granolas are much higher in carbs.
  3. 4 grams of carbs for fruit is not much. 1 whole strawberry is 1.5 carbs. 1 cup of blueberries is 10.5g. Again, the key is to measure.

Entering your food in an app like MyFitnessPal will give you a better idea of the carbs you are actually eating, but only if you measure everything.

From what I see, you are starting with 27 carbs if your carbs are correct on the granola, and you are only eating 2 strawberries.

Switching to OmniPods is easy, and the training is about an hour max. Don’t worry - it’s easy. But nothing will change if your insulin/carb ratios are off, or you are not counting your carbs correctly.

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I use DiabetesM to track all BG tests and food/carb/insulin intake.

This has been a point of contention in other groups, my Dr, as do many others, wants me treating from net carbs which is total carbs minus fiber content. Oikos Triple Zero is 14g carbs but 8g of fiber, hence the 6g net carbs. Funny but after going through a discussion on another forum I tried not deducting the fiber and treated from total carbs and 90 min later I’m crawling to the kitchen to get juice (exaggerated a bit😂).
So that’s confusing to me as well and part of my notes to discuss with my new dietitian on Monday. I have my nutrition apt, then eye exam and then 2 1/2 hours later the pump training all on Monday, April 23rd.

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Oh, I literally added 2 large strawberries and nowhere near a cup of blueberries, actually a little less than 1/4 cup so I really feel my carb counts are spot on. Yes I’m using the label from the product I buy and it’s a store brand bar that I break up and add to the yogurt. Like I said, I’m certain my carb counts are good, if they are off it might be by 1 or 2 g at most.

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@Katers87 I did stay stable at around 150 during the Basal test. Why I was 150 when I woke up, I can’t explain because I had a tendency to go hypo overnight when I started going to the gym at night vs morning and I don’t recall what I was doing back when I did this testing. I asked about Novolog because of some other comments I’ve read that ppl getting better results from it vs Humalog.

I totally agree with taking to others and that’s why I joined this group and migrated away from another that was good in the past but not so much anymore, Beyond Type 1.

Thank you for your input this does help…

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Now that the weather is changing I’ll be out with the dog much more often and for longer periods of time.

I do need to get my fat ass back to the damn gym. I’m having a hard time balancing my work schedule and getting to the gym a lot due to my selfish wife. Lol g story but I work from home but put in 16 hour days, I’m in sales and on commission so you do what you have to do.

When I’m finally done working I go downstairs to her sitting on the couch drinking and doesn’t lift a finger to help with dinner, the dog or really anything anymore. My Type 1 has changed her lifestyle so she acti g like a 5 year old to make sure I know that. Sad at the very least and she’s one of the ones who knows everything about everything so she trying to tell me how I should be dealing with T1 and does not understand how my numbers are not perfect all the time.