FUDiabetes

Jumping in to pumping with Omnipod

I am taking the plunge into podding by switching over from MDI Tresiba/Fiasp (using MDI my A1c was in the 6 +/- 0.3 range for 5 years with good TIR) to Omnipod pumping. I think the main driver for making the switch right now is curiosity…I want to know if I can have an easier time of it by podding. Can I improve my TIR and A1c with fewer time-outs from day to day life and less mental effort by using the Omnipod? Can I catch/correct nasty inadvertent BG peaks or unintended nighttime high BGs? Only time will tell…hopefully I can use this thread to get my rookie questions out there and start some good discussions that will benefit everybody using Omnipods.

Here is where things sit right now:
Believe it or not, until about 2 months ago I had never seen a pump up close. Discussed with my endo and visited with a CDE in November to see what various pumps look like, ask questions and get a feel for what the Omnipod is all about. They both were pushing the Dash.

Signed up on Insulet web site (requesting Dash) and let their sales force do the heavy lifting of figuring out coverage with my insurer (private insurance). The answer came back: Dash not covered, “conventional” Omnipod is covered. I have no reason not to try the conventional Omnipod and have read the generally good reviews so I decided to go that route. I also like the option of looping after things get dialed in.

Insulet sales force seemed very responsive, got the PA approved and shipped out 40 pods and a PDM starter kit in late December. Now I have my appt with the trainer to start the Onmipod on 1/14/20. Trying to get ready by (1) switching over from Tresiba basal to Lantus, so I have a backup basal that is faster to respond than Tresiba (2) requesting prescrips for Fiasp in vials, syringes/needles for backup corrections and (3) switching over from Contour Next BG checks to Freestyle which meshes with the Omnipod PDM and seems like a more convenient way to go.

As questions and good news/bad news updates pop up I will be sure post on FuD…Thanks in advance for all the help I am going to ask for, Stay tuned!

7 Likes

Exciting times. Can’t wait to hear about your new strategies to eat food that is hard to bolus for on MDI.

3 Likes

Reading through your post, it looks like you have done all the background work and lined it all up very well.

Maybe one other thing…do you have the PDM and pods in hand? Or did they send it to the trainer?

If you have it, I can tell you that there is a reset on it. So I would definitely suggest running through the PDM setup a few times. Program some dummy basal rates, program all your profiles and stuff. You can even fill a pod with water and activate it without sticking it to your body. Just have it on the table. That way you can run through some test boluses and enter carbs or whatever.

After you do that, you can go into the options and hit “reset”, and the PDM returns back to it’s “fresh out of the box” state. So it does not hurt anything. It just gives you a bit of experience so that when you go into training, you have better questions and have done some of the functions.

I think it is much better to do that a few times to get up to speed on it, instead of going in blind!



The reset can be found by going to:
Home >> Settings >> System setup >> Diagnostics >> Reset PDM

I strongly encourage you to set it up, practice on all the menus with a non-insulin pod and get familiar with it, and then reset it before your training!

2 Likes

Ha! Had a bagel Sunday and could not crack the MDI bolus code. Doubtful I will go for another bagel for a long while.

1 Like

Hi @John58 - I was a long time MDIer. With CGM and MDI my A1Cs hovered in the mid to low 6’s. I could never get the levemir just right.

The pump basal let me break the 6 barrier into the 5’s where I have stayed since :slight_smile:

Good luck. (and the trick is to bolus when you put a new pod on to get it working :wink:)

4 Likes

There really is no difference whatsoever between the two from the treatment point of view, they just have different PDMs; you might prefer one or you might prefer the other.

I have no problem switching from the pod to Lantus, but I admit my HbA1cs are no where near as good as yours. The UST400 pods that you are using can’t do a 0 basal (the Dash can) but the 0.05IU/hour basal that the UST400 delivers is find for a transition from Lantus basal to pod basal; I sometimes use the pod for bolus while using Lantus for the basal, it just works.

Some pods will fail, this will cause problems with the Fiasp (or Lispro, or Aspart, whatever you are using in the pod) because Insulet replace the pod but not the lost insulin. This morning I spent a half hour on the phone with them as a result of a Dash PDM system error (I don’t think you will get these with the UST400 - a definite plus). I lost 2IU of Fiasp; the pod had only been in for a few hours, so I had to attempt to extract the Fiasp, squirting 25% of it over the computer keyboard, so that I wouldn’t run out of Fiasp.

The way round this is to persuade your endo to over-prescribe the Fiasp on the basis that you will certainly lose a few pods during the startup phase.

The magic for me with nighttime highs was using a CGM. The pod and MDI really aren’t that different. Sure, we can micro-dose with the pod, but my experience of nighttime highs or, for that matter, bagel moments, is that it just takes a big dose of insulin then correction (sugar or more insulin) an hour later. That said, the PDM is a damn sight easier to use than MDI; it’s a lot easier to bolus three or four times during a restaurant meal with a PDM than it is with a big bottle of insulin and nurse ratched’s syringe.

5 Likes

It is not “over-prescribing” it is “appropriately prescribing” :wink:

There will always be some loss in insulin. My son uses pens and his doses are pretty small because he is a little guy. We typically prime more insulin than inject into him so our need is more insulin that is injected.

4 Likes

OK Day 1 with Omnipod has started off strong…started it yesterday afternoon. After a post-dinner high and a midnight low I’ve been cruising in a great flat range. Hope to be posting flatline plots sometime soon. Hockey tonight will be a good test of temp basal strategy etc. Despite everything I’ve read I firmly believe my best strategy is winging it with a best guess temp basal…and several gluc gel packs with me on the bench.

Challenge 1 for me is keeping the pod on the back of my arm. With Dexcom, I have occasionally ripped poorly taped sensors off my arm while peeling off sweaty pads and undershirt after skating. For Omnipod, I bought two things to try:
These cheap pre-cut tape patches:


And this Velcro bicep band:
image image

Curious if anybody has any pointers for protecting the pod from disruptions caused by jarring it. I’ve already rammed across a door jamb with no ill effects…but I’m a little paranoid that it is a little too bulky for rough treatment of my upper arm.

3 Likes

I have only lost a few. Since they are only on for 3 days, they seem to last much better than the Dexcom sensors that need to go for 7 or 10 days.

That band looks like it will be good.

One suggestion is that the inside of your arm (the part that is next to your body) is better for when you are in a crowd.

Like if I am going to an event where I will be walking through a crowd, I will put in on the inside of my arm instead of the outside.

Not sure how that translates to hockey, through…

That is how I do everything.
:+1:

4 Likes

You could try OptiFlex, too. It’s inexpensive in a roll. But, yea, I’ve had pods fall off during runs, too, on exceptionally hot days. I wear my pod on my abdomeñ so it rarely gets bumped.

3 Likes

So far so good! My first pod expires this afternoon and I am going to try to keep it going for the extra 8 hours just to see what happens when it is all the way dead. The trainer suggested, for pod changes, to leave the old pod on for about an hour after the new pod starts up. I’m a little confused about what that will accomplish if that extra hour is from (3 days plus 8hrs) to (3 days plus 9 hrs). Should I expect the last of the basal to continue to seep out?

2 Likes

The 10cmx12cm tegaderm patches:

https://www.amazon.com/gp/product/B0055AGR7U

That said, I couldn’t get reliable performance from a pod on my upper arm, not because I ripped it off but because I don’t seem to have enough fat there. I gave up and use the back of the waist and my upper chest (four sites).

The tegaderm bridges the “catch” area between the pod and its own adhesive, but once it is on it won’t come off - it sticks to the pod much better than my sweaty skin.

3 Likes

I’ll second that Tegaderm works (for me). I put some both under and over the Pod adhesive. I’ve never had a Pod fall off in the 3 years I’ve been pumping.

2 Likes

The pod lasts 80 hours from the time you put the insulin in the pod, or until you deactivate it.

It will deliver basal for that amount of time - from the time you activate it on your body until the 80 hour clock times out, or you deactivate it. But no more than that.

I do not think there is any real use to keeping it on after it expires at 80 hours or you deactivate it. No more basal will come out of the pod, absolutely none.

If you pull the pod off, your body will close up the insertion point, and insulin won’t leak out. So leaving it on your body to prevent insulin from leaking out also seems pointless.

I think that is one of those unnecessary things they tell you. I really don’t think there is any value to it.

I think the better thing to do is remove the old pod, activate a new one, and give yourself a small starter bolus to get the site working. I find that helps.

If I put on a pod and don’t bolus, the small basal amount that comes out does not seem to get a very good start. So I make it a point to do a bolus when I activate it. I refer to this as an “activation bolus”.

But no, leaving it on after you deactivate or it expires does not seem to have any real value that I can think of.

4 Likes

I mostly agree with all Eric said, but I do leave the old pod in place if I have done a bolus in the last hour or so. I discovered that removing a pod too soon after doing a bolus can in fact result in insulin leaking to the surface (perhaps a consequence of the tunneling I experience anyway, or because of a less rapid absorption of insulin by the third day). An hour is unscientific, but it feels like a safe amount of time to prevent any leakage of insulin. This practice works well for me, as well as doing a prime bolus of 0.25U with the new pod

4 Likes

Yep, on my first pod I interpreted some higher BG to be a symptom of degraded absorption on the third day. Going to take a few weeks to figure out how to deal with that, if it continues.

Shin guard sleeves…my son plays soccer and just puts His guards under his socks, so he had a few that he never used…found some on Amazon also…I also miss the eversense… the Bluetooth was much better…I’m constantly restarting my miaomiao2 Bluetooth with the libre, but its a lot cheaper…

1 Like

Well I’m about a month into Omnipod so naturally I’ve had a few questionable events…more than a few actually but some can be written off as undiagnosable meals while travelling, etc. Overall I am loving it compared to MDI…but my 30 day average BG is not so good compared to MDI. Although 3 weeks of travel will also do that to my averages so I will not lay all the blame on my rookie pumping mistakes.

The main question in my mind after about 30 days is how to decide when a site is not absorbing properly, vs. the usual possible reasons for a slow drifting BG rise that is hard to correct. I tried three pods on my thighs and (despite some nasty highs up to 250-300 in evenings or when I was not attentive to correcting) was too stubborn to give up on those sites. I suspected the site was not absorbing well but there was no other evidence besides the high BG’s. When I super-corrected with a large bolus the BG would come down. My suspicion is that my basal was not absorbing in my thighs but that is just a guess.

Is there any way other than trial and error to determine whether a site is not absorbing basal as it should? When these pods were going I was travelling and frankly did not have the patience to do a full on basal test at the time. Now that I’m back home I might try another thigh and fiddle more with the basal, see if anything can be figured out.

The second question is a little more pragmatic…I can’t do a thing with the PDM outdoors on a sunny day. There’s a lot of glare, reflection etc on the screen that was giving me trouble. Are there any add on anti-glare screens that seem to work? It was kind of a pain to search for a shady spot and put on my readers just to be able to see the screen.

1 Like

I have had T1D for over 50 years and now seem to get different absorption rates quite a lot. Before I insert I really examine the area closely and that has helped. I used to poke anywhere on my abdomen.
Now I change insulin site if BG seems to be going up for no reason. Sometimes blood comes out and assume it was probably an absorption issue. Sometimes not. Very tough to tell when it is time to “wait and see” or change when you are going up without any reason.

1 Like

I’m not sure what other evidence you would need. For what it’s worth, I also experience sluggish uptake in my thighs, though injections absorb normally. I’ve pretty much given up on my thighs (which are not fleshy) for pods, but if I do use them, I run the basal 15 or 20% higher for that pod and it seems to work well enough.

You’ve tried pressing and holding the “?” button to increase the screen brightness, right? That, or finding shade, usually works for me so I haven’t explored alternatives, sorry.

3 Likes