FUDiabetes

"New" to Omnipod and Pumping: 4 years in and I feel like I'm missing something

Siphoning aside, if you were leaking, then yes, you’d face a long stretch of correcting to try to get back down. 1U would be a huge prime for me (I do 0.15), but it probably started to bring you down.

I think elsewhere I’ve written about tunneling. You may find you can’t do larger boluses all at once, particularly near the end of the pod’s life. In my experience, once a site starts leaking, it will continue to do so. The basal seems to get through, though, so if I’m not in the mood for an early pod change, I’ll just inject my boluses (in round numbers, and let the pod deal with the decimal amounts remaining).

I do that but only if I recently gave a bolus. I personally don’t find it really matters if the pod has only been delivering basal for several hours. And I could be wrong, but I thought that the Omnipod’s lack of tubing meant it wasn’t really susceptible to the siphon effect (or had less of an error factor than tubed pumps).

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Hi Allison,
Sorry to interrupt! Just saw this and it caught my eye again.

As I read through your thread I keep thinking this issue:

Sounds like absorption problems. All the Gary Scheiner stuff is well and good. Gary is a sharp guy. But if your body is not absorbing well after 3 days, leaving the pod on there after putting on a new one probably won’t help.

Some people have a tissue type that just doesn’t absorb well after several days or large doses. This is the problem I have.

This is just not something any pump maker will tell you!

Imagine watering a very nice lawn over and over. It has been cultivated and aerated properly and has very good soil. The water absorbs very well. Now imagine doing the same thing to a lawn with crappy soil and hasn’t been aerated. Eventually you see puddles on it.

The reason I am mentioning this is because you said “day 3”. Would you be able to swap after 2 days for a few weeks and see if it gets better?

I made this little picture as an illustration. I think this shows it well. I know for sure day 3 is not as good for me as day 1.

:smiley:

image

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Do you change pods every 2 days? Or stretch out boluses to minimize the harm? Supplement with shots? Turn up your basal for Day 3?

I don’t change every 2 days, just sometimes.

It was very bad with Humalog, not as bad with NovoLog. But sometimes it is still a problem with NovoLog.

So mainly just being aware of it I can 1) bump up the basal for day 3, or 2) swap it out early if it is bad.

Just depends. But simply being aware of it makes me more aggressive with pod swaps or higher insulin on day 3.

Maybe if you take it out on day 2 and examine the infusion site you can see if there is a difference. I see those big red spots often.

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The solution for me – which doesn’t mean it will be your solution, this being diabetes, after all – was to find a “safe” minimum bolus amount that prevented leaking even on Day 3. I’ve found I can bolus up to 5 U at a time (I generally aim for 4 to 4.5 just to be extra careful). The remainder of the bolus I either deliver by extended bolus over 1/2 hour or 1 hour, or inject (and if I’m going to inject anyway, I may as well inject the whole thing). I went from multiple cases of “leaking” pods and two-day lifespans to no leaks, routinely getting my full three days, and very rarely having unexplained high trends around Day 3.

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Great thread Allison.

Regarding skin allergies to the POD (and/ or Dex adhesive). I updated a post about adhesive issues with CGM/pumps. I have very sensitive skin (particularly with adhesives). I’ve been following this routine for a year plus and, for me, I’ve only had 2 or 3 sites that have bothered me.

Avoiding adhesive irritation

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Thank you to everyone for your tips and tricks! I’ll keep you posted.

I just got up my courage to pre-bolus lunch by 30 minutes…I was stuck high to begin with from breakfast. I’m stretching out my lunch now, hoping for a recognizable blood sugar curve that I’ve been missing for the last several months.

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I’m on the same path - trying out more assertive corrections and pre-bolus doses.

I took 4u of Afrezza at 10:30, saw the CGM curve below, pre-bolused 3.5u via my pump and am about to eat a 35 carb lunch.

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If you can avoid this, this will certainly help. We’ve found that, at least for our son, we MUST wait for him to be in a good range before he eats…if he doesn’t, his BG explodes upwards to 400. We never feed him, ever, if he’s above 150. Ideally, we like him to be as close to 100 as possible…but that’s just us. Some people may be more comfortable being around 60 or 70, but for Liam, that would be too dangerous for us right now. So our goal is 100. If that means first “correcting” him by bolusing him, then we do that…then wait. Once his BG’s are on the down-trend and get near 100, we will typically do an extended bolus with 25% up front and the rest over 1 hour, then feed him right away (or wait a few more minutes if he still has ten or twenty more bg points to go down still.) Then, after he eats, we have an extended bolus on, if he levels off, then starts heading back up again, we usually SUSPEND the extended bolus (the remaining insulin that is still set to go in over x number of minutes), then give it to him as a straight bolus…we typically only do this if he’s at or over 150 and “double arrows up”…if he’s only single arrow up, we just let the extended bolus ride

There are so many variables that go into consideration when determining when to eat, when to bolus, when to extend, when not too, when to suspend extended and give straight bolus, etc., It all takes a lot of practice, but we’ve found that TIMING is really the most important thing in diabetes for good management. Timing on eating, timing on bolusing, timing on corrections, etc., The higher your BG’s the more insulin it takes to correct the high…so we just try to not get high if we can avoid it.

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One trick we have found, is that if we are on day 3 of a site, and we have to give a large amount of insulin, i.e. 10 units or something like that, we use a syringe and deliver it so we don’t have to rely on the pump site that might be sketchy. That keeps us in range more. And a pen vial and a couple of syringes fits in our meter case really well.

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Thank you, @Eric, @Millz, @ClaudnDaye, @Chris, @Beacher, @Katers87, @Lisa, @TravelingOn and everyone!

Do you find a variable duration of insulin based on activity levels? Or do you think it is pretty darn stable? In my shots days (when I was better controlled), my DIA seemed shorter (2.5 to 3 hours) if I was super active or working my brain harder than usual at work. For stationary times, it seemed like it could last 5 hours or so…my CDE back then said that was not possible but I remain unconvinced by her response.

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Absolutely it makes a difference!

100%, yes without a doubt it makes a difference.

Your CDE is wrong. Your instincts are correct.

Should I tell you why activity level affects duration, or do you want to chew through the idea a bit yourself first?

This is not the same as activity affecting your insulin sensitivity, IC ratio, correction factor, and all of that (which of course activity does affect that as well).

Just speaking of duration time and speed of action. Why would activity affect that?

(@daisymae will vouch for the fact that I often give her quizzes!)

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That part surprises me. I’m going to think on it for a while. I need to get the Diabetes part of my brain back in condition so this will be a good exercise. Not optimistic that I’ll ace it, but it will be a good activity anyhow!

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I just want to clarify something when I said this:

I am not saying that activity will cause everyone’s insulin duration to be different. It is possible someone won’t notice a difference in duration when they are active or not active.

What I am saying is wrong is the CDE’s statement that it was not possible.

It certainly is possible for people to see a difference, and there is a reason for that.

I definitely notice a change in my insulin sensitivity, with more activity but I haven’t noticed a significant change in duration. Then again, I’ve never paid much attention to that specifically. I think it would be hard to verify with so many other variables.

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My best guess which I may or may not communicate well:
Activity can increase the cells’ efficiency for making use of insulin.
Activity also increases the mobilization of the insulin (i.e. circulation around the body), allowing it to be taken up faster…leading to shorter DIA.

Am I close?

activity levels change everything with regard to insulin. i know that when i am swimming a lot, insulin hits my body MUCH faster and i am so sensitive to it, that i cut my dosage in 1/2 post work-out and still maintain a flat line in blood sugars. also, insulin is quicker to get in and out in almost 1/2 the time it usually takes. its almost, for me, IMHO, as speedy as taking an IM injection.

as well, this can last for up to 72 hours post work out, depending on the intensity of your exercise.
the harder i workout, the less insulin i need.

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You got it.

What is confusing is that it’s two different things. Activity can increase your efficiency, meaning less insulin is required. That changes your IC and correction factor and all of that.

But activity also makes it faster. The faster it gets into the blood stream, the faster it leaves. So activity can shorten the duration.

The same reason intramuscular (IM) injections make the insulin work faster. There are more blood vessels that absorb it, so it goes in faster. More blood circulation from exercise also means faster absorption. And faster in means faster out (shorter duration).

And the action of the muscles also works it in faster. Injecting in your legs when riding a bicycle in a race will make the insulin work faster than if you inject it in your arms in the same bicycle race…

So exercise means you can need less insulin. Your body is more efficient at mobilizing the insulin and glucose. But it can also mean the insulin will work quicker.

Does all that make sense?

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Sure does, thanks! Totally explains my weekend control vs my work day control. #stillworkingonthat

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So I got more assertive with my correction dose today, got myself running nicely at 112 for two hours, got home from work and had some time before dinner so I grabbed a quick shower. Tanked from 112 to 56. My correction dose from 3.5 hours earlier seemed to have gotten energized by that shower! And I never felt the low. I haven’t had lows hardly at all in the last few months, so I guess I just don’t feel them anymore due to disease progression? I.E. It’s not like I’ve had so many lows lately that I’ve exhausted the hormones that trigger the symptoms.