My son (8 years old now) was diagnosed with Type 1 about 6 months ago. We have been struggling with control ever since but out most recent issues is with the omnipod dash pump. He was started on this about 3 months ago and it was definitely more convenient and led to slightly better control but lately it seems like it is working less well. For the last month or so it seems that he is requiring more and more insulin the long he is on the pump (meaning on day one his normal basal and carb ratios seem OK but by the last day we just give more and more insulin and he still continues to go high) We have tried different lots of the pumps, different vials of insulin, different locations for the pump and do not be able to figure out anything that seems to make a difference. Any thoughts or suggestions are appreciated
@Oshii, Welcome to FUD! Sorry you are having problems with the Omnipod. Sounds like potentially you are experiencing issues with the way the insertion set works with your child. When my son is using a pump he limits himself to 4-5 units in one bolus because any more doesn’t seem to be absorbed. One of the benefits of tubed pumps is the ability to trial out different infusion sets. Have you tried to apply the omnipod in different ways i.e. with pressure or other things. Some other members with more omnipod experience will be by shortly I am sure.
I had read online about trying to pinch up on the outside and push down in the middle so that is the only thing I have tried to apply it differently.
Welcome to FUD!
I think I know what is going on.
Is he using Humalog?
Yes he uses humalog
I knew it.
I have some links for you and an explanation. I have had this discussion on FUD before. I will find the thread and references.
You need to check with your insurance if NovoLog is covered. For many people, Humalog degrades in a pump after a few days.
I had to make the switch when I started using a pump.
I will try to track down a good relevant thread about the subject and copy it and paste it into this thread, so it will be easy for you to see.
In the meantime, I suggest you check with your insurance and find out if you can get NovoLog covered in place of Humalog. Let me know how that goes. You may have an insurance fight on your hands, depending on who your insurance company is.
Do you have United Healthcare?
Here is a link to the thread. It’s a little bit long but has all the references and stuff in it. The only confusing part is the insulin names. Humalog is a brand name, they don’t use that name. So when reading the thread you have to keep changing the names in your mind so it makes sense.
Read through this thread and then feel free to post either on this thread or the one below.
Thank you so much! I work for a large healthcare company and they own their own insurance company called Medcost. A quick look at their formulary shows they do not cover Novolog but do cover insulin glulisine as their other fast acting insulin so I guess I’ll have to learn about if that would work. Thank you again for your help.
I don’t have much personal experience with that one - glulisine, brand name Apidra.
For a lot of the insurance plans, you can get the alternatives if you can demonstrate that the other ones do not work well. You can discuss doing the insurance appeals with your doctor.
But before you do an appeal, you need a denial. So the way it works is you ask for a prescription for NovoLog, you try to get it, it gets denied. Then you can start your appeal.
Happy to help you if you want, just let me know.
Also, I can send you some NovoLog and you can try it out and see if it works better for your son first, and then decide if you want to pursue it.
I have the same experience (but I’m 62, not 8, so far as I can remember 8 is a lot more difficult). I use the same system - Omnipod Dash combined with the Dexcom G6 CGM in my case. I’ve seen effects like the ones you describe and the general problem “sticky highs” is something that is often referred to.
I was using Novolog (in the Fiasp formulation - Novolog with added nicotinamide), I changed to Novolin. I’d previously used Humalog without the same problems. Swapping the insulin has made no difference. What has seemed to help was the end of winter, getting out, exercising; not that I’m saying I feel better, muscle aches, curious dreams, but the symptoms I was obsessing over have been replaced by other problems.
I don’t know how it works for an 8 year old; I do know, but my own 8 year old life seemed to have consisted of a lot of things not relevant to this conversation. Nevertheless every thing we do affects our BG, our insulin adsorption, everything.
I developed diabetes when I was 12; it is hell. All the same, it’s the same kind of hell lots of other people experience, the trick is to get through the first 30 years then deal with the kind of tight BG control many, maybe most, of the people on this list aim for.
“High” for me means 200mg/dL (translations to mmol/l on the internet, I’m assuming US), but really, so what; I go high all the time. Dangerous is a different number; I start checking my ketones if I remain about 250mg/dL for an extend period.
The more we understand the better we are at looking after ourselves and other people.
There’s compelling evidence that swapping from Humalog should make a difference, but my situation was like yours – things looked better for a month or two and then Novorapid was erratic and unpredictable, so I went back to Humalog.
@Oshii, do you ever see or smell insulin on your son’s pods? Some people using pods get what’s called tunneling, where the tissue around the cannula forms a tunnel, and insulin, particularly when it’s a bolus, backs up along the tunnel, resulting in higher BGs. I’ve found that a lot of motion where the pod is – if it’s on an arm then maybe playing tennis or scrubbing the tub (no, OK, I guess your eight-year-old wouldn’t be scrubbing the tub) – can bring on tunneling. So I try to avoid bouncy/jarring/jiggly motion when my pods are on arms or legs. This is less of an issue when the pod is on more “stable” areas like abdomen, waist, chest, and top of butt .
To avoid tunneling and improve absorption over the three days, I also use the pod just for basal and really small boluses, and either inject the rest of the bolus or do an extended bolus. But injecting may not be appealing for a youngster when they already have a pump.
Just something to consider.
@Eric I hadn’t heard that about Humalog. My previous Endo had tried to get me to change to Humalog due to my search for 1/2 unit dosing pens; something told me not to switch…now glad to have avoided the potential problem.
@Oshii I’ve been on Omnipod for since December. @Eric’s suggestions have been very helpful, so please give what he offers a try. I personally have found the stomach and love handle areas work well for absorption (adsorption?), though with the age difference, that might not work for your son. My thighs haven’t worked so well; the pods go on and stay on, but there seems to be an absorption issue unless I’m exercising (walking, biking, etc.). The backs of the upper arms work well for absorption, but I’m a side sleeper and if it isn’t in just the right place, it tends to bother my sleep (again, age differences may impact for your son).
There are several threads here on FUD on Omnipod that you might want to review for tips, things to try, and how to approach alarms and the like. Examples: 1) If in doubt, change it out, call Insulet and ask for a replacement, don’t be shy about it; 2) If a pod starts screeching continually, no indication of error, don’t use a hammer, there’s a small hole on the underside sealed with a bit of silicon about mid-point flat end, use a paperclip or needle to punch through it and break off a small piece of the circuit board inside, it silences the little speaker inside. Many more in the threads…
But that’s so much FUN!
Agree, CatLady, the hammer is way more fun than looking for a paper clip and much more cathartic
My son’s ommipods often behave this way too, with site not absorbing as well on day 3, even though we use novolog. He has had diabetes for almost 7 years and is a muscular kid without a lot of fat pads, so he hasnt found a site that won’t become problematic with heavy use although it is better if he rotates areas. Abdomen, thighs and upper buttock. I’ve heard from multiple folks on this thread and our endo agreed that the strategy of using pump for basal and pen for boluses is a good way to handle this challenge, although its hard to get my busy teenager to do it consistently! But for kiddos its important to highlight that you only have to switch for LARGE boluses. They can bolus for their main meal estimate or for big corrections with the pen but still bolus via pump for a snack or just a few additional carbs. Or use the pump for boluses on the fly and the pen at home – the idea is just to decrease the # times that a large bolus goes thru the pump. I think its easier to accept doing 2-3 shots a day rather than an indefinite higher number, and important to compromise to something acceptable to him, even at a young age. I’ve found that having my son be part of the decisions really helped keep us on the same team as he got older. Good luck, sounds like you are both doing a great job, and it gets easier!
@katiereeder solid advice!
I seem to have problems with specific lots. I don’t know what the difference is, but I can use one lot and have no issues, then a bunch of issues with a particular lot. I don’t know if I am reacting to something in particular, the depth, the cannula or what. I am attached to having a patch pump and don’t want a tubed pump, but the benefits of a tubed pump is you can change insets and depths. I know my endo’s theory is some brands of insulins clog an Omnipod easily. I use Humalog.
You can always call insulet for a replacement, I usually save them up to call in all at once. They will only change out 10 at once per call. I usually change mine out really easily and have my script written for changing every 2 days so I have a generous supply and don’t have to worry about how fast I am switching or using them etc. But my insurance covers whatever I need for a set price of $40.
I never used Apridra in my pump, but I did try it on MDI. It worked, but the timing of absorption was a little different.