FUDiabetes

Omnipod Issues / Questions

Hello, i am new to the site but have lingered for a while doing some research.

I have been diabetic for 32 years, and 32 of those years i have been on MDI, 20 years ago i trialed a pump when they had just come to Canada but i was not a fan of the tubing and just how it felt. This year i wanted better control and wanted to stop the dawn spikes. Signed up for a pump program and decided to go with Omnipod because of the tubeless option, coming from MDI figured this would be the best option.

I have a couple questions about Omnipod issues that i have been having. I live in Canada and my trial period with the Omnipod is about to run out in a couple weeks. I have been having some issues since podding, ratios and correction numbers (thats normal for a new pumper) It took me almost 2 months to get my numbers working because of site absorption issues. Some trends that I have noticed

new pod:
Day 1 absorption is terrible, i am running high most of the day with alot of corrections to the point i need to take a needle shot to get it down.
Day 2 absorption is working great and numbers are in the range set by my endo, everything is working fine but sensitivity and tenderness starts to occur.
Day 3 best absorption but small bumps and touches can be painful. Leg placement i get red bumps like a pimple that are tender and take over a week to go away. Arms are decent but i like to use my arms for the CGM (libre 14 day) by the time i replace the Libre i like to leave my other arm to heal up before sticking a sensor on it again. Abdomen is the best place i have found but it is tender to touch in that area. Favorite place so far would be about an inch below the belt line above my butt, but my absorption is not great, but i dont feel the pod or sensitivity issues.

is this normal when getting use to the pods?

My endo has given me some infusion sets to try tubing and see how it feels, nothing hooked up but an old phone to the tubing as a mock up pump device. The sites have been alot less noticeable, i found the pods are not as small as advertised and i bump them on everything and can alway tell its stuck to me. Over the last 4 days with tubing testing i totally forget i have it on me other then when i change my clothes or go to the bathroom, i have not had any tenderness with the smaller infusion set.

Could it be from the 30 degree angle on the pods or the canula that is causing me the issue, i have the 90 degree infusion sets and they dont seem to bother me.

has anyone else had this issue before, i only have 2 weeks before i can switch to another company and was considering the Tslim X2.

Thanks.

Also, when i play any sports i feel that the pods bounce alot, i am not a heavy person 170lbs, fairly lean. running and tennis i feel like the pod hangs off my skin and i need to take it down to really hold. It has not fallen off but its noticeable. Everyone talk about how great they are with being active. I play hockey in the winter and was not sure how the pods hold up to equipment and physical contact. I could disconnect with tubing for an hour while playing hockey correct.

Thanks

We call it the “Beach Protocol”.
With the Tandem t:slim X2, at the beach, we will give a bolus for two hours worth of insulin. Then disconnect the pump for 2 hours.
Repeat as needed.

Never thought of that, thanks.

I never had day-to-day issues when I changed, but I had to avoid the place where I had been doing the MDI (my stomach); I do back of the abdomen, upper arms and chest (not one of the ‘approved’ places). I don’t do legs - too many years of MDI and there really is no subcutaneous fat there, also they are prone to wardrobe malfunctions.

I get pain sometimes, but it is individual site specific; if I keep whacking the damn thing eventually it fights back. I use a G6 but only in the approved location (stomach) which is the place where I can’t put the pod, so that works for me.

I limit boluses to 5U, per Bernstein. If I need to go over that I swap to an extended bolus, perhaps only over 1/2hour. I used to have sticky highs but since I’ve gone to sort-of-low-carb-but-not (max 30g/meal, preferably 15) those have stopped.

If you can bear the tubes then you are probably better with them; my issue is that I move around a lot and don’t have anywhere to hang the stuff. Carrying a cell around for the G6 is a major (and oft omitted) chore for me.

John Bowler

Thank you. I do find when bolusing larger meals I get crazy highs. I normally have to bolus 45 mins early, still gives me issues. I normally try to keep my meals smaller but a larger carb diet kills that. The lower back bum area is the best place I can place the pod, but I got it on the side of a chair oh man that hurt.

My only concern with tubing is to be attached every day all day. For a couple months sure but having a tube all the time just seems super annoying. I’m sure I will get use to it as thousands of other on the site have.

So much to think about

Try an activation bolus. Put it on before a meal, and then take a meal bolus.

Taking a bolus right after putting it on seems to help it get started for me.

Tubing pretty much kills any other pump option for me. That’s just my choice, but I can’t deal with the tubes.

The pods are about like a Dexcom sensor to me, as far as comfort. If you can get used to wearing a sensor in the same spot for 7+ days, wearing a pod in the same spot for 3 days is pretty easy.

I do my pod changes in the morning before breakfast. I had changed one at night and it leaked or was not working correctly and gave me some crazy highs until the next morning. Learned my lesson and timed it out to change around breakfast.

I do notice the bump I have a libre so it’s flat can’t tell I have it on. Wish I can get dexcom.

Dont think the size is that bad, I notice it because it always feels like the cannula moves up and down when I move and I notice that. If I tape the pod down it’s much better but I have tape under the pod and then extra to hold it down.

Yes, Day One can be problematic for me. What I’ve found that helps is to make sure there are NO air bubbles in the syringe when injecting insulin into the pod. Also, I only place the POD on my abdomen now since arms had extremely poor absorption. Try this copied from “https://loop.zulipchat.com/#narrow/stream/144615-omnipod_users/topic/Slower.20insulin.20absorption.3F/near/166178297”:

Here are my best practices to help minimize highs after pod changes and difficulties with small boluses and low basal rates.

  1. Insulin should be warmed up to room temperature at the least before filling a pod. Better still is to warm the supply vial to body temperature by wrapping it into a clean sandwich bag and carrying it around in a warm pocket for 10-30 min .

All this is because the solubility of gases is LOWER in aqueous solutions as temperature increases, so a warmed solution has less dissolved gas (not intuitive because most of us reason about water solutions where most solid compounds dissolve faster and to higher concentrations at higher temps).

  1. Fill the syringe and do the standard things to expel as much air back into the vial . Then invert the syringe so the needle is pointing down and flick the syringe vigorously to get all the remaining bubbles to float up and collect at the plunger . You can monitor this by looking through the syringe at a light source. You’ll notice a fair amount of very small bubbles that take up to a minute or so to collect at the plunger.

Always keep the needle pointed down at this point. The volume of residual air at the plunger is almost always small enough that when you fill the pod, the air remaining in the syringe will be trapped in the void volume between the plunger and the needle tip .

  1. Fill the pod as slowly as possible, over 30 seconds or so . This should help minimize the shearing of any remaining air into smaller bubbles in the loaded chamber and may help the priming step expel a greater amount of the remaining air.
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That is super helpful, thank you for that info. I will follow this the next pod change. I do keep my insulin out at room temp. I use the pen fills so not a lot of insulin is left out all the time. If i need to fall back to a pen i can.

I do remove the larger bubble when doing the pod fills, but the rep at omnipod said dont worry about the tiny bubbles it does not have to be perfect as when the pod is primed it will eliminate those bubbles. When i take the plastic cap off the pod i have insulin around the cap so i figured it was from the priming, could the site be tender because of those tiny bubbles getting pushed under the skin? I can see the bubbles causing an issue with insulin ratios not being correct over the first day. Can they cause irritation under the skin also. I will follow those tips on my next change to see if it helps.

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When you remove a pod, is the site wet, or do you smell insulin after doing a large bolus? You didn’t mention leaking (aka tunneling) but your big spikes after meals, despite tweaking ratios for a while, might indicate that. For various reasons I now only give small boluses with the pod – no more than 2 or 3 units – and inject the rest. This helped level out the roller-coaster that resulted from tunneling.

What insulin are you using? For a little while I used Fiasp in my pump and experienced red pumps at the insertion site that took a week or two to go away. I never had this problem injecting Fiasp.

I never feel the pod on me (though it was noticeable in the beginning just because it was new) and very rarely feel it in me, but I can imagine if you are sensitive to it, it would be a huge nuisance. As for sports and the pod getting in the way or loosening, if I know some particular activity is on the schedule, I’ll place my new pod somewhere suitable – for instance, not on my right arm if I’m playing tennis or painting walls two days from now, or not on my right hip if I know my messenger bag is going to be weighted down. One learns as one goes.

And it may just be that the Omnipod isn’t for you – especially if two out of every three days you get rotten numbers and a lot of discomfort. It just doesn’t work out for some people. There are a couple of newer tubed options in Canada now that might be worth exploring.

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I am on NovoRapid, the rep from Omnipod said not to use Fiasp as it has issue in the pods. I did some research and could not find that on any site. I have been on Novorapid for some time maybe 15 years or more. I may have to look at a tube pump, but the tubeless is what keeps me wanting to stay on omnipod because its just easier. The days the pod is really sensitive or rubbing on my car seat on a long trip really makes me wish for something else. Thank you for all the information it has been super helpful. I will try other info from “Trying” on my next pod change to see if it helps.

Likewise; my preference is for no more than 3U in one bolus but my limit is 5U. Above that limit I tell the pod to do the bolus as an “extended bolus” with an extension time of 0.5 hours. I’d actually quite like to be able to program the pod to limit the maximum delivery rate to maybe a tenth of what it is.

Certain carbs give me a big spike, but this doesn’t come from “fast acting” carbs like fruit, it comes from things that have a very high percentage of carbs, like bread or staples (potatoes, rice etc). I no longer eat the latter, I do eat fruit and vegetables, the post meal spike is much less with those.

John Bowler

At least in the USA a sales rep from a pump company would be legally prohibited from suggesting that you use Fiasp in a pump as the FDA has not approved it for such.

In the USA, a doctor can prescribe the Fiasp off-label for a pump but the company (including sales rep) can not market or promote off-label use.

You have mentioned Canada so I don’t know how that would work up there.

We successfully use Fiasp in our Tandem t:slim X2 and I would be surprised if the Fiasp would work in the X2 but not the OmniPod.

I have never used Fiasp. That is the faster acting insulin over Novorapid?

Fiasp is Novolog (I guess called Novorapid outside the USA??) with two extra ingredients intended to make the onset of action faster.

Vitamin B3 (niacinamide) for speed and an amino acid (L-Arginine) for stability.

Our doctor prescribed it off-label as it is neither approved for pumps nor pediatrics in the USA. But our Ped Endo was excited for us to try it out as she expects these approvals (Peds and Pumps) to be coming through soon and she would like to have experience already when her other patients ask about it.

We have been on Fiasp via the X2 pump for a year now and are happy with it.

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Your frequent pain and discomfort trouble me. I’ve certainly read of, and experienced, occasional discomfort or pain, but not with nearly every pod. So I’m wondering about your insertion technique, whether the cannula is getting securely inserted.

When you apply a new pod, do you firmly press down on the pod itself, not just on the visible adhesive around the edge, to make sure the whole pod is firmly stuck to the skin and the cannula won’t jiggle around?

Do you pinch up sufficiently before activating a pod, and press down slightly on the top of the pod after pressing “Start,” to help ensure the cannula inserts properly? My trainer never told me about doing this, and the “rebound” of the insertion meant the cannula didn’t always go all the way in, leading to discomfort in the early days.

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My trainer did inform me about this and i have been doing this, find it hard to get a good grip when on the back or arms sometimes. I feel the pod it self is not always fully attached to the adhesive tape and it wobbles around alot.

Dude I’m experiencing such similar high issues. I’ve been on MDI for my whole diabetes career, 18 years now, and just switched to the Pod. I’m having a heck of a time coming down from highs with my Pod and feel like I’m correcting like crazy. I finally started messing around more aggressively with the settings and it seems to have helped. I haven’t experienced a lot of pain with different sights, though. I think from my experience (which is limited) my biggest piece of advise is to just really experiment (safely) with your settings.

I don’t know if that helped at all…

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We’ve only been Podding for going on 5 years now I think? The biggest impact settings in my view to controlling the roller coasters is correct basal rates and correct ISF. Those two things, in my experience, really decide how flat your line is. Incorrect bolus settings are easy to see because you either go up really high post prandial and don’t come back down for a while (I:C too low), or you hardly go up at all and then drop low (I:C too high)…but Basal/ISF are the settings that are both hardest to figure out and most significant to determining how little you go up and down when you are fasting.

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