OmniPod bolus question..

[toffski]

Hi,
Ive been using the OnmiPod for about 2 months now and initially found that I required much less insulin when bolus before meals.

Previous to using the OmniPod I would typically take 4 units of Humalog (via Pen) to cover my standards two slices of toast, which has been the same for years.

With the OmniPod I found I needed much less, 1.5 - 2 units of Humalog.

However, after 2 months of pumping I'm finding I need more and more insulin. This morning, 5 units of Humalog for exactly the same breakfast.

What I want to know is this normal? Do you adapt to the system after a few months of use?

Cheers
Chris

 

[Juicyj]

Hi @toffski I am not an omnipod user, but I know another moderator who uses this, so will tag @himtoo

 

[himtoo]

Hi @toffski
couple of things to report

my overall TDD ( total daily dose) dropped from around 75-80u on pens
to around 55u on the pod.
my basal dropped from 32u on lantus to my current (novorapid ) 24.3u on the pod.

and yes my bolus needs did drop to start with quite a bit -- and the huge positive is many many less hypos

so possibly you could just be experiencing the kinds of changes that seem to happen to all of us with no apparent reason
possibly the warmer weather ?
or more stress in your life ?

2 months is not that long on the pump yet so have you had a chat with your DSN to review all your recent results to look and see if there are any patterns in there that maybe you are missing ( they are experts in this as they do it day in day out )

also going to tag @noblehead and @catapillar - they both on Omnipod and may have some other thoughts or suggestions.

all the best !
himtoo

 

[toffski]

Thanks for the info @himtoo, its very much appreciated!

 

[noblehead]

What I want to know is this normal? Do you adapt to the system after a few months of use?

Almost certainly you do.

Looking at your bolus dose for your toast changing from 4 to 2 units after changing to a pump I'm wondering if your basal rates were too high to start of with and was compensating, has your basal rates reduced recently @toffski or has your insulin increased overall?

 

[toffski]

Hi @noblehead, it seems my bolus have increased overall across my day which is something I wasn't expecting at all. I've had to adjust my basel rate so I get more insulin from 5am to midday and I guess I'm kinda in the "adjust and experiment" phase. I just cant help thinking that things seem to have changed over the last few weeks where I'm needing more and more insulin in the morning without warning.
I have been trying new locations for the pod's but to no avail - thinking the issue could be differing absorption rates at differing sites. This breakfast issue has really come out of nowhere!
By the way, I'm using a Freestyle Libre CGM which is excellent but maybe I'm suffering from data overload.

 

[himtoo]

aahhh !! that bit of info does help -- as you are only a couple of months on the pump you will just about be getting there with rate adjustments , so the addition of the Libre could suggest you are micro-managing maybe a bit too much.

One of the things that is the hardest to do is to remember to think in real time -- so seeing the same thing happen 2 or 3 days ( at a minimum) is what I always try to do now on the pod. -- the changes are tiny too in comparison to MDI changes .

another thing to consider --- did your DSN help you set your initial settings on the pump --
My DSN started me on only 12u as my basal , spread out at 0.5u per hour for all 24 hours ( as previously mentioned 32u on lantus for me) -- well that is a massive drop -- but by doing loads and loads of testing for about 8 weeks i was able to titrate up slowly and methodically to my current 24.3 now )

 

[noblehead]

Are you in regular contact with your pump DSN, if so produce the data to them them and ask for their advice @toffski ,usually people do find they use less insulin on a pump then they do on MDI (provided diet/exercise hasn't change).

TBH my insulin usage hasn't changed a great deal sense starting on the Omnipod, I:C ratio's are about the same but I do take around 3-4 units less for my basal needs, sure pre-pump I was on 18-19u of lantus where at the moment I'm averaging around 15u on the pump.