New podder and having a bit of a meltdown

[KC49]

Hi, I went onto omnipod 10 days ago, and some days have been great, but increasingly I’m having issues with the amount of insulin I bolus not having anything like the expected results. As in, yesterday I took 55 bolus units for 250 grams of carbs, when usually I’d use 25-30 units for that amount, depending on things like if it’s a workday (I have an active/physical job) or where I’m at with my period/monthly cycle. And then today I took a bit extra for my breakfast, and two top up boluses because it was going up and up (I have a dexcom so I can see sugar levels all the time). It’s finally starting to go back down from 14,5mmol, but it keeps going down a little and then flattening out or rising again. At the moment I’ve taken 11.7 units (in three boluses) for my 60g of carbs breakfast/brunch, and it’s stopped falling again.

I don’t think it’s just that my ratio has changed radically in the last 10 days, bc some of the days it all behaves like I’d expect it to. Two nights ago I took a small correction at bedtime, worried it was too small, and ended up a shaking sweating mess at 2.4mmol an hour later.

everytime I remove a pod (I’m onto my fourth now) there’s a red bump, that feels like a bruise and takes days to slowly shrink. And every bolus hurts like hell. So far I have reacted badly to every insulin I’ve tried (skin reactions but not what they consider to be an insulin allergy bc it doesn’t cause a red rash), and they hoped a pump might help with that.

I’m putting the pods into the backs of my arms, hoping that the skin on my stomach and thighs will get a chance to recover from the MDI. They aren’t even sure it’s the insulin causing it, but the pain in my skin happens everywhere I inject, so the theory I’m working on is it’s something in the insulin that my skin doesn’t like, even if it’s not a standard insulin reaction/allergy.

Does anyone have any experience or advice? I’ve tried reading through some of the forums but just end up reading about other things.

If I don’t eat at all, the basal seems to be working great, much better than tresiba or any other long acting (on which I went low every afternoon and woke up too high every morning) but what the hell is going on with the boluses? Like why aren’t they working?

 

[Soplewis12]

Hiya, are you making sure you are prebolusing? I use omnipod dash with novorapid & generally take the bolus 15-20 mins b4 eating. Have you tried using the extended bolus, I use it for every teatime meal.

 

[KC49]

Hiya, are you making sure you are prebolusing? I use omnipod dash with novorapid & generally take the bolus 15-20 mins b4 eating. Have you tried using the extended bolus, I use it for every teatime meal.

I use fiasp, which you only take at the time of eating or 5 mins before- which I’ve been using with injections for a few months so far. I’m not having a problem with going low and then too high, which happened to me sometimes with pre-bolusing on novorapid.

my pod isn’t registering any issues or alarms with delivery, it’s just that my bolus insulin unpredictably doesn’t work as I would expect it, and I don’t know what’s wrong

 

[Soplewis12]

I use fiasp, which you only take at the time of eating or 5 mins before- which I’ve been using with injections for a few months so far. I’m not having a problem with going low and then too high, which happened to me sometimes with pre-bolusing on novorapid.

my pod isn’t registering any issues or alarms with delivery, it’s just that my bolus insulin unpredictably doesn’t work as I would expect it, and I don’t know what’s wrong

I'm genuinely unsure myself it is strange. I had many meltdowns when first started using the pod, feel your pain.
Can only think to call your team on Monday.
Ps the wee red bumps happen to me all the time.

 

[KC49]

I'm genuinely unsure myself it is strange. I had many meltdowns when first started using the pod, feel your pain.
Can only think to call your team on Monday.
Ps the wee red bumps happen to me all the time.

thank you- I’m hoping it’s just teething problems!
Do the red bumps go away again by themselves? Two of mine have been small but the third was a bump more than an inch big and very visible- made me glad it was on the back of my arm so I couldn’t see it myself!

 

[Soplewis12]

thank you- I’m hoping it’s just teething problems!
Do the red bumps go away again by themselves? Two of mine have been small but the third was a bump more than an inch big and very visible- made me glad it was on the back of my arm so I couldn’t see it myself!

They do but there has been the odd one that has left faint scarring.
In the early days I had one on my lower back & insulin seeped from it & I had a terrible skin reaction, skin was weeping & scabbed over the whole of the pod shape.
Changing from pens to pod is a whole new ball came but you'll get there. X

 

[KC49]

They do but there has been the odd one that has left faint scarring.
In the early days I had one on my lower back & insulin seeped from it & I had a terrible skin reaction, skin was weeping & scabbed over the whole of the pod shape.
Changing from pens to pod is a whole new ball came but you'll get there. X

Oh that sounds horrible! I really want the pod to work out, it’s been so nice not having to open several layers of clothes every tea break to stab myself I just can’t work out why the bolus is so unpredictable. Maybe there’s a trick to putting the pod on that I haven’t figured out yet, looks like the needle/cannula goes in deeper than the dexcom one. But I thought if it hit muscle that would make it work too fast, not make it only half work. Hopefully time will tell

 

[Soplewis12]

Oh that sounds horrible! I really want the pod to work out, it’s been so nice not having to open several layers of clothes every tea break to stab myself I just can’t work out why the bolus is so unpredictable. Maybe there’s a trick to putting the pod on that I haven’t figured out yet, looks like the needle/cannula goes in deeper than the dexcom one. But I thought if it hit muscle that would make it work too fast, not make it only half work. Hopefully time will tell

Let us know how you get on x

 

[Hopeful34]

Sorry you're having issues with the pods. It sounds as if there's too much insulin going in at one time for your body to absorb rapidly enough, so it's pooling beneath the pod and causing the lumps. Unfortunately I had the same issues with the pods, because the cannula is only 6mm rather than the 8 I use on a tubed pump.

Fiasp would be 'stingy' for me if I didn't bolus over 15 minutes, so you could maybe try the bolus going in over a longer period of time if you don't already do that, or try a few lower carb meals to see how that goes.

 

[KC49]

Sorry you're having issues with the pods. It sounds as if there's too much insulin going in at one time for your body to absorb rapidly enough, so it's pooling beneath the pod and causing the lumps. Unfortunately I had the same issues with the pods, because the cannula is only 6mm rather than the 8 I use on a tubed pump.

Fiasp would be 'stingy' for me if I didn't bolus over 15 minutes, so you could maybe try the bolus going in over a longer period of time if you don't already do that, or try a few lower carb meals to see how that goes.

Thanks for the advice- I’ll try doing a short extended bolus and see if that helps. I actually ate lower carb before diagnosis, but I’ve had such a **** time with skin issues since then that I have no energy for healthier eating, and I find carb calculating for home cooked meals to be kinda stressful and suck the joy out of cooking. I’m currently reducing my Lyrica dose slowly, bc it might help with the pain but it makes my head feel fuzzy n horrible.

A fiasp bolus via pen would sometimes sting, but not often and not too badly. My boluses on the pump are sometimes take-your-breath away painful, but only for a minute and it passes. I was worried the cannula is too long, on the pen I use 4mm needles. I’ve seen photos of ppl using an omnipod on the front of their bicep, but I don’t think I have much fat over the muscle there. My belly has the most squidge, but it’s still sore from past reactions so hoping to give it a break.

mind, the only time I tried a bolus injection into my upper arm it hurt so much I never did it again. Feels like I’m screwing up all the parts of my body with insulin, even tho it’s what stops you dying so it’s a necessary evil

 

[Hopeful34]

Oh bless you, you're between a rock and a hard place.

The only other thing I've just remembered is that I'm fairly sure the pod cannula doesn't go in at 90 degrees (someone correct me if I'm wrong please), which means it's not actually 6mm under your skin.

I hope you find a solution soon. I found the Omnipod tech team great for help.

 

[In Response]

I use fiasp, which you only take at the time of eating or 5 mins before- which I’ve been using with injections for a few months so far. I’m not having a problem with going low and then too high, which happened to me sometimes with pre-bolusing on novorapid.

I use Fiasp on a pump and can pre bolus whenever I want.
I find the speed Fiasp works depends on my levels.
It works very fast when my levels are in the 4s and 5s but can take an hour if my levels are in double figures.
I adjust my pre bolus time accordingly. Yes, I have been known to pre bolus an hour ahead.

 

[KC49]

I use Fiasp on a pump and can pre bolus whenever I want.
I find the speed Fiasp works depends on my levels.
It works very fast when my levels are in the 4s and 5s but can take an hour if my levels are in double figures.
I adjust my pre bolus time accordingly. Yes, I have been known to pre bolus an hour ahead.

That is really interesting! And something I’ll watch out for, it does feel like if I’m around 4 or 5 before a bolus then everything works out as hoped, but if I’m already too high then it feels like I’m throwing a grain of sand onto a beach, until some time later when everything suddenly decides to work. Or I get annoyed and just do more. There are so many variables to try and work out that if it was an option that I’d give up on the whole **** thing. I think part of today’s problem was that my insulin was leaking out of the pod and not going into my arm, looked like that when I changed it. But that was a few hours ago and I’m back in double figures so I just don’t know.

 

[KC49]

Oh bless you, you're between a rock and a hard place.

The only other thing I've just remembered is that I'm fairly sure the pod cannula doesn't go in at 90 degrees (someone correct me if I'm wrong please), which means it's not actually 6mm under your skin.

I hope you find a solution soon. I found the Omnipod tech team great for help.

I think I’m gonna call pod support on Monday and hope I get someone with good English- I live in Norway so all my pod guides are in Norwegian and my norwegian isn’t good enough to understand them, this forum and google are my guides!

 

[KC49]

Sorry you're having issues with the pods. It sounds as if there's too much insulin going in at one time for your body to absorb rapidly enough, so it's pooling beneath the pod and causing the lumps. Unfortunately I had the same issues with the pods, because the cannula is only 6mm rather than the 8 I use on a tubed pump.

Fiasp would be 'stingy' for me if I didn't bolus over 15 minutes, so you could maybe try the bolus going in over a longer period of time if you don't already do that, or try a few lower carb meals to see how that goes.

Sorry for all the questions, but - How do you bolus over 15 minutes? I’m trying it with my pod but seems that half an hour is the shortest extended option, and now I don’t know if should do it 15 mins before eating or 30 mins, or if that will mean the fiasp is working too much sooner than the food?!

 

[Hertfordshiremum]

Hi, I went onto omnipod 10 days ago, and some days have been great, but increasingly I’m having issues with the amount of insulin I bolus not having anything like the expected results. As in, yesterday I took 55 bolus units for 250 grams of carbs, when usually I’d use 25-30 units for that amount, depending on things like if it’s a workday (I have an active/physical job) or where I’m at with my period/monthly cycle. And then today I took a bit extra for my breakfast, and two top up boluses because it was going up and up (I have a dexcom so I can see sugar levels all the time). It’s finally starting to go back down from 14,5mmol, but it keeps going down a little and then flattening out or rising again. At the moment I’ve taken 11.7 units (in three boluses) for my 60g of carbs breakfast/brunch, and it’s stopped falling again.

I don’t think it’s just that my ratio has changed radically in the last 10 days, bc some of the days it all behaves like I’d expect it to. Two nights ago I took a small correction at bedtime, worried it was too small, and ended up a shaking sweating mess at 2.4mmol an hour later.

everytime I remove a pod (I’m onto my fourth now) there’s a red bump, that feels like a bruise and takes days to slowly shrink. And every bolus hurts like hell. So far I have reacted badly to every insulin I’ve tried (skin reactions but not what they consider to be an insulin allergy bc it doesn’t cause a red rash), and they hoped a pump might help with that.

I’m putting the pods into the backs of my arms, hoping that the skin on my stomach and thighs will get a chance to recover from the MDI. They aren’t even sure it’s the insulin causing it, but the pain in my skin happens everywhere I inject, so the theory I’m working on is it’s something in the insulin that my skin doesn’t like, even if it’s not a standard insulin reaction/allergy.

Does anyone have any experience or advice? I’ve tried reading through some of the forums but just end up reading about other things.

If I don’t eat at all, the basal seems to be working great, much better than tresiba or any other long acting (on which I went low every afternoon and woke up too high every morning) but what the hell is going on with the boluses? Like why aren’t they working?

Hi Sorry I can’t advise on your pod but have read your thread with interest as my nurse has suggested discussing Omnipod at out next telephone appointment. I have bad reactions to injections, a red lump appears often within 5 mins and I bruise badly. Some weeks it hard to find a gap. The red lumps do go eventually. My nurse said she had seen this before, and thinks it’s a reaction to the needles, previously novofine. I tried longer needles as it’s supposed to help prevent bruising but the big improvement has been with silicone coated needles, ‘microdot’ I am still finding 8mm minimises the bruising but these do come in 4mm and 6mm too. I wasn’t well a couple of weeks ago and had to inject every 2 hours and did have some bruising appear but the red lumps have gone and it’s a definite improvement. Thought this information might help you if your nurse hasn’t suggested already that it could be the needles themselves. I am Type 1, 3.5 years.

 

[KC49]

Hi Sorry I can’t advise on your pod but have read your thread with interest as my nurse has suggested discussing Omnipod at out next telephone appointment. I have bad reactions to injections, a red lump appears often within 5 mins and I bruise badly. Some weeks it hard to find a gap. The red lumps do go eventually. My nurse said she had seen this before, and thinks it’s a reaction to the needles, previously novofine. I tried longer needles as it’s supposed to help prevent bruising but the big improvement has been with silicone coated needles, ‘microdot’ I am still finding 8mm minimises the bruising but these do come in 4mm and 6mm too. I wasn’t well a couple of weeks ago and had to inject every 2 hours and did have some bruising appear but the red lumps have gone and it’s a definite improvement. Thought this information might help you if your nurse hasn’t suggested already that it could be the needles themselves. I am Type 1, 3.5 years.

Thanks for your reply- it’s interesting to know that you’ve been told it could be the needles themselves causing you problems (and you have my sympathies cz sounds like your having a **** time of it as well). I had asked if it could be the needles bc so far they’ve tried me with four different long acting and two types of fast acting insulin, so I wondered if it could be the needles more than the insulin. some insulins were worse than others but the skin reactions have never stopped. I have another appt in January so I’ll ask about the needles you’ve mentioned.

If you’re considering the pod, it’s too soon for me to know if it will work out for me, but on the days when it works it’s amazing- incredibly convenient and so unbelievably nice not to keep poking needles into yourself. On the days it’s worked my dexcom says I had average glucose of 6.6mmol, which I’d be very happy with to keep all the time, and I didn’t have any major lows. I’m really hoping with some more trials n error n tweaks that I’ll settle in ok with it and keep my stabby-pen for very occasional use!

 

[Soplewis12]

Sorry for all the questions, but - How do you bolus over 15 minutes? I’m trying it with my pod but seems that half an hour is the shortest extended option, and now I don’t know if should do it 15 mins before eating or 30 mins, or if that will mean the fiasp is working too much sooner than the food?!

Hiya, by prebolusing your just taking your insulin 15-30 mins before eating, this reduces the food spike 2 hours later. I was told by my specialist nurse to try extend bolus by 60% instant delivery and 40% over an hour, which did help. She also mentioned a lot of people do this if eating a meal over 60g carbs. This is why I do it for every teatime meal.
Noticed that you are struggling with the carb counting for home meals. I know it's awful but it is necessary. I don't know but it may be that the high BG results could be a miscalculation of carbs? X

 

[KC49]

Hiya, by prebolusing your just taking your insulin 15-30 mins before eating, this reduces the food spike 2 hours later. I was told by my specialist nurse to try extend bolus by 60% instant delivery and 40% over an hour, which did help. She also mentioned a lot of people do this if eating a meal over 60g carbs. This is why I do it for every teatime meal.
Noticed that you are struggling with the carb counting for home meals. I know it's awful but it is necessary. I don't know but it may be that the high BG results could be a miscalculation of carbs? X

Thanks- I haven’t really started playing with the extended bolus for bigger meals yet, but I will try it out for that. Was more wondering how to do a shorter extended bolus to avoid the lump building up, as suggested by Hopeful34 above.

I always carb count, I just haven’t been home cooking as much bc it takes so much longer to weigh and carb count all the different ingredients and then divide into portions to get an accurate count on, say, home cooked stew. Packet food has an easy carb count per weight, so it’s just one thing to calculate even if it’s not as healthy.

I pre-bolused when I was using novorapid, but with fiasp it’s not advised to do so, bc it works faster. But if I ask the pump to bolus like I would with MDI and it makes a lump, then I don’t get the expected results. So I want to do a short extended bolus, if that makes sense. And then I could do a longer extended bolus if needed, for a larger meal. The last few days I’ve been getting high BG from things I eat often, usually with similar results, which is why it’s been driving me mad.

Today I’m testing out doing every bolus as a 30mins one, waiting til it’s almost done to start eating. Just not sure when in that 30 min window I should start eating, to avoid going low too soon or high too long after. Will see how it goes, maybe it’ll be just right eating at 20mins in

 

[Soplewis12]

Thanks- I haven’t really started playing with the extended bolus for bigger meals yet, but I will try it out for that. Was more wondering how to do a shorter extended bolus to avoid the lump building up, as suggested by Hopeful34 above.
Hi, the shortest timescale is just the 30 mins, not sure if that will help. It could be as suggested that the 4mm cannula doesn't suit but its so early days for you. It can take months to get it right. Be kind to yourself, you're doing everything you possibly can x

I always carb count, I just haven’t been home cooking as much bc it takes so much longer to weigh and carb count all the different ingredients and then divide into portions to get an accurate count on, say, home cooked stew. Packet food has an easy carb count per weight, so it’s just one thing to calculate even if it’s not as healthy.

I pre-bolused when I was using novorapid, but with fiasp it’s not advised to do so, bc it works faster. But if I ask the pump to bolus like I would with MDI and it makes a lump, then I don’t get the expected results. So I want to do a short extended bolus, if that makes sense. And then I could do a longer extended bolus if needed, for a larger meal. The last few days I’ve been getting high BG from things I eat often, usually with similar results, which is why it’s been driving me mad.

Today I’m testing out doing every bolus as a 30mins one, waiting til it’s almost done to start eating. Just not sure when in that 30 min window I should start eating, to avoid going low too soon or high too long after. Will see how it goes, maybe it’ll be just right eating at 20mins in