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Rising sugars on pump changeover

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patparry

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I use Omnipod Dash and change the pod in the morning every third day. About an hour after the change my sugar level starts to rise and this continues through the next twelve hours or so, needing several boluses but not dropping below about 12 or 13 despite them. Then, during the night, it's as if the insulin 'catches up' and I end up with a hypo. By the next morning I'm fine and the next two days (until the next pod change) are stable. I'm tempted to take a bolus from the 'old' pump just before I make the change but - just occasionally - the sugar level rise doesn't happen and I'm concerned that I'll cause a hypo. I have site problems after sixty years of injections and then cannula insertions but can't see how this would cause an initial rise and then what seems to be OK absorption. Is this a problem for anyone else?
 
hi and welcome to the forum @patparry ..........I have used omnipod for 7 years and i find this issue as well......i always take a small bolus on the old pod before change ( 0.3-0.8u) depending on where shoogs are and then i always put a temp basal increase on the new pod to help kickstart absorption at the new site ...this works for me pretty well ...but i also have had a delayed hypo after change sometimes.
i also change my pods between 10am and noon most times.
 
I do not experience this myself but I have heard of others.
If this helps s predictable, can you create a pump change basal profile which is higher for 12 hours and then lower for 12 hours.? Then you can revert to your standard profile the next morning.
 
This also can happen to me. What has helped me but not always is to leave the old pod in place for at least an hour after the change. I'm reluctant to try a small bolus or temporary basal as the rise is inconsistent.
 
I'm experiencing exactly the same problems and am currently on a 'pump holiday' i.e. at the end of my tether and back to jabs. However, I want to give the pump another try. I experience big highs post pod change (up to 18 and 19) for circa 12 hours despite initial bolus, bolus correction and temp basal increase. Like you, after 12 hrs, control is pretty good unless I get a pod reaction i.e, red lump at cannula entry and/or adhesive reaction. Any ideas how to get better control/lifespan out of the pump plus how to improve absorption and prevent redness and inflammation at pod site. Yours very frustrated.
 
Hello Patparry
I did have this problem for the first couple of months but I found the answer for me. I attach the pod, then pinch up the area and push down the cannula end into the skin. I also avoid bolusing for a couple os hours.
I found my problem was leakage or bleeds around the cannula, which is less insulin going in body. Every time I used to take pod off it was wet with blood or insulin. It was recommended to me by another powder.
It's what I do for me. We are each different.
 

I have this problem on changing pod and end up taking 5 extra units to try and solve the problem but end up with hypos later in the day. Does dash omnipod advise anyone? I will remember to take a bolus from old pod before I change it in future
 
Heathy said:
I have this problem on changing pod and end up taking 5 extra units to try and solve the problem but end up with hypos later in the day. Does dash omnipod advise anyone? I will remember to take a bolus from old pod before I change it in future
Click to expand...
I still have no answers post discussions with professionals. It appears we have to sort pump change highs ourselves as all bodies are different. I’ve had a month ‘pump holiday’ which has stabilised control but am now ready to go back on pump as body is like a pin cushion and am concerned about absorption rates in over jabbed areas. Does anyone have 3 days poor control then 4 days good for no apparent reason? Still worried about pump change highs and different absorption rates on different parts of body but as always we persevere. If I get any answers or, if anyone else has any different ideas, please let us all know.
 
so even though this is a known problem professionals cannot advise us or do not know why? After highs all day yesterday (after pod change) had 3 hypos during the night. There must be a solution without having to take multiple boluses on day of changing pod - does anyone know who can I chat to in charge of omnipod dash systems? advice on pod sites that are the best for absorption I have been using the thigh maybe i will try abdomen again.
 
I think I may have sussed why pump fails and blood sugars rise but do not know how to solve. Cannula sometimes, not always, gets blocked on basal after say 2.5 days of use, with blood? I think only bolus is getting through as a bigger and more immediate dose as opposed to bolus trickle hence, I am playing catch up with basal on pod change. I took pump off today whilst it was still active and no basal getting through. I cut the end off the cannula and insulin started pumping again. New pod today took a while to catch up as no basal in the body. I’ve started tapping the pump to ensure insulin flow. No idea if that will work but let’s wait and see. How do I stop cannula basal block? Thoughts / ideas. Clearly I can change the pod but playing basal catch up again.
 
If you're using Fiasp, I've read that some people have had issues with using it in a pump, so may be worth trying a different insulin if that's what you use.
 
After 3 successful pod changes, I have now had highs of up to 15.6 for 8 hrs. Insulin absorption is now catching up, so much so that blood sugar was oscillating around 3.1 before taking sugar to correct. Pod site is slightly itchy telling me that maybe there is inflammation post cannula application. Suggests to me that sometimes cannula insertion is ok and stress free at the pod site and other times inflammation inhibits insulin absorption for up to 8 hours! Any ideas how to get consistency on pod change. Believe you me I do change sites and there’s just no explanation. One week upper arm ok. 2 weeks later, highs for 8 hrs. Anyone else have similar experience and any ideas how to cope with pod change.
 
Hi Del

How did you find the pump break? I am seriously considering the same but wondering what my diabetes team will think. I don't want to stop the pump completely. I just need to go back to basics for a while without all the added factors to consider ( is it a bad site, is the cannula kinked, is there air in the reservoir or tubing etc...)

I also run high after set change... I don't know why, even temp basal or extra bolus does not work... its like water. I do wonder if the anticipation of the new site 'not working ' is causing the high from stress. I have been pumping for 9 years and it's only since a very bad episode last summer with a kinked cannula that I have struggled so much.

Having a really tough time figuring out what is going on. The leaky reservoirs have been the last straw. I reverted to MDI today while I await Medtronic to get back to me with a fresh pump or whatever they are going to do ( shocked that they never bothered to ring me back when I informed them I couldn't bring my sugars under control with the pump and I had ketones too... and no word from my diabetes clinic either... I really do feel stranded apart from forums like this.

I actually found the bolus shots with my pen worked much better than in has with the pump in a long while! So it's either an issue with the pump & it's causing lack of insulin through leaky reservoir or it is something I am doing... I just wish someone would tell me. I would even like to go back and re train on the pump and start totally from scratch. I am willing to basal test etc while on MDI to make that possible.

I have many other health issues which I have to factor in along with PTSD and anxiety and I am so burnt out with constantly thinking about my pump. It really does feel like a 24/7 thing right now. In my 25 years as a diabetic I have never been so anxious over it. I was awake until 4am with it last night yet again.

Good luck with starting back on your pump!
 
Hi. The pump holiday went well thanks although sugar control not quite so tight. Back on the pump I am now getting 83% in target however, I changed my Omnipod this morning as I was getting very high readings yesterday for no apparent reason. The site was itchy which suggests inflammation and possible poor insulin absorption. Today’s pod change has been smooth and no highs. Not sure we are supposed to do this but, on pod change, I inject 5 units of Levemir into the area where my pod/pump is going. This appears to work and no immediate lows. Pump effectiveness is very much site specific and even then, sometimes the absorption is poor. Try the upper arm if you can and try the Levemir trick. It seems like we have to discover these things ourselves and it’s trial and error. Everyone is entitled to a pump holiday so do not fret. Keep going. Life is a roller coaster as a Type 1.
 
I have not visited this forum for many months but it appears your question has not been answered fully, so this belatedly is what I have discovered as a Pod user for 2 years. The problem arises because it is difficult to remove all the air out of the syringe prior to filling the pod. The shape of the syringe at the needle end is not ideal and captures bubbles that are not easily seen - and they are difficult to remove properly. When drawing the insulin into the syringe from the vial do it slowly, giving time for the liquid to pass through the narrow needle.. You will no doubt have seen the large bubble that always collects at the top of the syringe after some insulin has been drawn in, and you need to push that bubble back into the vial. But you need to do this carefully. While keeping the syringe tightly attached to the vial above it, angle the syringe (and maybe tap it) so that as much of the bubble as possible is positioned directly under the needle and slowly press the plunger and watch the bubbles go back into the syringe. When they have stopped, GENTLY and SLOWLY draw more insulin out into the syringe. I emphasize this because if you do it too quickly you will also get small bubbles coming in from the bottom of the plunger (because the piston is not air-tight). If for some reason you get any bubbles from either end of the syringe, squirt them back into the insulin vial, as just described.
Finish by slowly pulling the plunger all the way down just past the 200 mark. Remove the needle and gently quirt a small amount out at the top end (I catch it in a tissue). You should be able to do this with the syringe still filled up to about the 200 mark.
Now when filling the pod - Ensure the needle is pushed into the hole firmly but without exerting too much pressure. (I leave the pod in its container and, with a finger at its centre, hold the pod firmly in position). SLOWLY press the plunger to fill the pod, but do not plush it down completely. You should leave a little insulin at the bottom where there is a mark which exists as a guide. Although this may seem illogical because one expects bubbles to appear at the top, in reality the shape of the syringe by the needle seems to capture bubbles that fortunately do not get pushed into the pod.
Excuse me if I appear to be telling you how to suck eggs but if you do this carefully I can assure you that your pod will start working without the delay. While I have made this a lengthy explanation, the pod changing process will take less than 5 minutes and is much easier than with any other pump that I have tried.
 
Has anyone else tried a Levemir, not Novarapid, say 6 unit jab in area of new pod change, before pod change. It seems as though it may kick start insulin absorption especially basal. Trial and error for me at the moment. The leg however just does not take insulin despite not having used legs for a number of years. Thoughts?
 
 
I am considering a pump break and going back to pens. When I saw the nurse about continuous highs she said try upper abdomen which is catching my rib or try back. What sites do you use? Tried thighs and arm still get highs no one seems bothered about continuous highs as long as hac1 ok but surely this is taking a toll on the body have lost a lot of weight and feel my diabetes is controlling me rather than me controlling my diabetes only this forum helps to know I am not the only one with high bs’s
 
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