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Monday, December 26, 2011

Pod change highs

Well, it's been almost two months since we started pumping, and things have been much better after a very rocky start.

(That is until, as you all predicted, those lows that we were having turned into heinous highs when the full-extent of Elise's illness showed it's ugly face and that coupled with the craziness of Christmas her numbers have been so coo-coo bananas that I don't even know where to start to fix them).

Holy run-on sentence, Batman.

Anyway, the one issue that is vexing me every three days is those pesky post-pod-change highs. Elise skyrockets into the 300s and doesn't come down for a looooong time; sometimes it can take up to 8 hours.

I don't think it's due to stress. Elise is pretty cool when it comes to changing the pod. I hand her the PDM and she presses the button like it's no big deal.

We also usually do it right before a meal, so I can give her a big-ass bolus. Take today for example:

She was 108 pre-change. We had an issue, and had to discard two pods, so the change took a bit longer than usual, but she was only "disconnected" for 10 minutes.

I bolused her for her dinner, plus another .5 of a unit for good measure. That's a lot of insulin for Elise... a dose like that should drop her by about 125.

She ate, and two hours later was at 340. I corrected and 2 hours after that she was at 359. BLERGH!

I'm hesitant to give her too much insulin because we're without the dex, and I find I am so much more cautious when I don't have a continuous flow of numbers to help guide me. I'm also less aggressive with corrections.

Can anyone tell me what I am doing wrong? Should I bolus her more? Do a change when it's NOT a meal time? Do a temp basal after I change? Does anyone have any tips that have helped them with this? And is this just a pod issue, or do kids who wear Animas or Medtronic also go through this with site changes?


Help me DOC, you're my only hope!


(yeah... I'm a nerd. So?)

24 comments:

  1. Well, we've been podding for a week and a half now....and can tell you for certain that we DID NOT have post-site change highs with Animas. In fact, he'd always be a bit lower, with a fresh site and a fresh flow of insulin.

    I just don't understand these highs after pod changes. What is the big freaking difference? A needle is being inserted, a cannula left behind...and for us, the experience is very different. We, too, have had to fight some highs that last ALL day long. Now, this could be just that we are dealing with a new insulin delivery system, Christmas and basal changes....but who knows. I haven't had a chance to blog about our switch from Animas to the pod, but I will soon. Basically, my vote is...all pumps suck because diabetes just plain sucks ASS. I'm so tired of trying to figure it all out. And for the record...we had plenty of issues with the Ping as well - strange highs that I couldn't get down, bent cannulas, etc. It's all a friggin' crapshoot.

    Sorry for the vent! But I hear ya, sister.

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  2. I just read an adult podder saying she overlaps her pods as to combat this issue, she said that she keeps the old pod on for about an hour after applying the new pod.
    A mom of a young dude in my area who pods said she increases her son's basal for the hour before the change with the old pod, then for the first hour with the new pod.
    It does seem to be a consistent issue, I have now answers as I am not experienced, but these are just two ways I've heard about dealing with it. ((HUGS)) I hope you find a great answer(s) soon.

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  3. We used to have the same problem, but here's what's working for us:

    We change the pod at 4pm. I give a 50% basal increase (from 0.2 u/hr to 0.3) for the next 4 hrs until 8pm when her basal rate increases automatically to her 8pm to 2am rate.

    Changing it at 4 gives us time to troubleshoot at dinner because I don't like troubleshooting at bedtime.

    Giving a small extra bolus at pod change didn't work for us consistently.

    We also keep the old pod on for anywhere between 20 minutes (because we've soaked the adhesive w baby oil so it will slide off easily) to several hours bc we forget about it.

    (YDMV, this isn't medical advice...Feel free to email me.)

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  4. I have read that some people bolus with the old pod before changing to the new pod because of absorption issues due to the inflamation of the new pod site. We haven't really expierenced high's because of pod changes..Hope this helps.

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  5. I have no answers of course since we are still on shots, but I'm so interested reading everyone else's response. Great advice from everyone....that's what I love about the DOC!

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  6. Can't help you much because we still use the Ping and The Revel over here but good luck!

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  7. This is still my biggest issue with the pod,and it drives me absolutely nuts. I hate we're having highs every three days because of it. I wonder if it's just that they are using such small amts of insulin that it doesn't make it all the way down the cannula until it's had a few hours to move forward. I could be completely wrong. But, that's my hypothesis.

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  8. I didn't have time to read all the comments, but I'll throw in my two cents. When I change my pod, I always bolus BEFORE, with the old pod. It seems that a huge bolus, with a new pod, in a new area of skin, doesn't always work, and its like the skin is saying "hey, this foreign thing isn't supposed to be here". So do it at meal time, do the bolus with the old pod, and then do trial and error a few times and see if you need to set a temp basal after that. I've pretty much eliminated the post pod change spikes by doing this.

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  9. Hi Friend! I didn't read all the comments, but this is what works for us. And yes, Matthew's BG soared with pod changes as well.

    Here's what works for us. Firt, I really try to change pods after lunch. That way I can see what the deal is by dinner.

    We bolus one unit on the OLD pod (Elise would probably use much less, you'll have to play with it) and then we add a temp basal of 60% for 3 hours. We started with 20% and just worked out way up.

    One other note, these questions are the very reason I'm on Facebook. Honestly, I don't keep up with old friends on there, but it's a faster way to connect with the DOC.

    Plus, there are 2 great groups you can join. Omnipod users and Type 1 Hangout. So many wonderful people to help you.

    I didn't do FB until the pod and now I'm grateful. I just "hide" everyone else.

    Shhh....don't tell! Hope this helps!

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  10. Hey honey - glad things are better for you and Elise and the Pod.
    As for highs - I give Grace .50 unit when the old pod is on, then wait for it to give it. Then I start the Pod change, and I try to do it when before she is going to eat - before a meal or snack. Then, after her Pod change, I do a temp basal of +30% for about 2-3 hours, depending on her BG before the Pod change and all.
    I'm afraid you are going to have to play around with it - both in giving a dose with the old Pod and temp basaling with the new Pod. Having Dex back will help you a lot too. You will get to know what works for Elise.

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  11. Well.... Here's what works for us.

    We change pods in the evening or late afternoon just because that's the only possible time to do it on school days.

    We tried changing it before meals thinking a big ass bolus with the new pod with jump start things. That didn't work well for us. At least not consistently.

    We feed her and bolus with the old pod. THEN we change it. Once the new pod is on, we do a temp basal increase for 4 hours of plus 50%. However, if her bg going in to the pod change is high, we might do a plus 75% basal.

    We tried giving a straight bolus with the new pod - and the old pod- but more often than not that would cause her to go low... only to be high later.

    Unfortunately, it's not going to be a one size fits all thing. You're going to have to tweak it to see what works for you. But maybe you can try some of the suggestions here to at least have a place to start.

    With the plan that we do, we've had some awesome pod changes. Like flat line on the Dex at 120 kind of pod changes. Every now and then. And, of course, we still have occasional times when it doesn't work. BUT... that's what is working for us. Just keep trying and you'll get it figured out. At least as much as any of us actually figure D out. And - just for the record - even with the post pod highs, we would still not go back to the tubed pump. And her numbers - overall - have never been better. Of course, that's just us. Everyone is different! :)

    Good Luck! Always here to help if you need anything!

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  12. You have gotten some great advice! LOVE, LOVE, LOVE the DOC for all it's varied experiences and tricks! It helps those of us who have been podding for over a year, too!

    What has almost always worked for Bean is an increase of 0.5u to 1u with the first bolus of the new pod. The amount depends on how she's been handling insulin (if she's needed more or less that 'usual') and I sometimes increase it due to her BG.
    However, if I forget to up the dose, I've been running a temp basal for two hours, usually upping it .10 or .15u ... I find it easier to deal with temp basals in units vs. percentages...just what I do.

    Hope you find something that helps soon! Those highs are beyond annoying because they feel (at least to me) totally preventable and my fault for having to change the pod!!

    Hang in there!!

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  13. i am so glad everyone has given such awesome advice! we are not on the pod...we are animas peeps here...but I am just curious why that happens with the pod? i've never encountered that with our animas.

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  14. I'm 34, diagnosed when 14. I tried Medtronic Minimed for 3 weeks. A total mess. Never had such highs! Not seen anything wrong with the cannule at changes. Turned back to shots and much much much more serene and happy! I do believe shots are also much more reliable than pumps. When I shot I'm sure that I'm taking insulin while I was NOT when bolusing! Love

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  16. We've never had issues with site change highs...it just flows from one site to the next, but it looks like you aren't alone and have gotten some great info :)

    Hope some of these suggestions work, and so happy to hear that you're working through some of the kinks!!!!!!

    I guess we've been very blessed because we rarely have a site issue, and the tubing hasn't been an issue. We couldn't be happier with our pumping experience, and hope the same for you :)

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  17. Yes, we did have highs after site changes when she was younger but they did not last eight hours; usually about four hours. We did not have Dex (and now she refuses to wear Dex) so we always corrected blind. In our case, no matter what the reason, if high in the 200s, it's 10 percent plus temp basal; 250 to 280 we use plus 20 percent; over 280 plus 30 and if 350 it would be plus 40 percent. Her correx factor is 1 to 100 still. We check BS every 1.5 to 2 hours and if not heading down increase the temp. Just keep monitoring every 1.5 to 2 hours. We do this for all extended highs; same in reverse for extended lows. After the second high, if the BS has not come down, we immediately temp basal up. We don't even question the whys of it anymore; more insulin is needed. If you need to put Dex on you could, as Elise does not object to Dex. So in an emergency you could resort to Dexcom.

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  18. This totally blows my mind! I had NO idea that a pod change high was happening out there!? The only thing I have not seen suggested on here is pinching up the skin when the pod injects??? I always pinch up the chunk of skin (harder on the legs, but I still try to get some pinched up!) as high as I can. I'm not even sure where I got that advice, the rep or somewhere on the DOC...I wish this pod thing would smooth out for you!? You said you were having trouble with pods at pod change time too??? I will say that I got a batch of "sensitive" pods that took a good month or more to finally get through, they would beeeeeep dead right when I filled them up! OR Ellie would barely bump it and it would die on the spot! Annoying as hell! But my rep said they had some issues and I should get through the bad batch pretty quickly. I did. I also called every one in and they replaced them all! Don't be shy about calling them in...they will replace them! I also noticed that I needed to slow down when injecting the insulin into the pod...like SLOWLY and it seems to keep the dead on insulin arrival incidents down. Anywho, I'll shut it up now! haha If you do a big ol' pinch when the cannula goes in and it works! Well heck ya! If not...hope one of the other 40 suggestions works! Know I'm thinking of you and your little pod wear-er! XXXOOO

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  19. I have no advice (MM pump), I am just so excited to see that you have 18 comments on a post asking for help! Gotta love the DOC!

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  20. a really lovely post. I'm now following.

    Amelia x
    http://wearableartblog.blogspot.com

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  21. Want to clarify that we have never used Omnipod. Highs after site change happened almost every time after site change when she was first diagnosed. We were using Animas pump. Switched to Minimed pump and highs after site change did continue. As she got older the highs after site change rarely happens. Seemed to happen first two years after dx. Thinking maybe it's because she used a lot less insulin? Walsh does mention "insulin depot" where insulin builds up at a site. Seems to me changing site before dinner, the largest meal, checking BS two hours after and if high, put on the plus temp basal. Amount of plus temp can be worked out with endo or through experience, taking into account safety first, using modest increases until you see what she needs.

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  22. We use a Minimed Revel w/ our 4 year old and have never had this problem. Of course, there are tons of other problems we have with the big D!

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  23. Sorry, just reading this post, but i had to tell you I have always had highs after I make a pod change. As for what I do, I actually bolus a certain amount (.35) once the new pod is on just to get it going. I've never had a low from it but it does get rid of those nasty highs from the change. Good luck! :)

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  24. We use the Medtronic Revel and have never had an issue with Highs after site changes. In fact, I don't always fill her cannulla because I find she goes low sometimes afterwards. I'm curious why the Omnipod does that? I did hear a Endo say that there are often failures with the Pod because so many come off the production line continuously...would that be a possible cause?

    Hope you figure out how to tweak it! Take care~

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