Author Topic: Omnipod is GO!  (Read 1951 times)

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Offline nytquill17

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Omnipod is GO!
« on: 04 June 2018, 09:17:49 PM »
Well, here I am wearing my first active OmniPod! It went on about 10:00 this morning (so 6 hours ago) and so far so good. I have had one low already, but I'm not too bothered - I expect things to be a bit wonky for a while. My clinic has me well in hand though and will be checking in with me by phone every day or so for the next little while and helping me with all the adjustments. I'm so grateful for them!!


Basal rate is currently a flat 0.8u / hr for all 24 hours. They have said that we will tweak that as we go. I've done a couple of boluses too already (they had me eat something there in the office so I could try it out!)


We didn't talk about extended boluses or temp basals yet today, just the basics, so I don't get too overwhelmed. I have a followup appointment in about a week. Meantime I have access to diasend software so I can email them and ask them for help figuring out my settings/levels at any time and they can see everything I can see, so that will be handy!
T1 DX 1995
Omnipod since 06/04/18 (Novorapid)
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline sedge

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Re: Omnipod is GO!
« Reply #1 on: 04 June 2018, 09:44:49 PM »
How close to your MDI basal dose of Levemir, is 35.2u of Novorapid?  Cos normally in the UK, they cut that by a third - so were you here, the TDD basal you are on must mean you previously needed 50+ Levemir.  I'm just interested to know if clinics take the same tack, elsewhere in the world?

Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline nytquill17

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Re: Omnipod is GO!
« Reply #2 on: 04 June 2018, 11:10:20 PM »
So if I do the math right, 0.8/hr x 24 hrs = 19.2u of basal per day. Previously had been on 27u of Tresiba so that is cut by a bit less than a third, but in that ballpark (7.8 instead of 9).
T1 DX 1995
Omnipod since 06/04/18 (Novorapid)
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline Pattidevans

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Re: Omnipod is GO!
« Reply #3 on: 04 June 2018, 11:16:04 PM »
Eh, good luck.  I am now on about 35% of TDD as opposed to pre-pump.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 Sept 2017.  45 (6.3) April 2018.


© 2015 Patti Evans

Offline nytquill17

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Re: Omnipod is GO!
« Reply #4 on: 04 June 2018, 11:21:40 PM »
Yes, I'm really hoping my TDD will come down a bit tbh. I know that it often does. But I'm happy to let them have the reins for now as, until I get more hands-on time with the pump, they actually have MORE experience than I do!

Have had a 2nd low now, but I may have overestimated the carbs in a midafternoon snack (which I only really had because I wanted to try bolusing again at home, haha!) In any case, I'm to call them tomorrow morning to check in how I got on overnight so they'll have a look at things then and probably have some recommendations for me. I know this is an out-of-the-usual situation so I'm happy to firefight with dextabs and extra testing while we get things figured out!
T1 DX 1995
Omnipod since 06/04/18 (Novorapid)
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline Pattidevans

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Re: Omnipod is GO!
« Reply #5 on: 05 June 2018, 08:46:37 AM »
Will be following your journey with interest Nyt.  Even when you get it all right now, don’t forget it will change from time to time.  However bythen you will be comfortable with adjusting it yourself.  Mind you there have been times when I’ve not been able to see the wood for the trees.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 Sept 2017.  45 (6.3) April 2018.


© 2015 Patti Evans

Offline Liam

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Re: Omnipod is GO!
« Reply #6 on: 05 June 2018, 01:21:07 PM »
I'd expect rather large changes, quickly and without the amount of data we'd normally require. They'll first want to cut the hypos. Maybe with bigger changes than you are used too.

All about getting you safe from too many hypos and close enough that fine tweaking can start.

DX Type I 1994.    Novorapid Animas Vibe pump
HbA1c 3/10 10.2%, 7/10 8.1%, 12/10 7.5%.
2/11 7.8%, 8/11 8.6% 9/11 8.3%.
3/12 62 (7.8%). 10/12 67 (8.3%)
4/13 63 (7.9%) 6/13 59 (7.5%)
1/14 71 (8.6%) 7/14 59 (7.5%) 11/14 (6.7%)
3/15 56 (7.3%) 12/15 49 (6.6%)
Ramipril: 10mg Quetiapine: 550mg Metformin: 2000mg

Offline sedge

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Re: Omnipod is GO!
« Reply #7 on: 05 June 2018, 01:53:25 PM »
Ooops!  Clearly my mental arithmetic doesn't work at that time - yours is much better.


TBH, only after the first 3 days, will you be 100% certain all the Levemir has left the building - so tomorrow is the first time you'd really want to start doing any alterations.  Hence your BGs today and the timings of them, will be the most useful to the Nurse in doing the calculations.

It's quite weird getting your head round having to adjust the hourly rate 2 or 3 hours ago to alter your BG 'now'.
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline nytquill17

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Re: Omnipod is GO!
« Reply #8 on: 05 June 2018, 02:38:06 PM »
Oh I'm happy to let them steer any adjustments for now! They did say that I might have more lows the first few days because of lingering Tresiba, but that in theeeeory all the Tresiba should have been out of my system by 2 p.m. yesterday based on when I took my last dose (Saturday 8 p.m.).


Yesterday afternoon/evening was a bit of a nightmare, I never saw a reading above 6.6, even immediately post-meal, and was scraping along the bottom all night, low 4s/high 3s and constantly feeling like I was just about to go low. I managed by eating 1-2 Dextabs every 20 minutes or so and even with that, was still having a hard time getting out of the 4s at all. So before bed I decided to have a bowl of rice to push my BG up and get a bit of a margin since the trend was significantly downwards! And indeed I got up to 15 before bed, with no remaining active bolus at that time, and 5 hours later was down to around 11, and 8 hours later down further to 9.


I'm expecting they will want to make some adjustments so I'm not at so much risk of going low / don't need to constantly prop myself up with Dextabs to stave off a low. But it's equally possible they'll want to wait for any lingering Tresiba to definitely be gone before making any snap decisions. Have just emailed them last night's info now and waiting to hear back!
T1 DX 1995
Omnipod since 06/04/18 (Novorapid)
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline Pattidevans

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Re: Omnipod is GO!
« Reply #9 on: 06 June 2018, 02:50:33 PM »
Nyt, there is of course the lingering TresibA.  In my experience Insulin does last somewhat longer than they say.. but some hours I am on 0.05u.. at least 3 hours in the afternoon.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 Sept 2017.  45 (6.3) April 2018.


© 2015 Patti Evans

Offline nytquill17

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Re: Omnipod is GO!
« Reply #10 on: 06 June 2018, 04:26:36 PM »
Had a phone call yesterday afternoon, we agreed to put basal down from 0.8 to 0.6 between midnight and 6 a.m. - worked a treat last night overnight! Nice and steady all night.

I suspect the next thing to be tweaked will be my I:C ratios because trend seems to be that I'm going low whenever I bolus for food! Had two further lows yesterday including one that required 12 Dextabs just to get me up to 6.

EDIT: have just had today's phone check-in. We're going to have the lower basal rate (0.6) begin at 10 p.m. instead of midnight, and also have reduced the amount of insulin given for corrections (from 1u per 2.5 mmol/L to 1u per 3.0). I still foresee a reduction in I:C ratio and probably a 3rd, higher basal rate for the morning after waking, but it's important not to do too much, too quickly, so patience is the game! :)

Really am so so thankful to have CGM during this transition period. I can't imagine doing this with only fingerstick tests to light the way - although I know plenty of people including most pumpers on the forum have done it that way!

First pod change at home will be due tomorrow. Slight hiccup being that I'm attending a conference from 8:00-1 p.m. or so and will be leaving the house at something like 6:30 a.m.; if I change it before I leave then alarms for the next pod change after that will come around WAY too early. I think I will leave with all the kit I need to do a pod change and decide whether to do it while I'm out (it's an incredibly user-friendly process, the only question would be whether I could find a suitable location in the conference hotel to actually do it) or whether I want to just extend the pod into the 8-hour grace period until I can do it at home.

Also, time to think about where to place the next pod! At the clinic they suggested that I start on the side almost round the back (which is where I placed the first one) and then move across the abdomen in a line. Only thing is I think that given that there is, um, "more of me to love" around the belly I worry that this will be a very bendy/rolly area when I move around (esp. during exercise) and might dislodge or kink the cannula if I start going across. I think going further around the back might be a good out-of-the-way spot, but I feel like as this is all so new to me I'd prefer to be able to SEE it. Could go with putting it into the tummy fat just below my ribs though, I think that area doesn't move around too much (provided I remember not to slouch!)

Eventually I will branch out into legs/butt/back and maybe one day even to alternative sites (a bit chicken to try them but we'll see when I'm more confident!). Can also do backs of arms but I worry that they'll become too overused for Libre sensors.

Anybody have any experience of putting infusion sites in a bendy spot? Okay to do or avoid?
T1 DX 1995
Omnipod since 06/04/18 (Novorapid)
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline sedge

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Re: Omnipod is GO!
« Reply #11 on: 06 June 2018, 10:40:34 PM »
I can't have em in my 'midriff bulge' although there's more than enough fat and I used to bolus in it no problem, for the simple reason it is too close to where I bend forwards - I understand that groove across my front is known as the waist …..

Then again I have to avoid the few inches below that line too for the same reason plus trouser waistbands land up fouling the cannula.  Hence because I am very short waisted the first 'belly' site is level and either side of my navel.  You either need brief underwear so the top edge is sited below the cannula or deep front knickers, to be well above it.

Then of course, theres another row underneath the navel I can go across at the front that I can't at the rear, else they'd be in the part I sit on.

The only way you'll know if 'there' is OK for exercise - is to TRY it, Nytquil!
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Pattidevans

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Re: Omnipod is GO!
« Reply #12 on: 07 June 2018, 07:13:42 AM »
I much prefer the midriff,  but have to use the belly otherwise I’d be giving myself problems eventually.  I find the side of my hips difficult as I tend to rip the cannulas out as I pull my pants down.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 Sept 2017.  45 (6.3) April 2018.


© 2015 Patti Evans

Offline nytquill17

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Re: Omnipod is GO!
« Reply #13 on: 07 June 2018, 10:57:43 PM »
Had a bit of a whirlwind day! My closest friend here in TO as well as my PhD supervisor were both presenting at the same conference on the same day, so I went to hear them talk. Of course pod change time fell right in the middle of all of that! You can postpone it for up to 8 hours but it does beep every hour, not the best in the middle of conference presentations but nobody seemed to mind (I did catch one person starting to reach for their handbag to check their phone when it went off, hee hee!)

On my way to the conference, I took the wrong exit out of the subway station, turned the wrong way down two separate streets, and then got entirely turned around inside the conference hotel (somehow there was a "right" 4th floor and a "wrong" 4th floor and guess which one I went to! And then I went down some stairs next to the elevators to try and retrace my steps quickly, only to come out in a completely unidentifiable place from where I first took the elevator...) so all in all I arrived at the first talk a bit stressed! It was nice to be able to quickly scan with Libre and add a correction for the stress high so discretely!

And then it went kind of downhill from there. Turns out the high may have been from insulin going off as pod change time approached, because it just kept getting higher. I corrected again when I saw it was going in the wrong direction still, and it kept going up after that. By lunchtime I was testing mid-teens and after I bolused for lunch I thought "this is the situation ketone tests are made for" so I did one of them and came back 1.5! Ooooops. Pod was 2+ hours past official change time and clearly not delivering useful insulin at this point, so I manually injected 6u with a syringe in my bag. I was a bit worried about having just bolused but I was also having a decently carby lunch (sushi) so I figured a smallish dose would be a reasonably safe "up the middle" kind of bet where I wouldn't end up either dangerously high with ketones nor dangerously low before I could do anything about it.

I changed pod immediately after lunch and BGs have since come back into range (even trending a little bit too low just now but I'm scanning frequently and armed with plenty of hypo remedies!)

So all's well that ends well but that was a more adventurous first pod change than I was really expecting! New pod is sited around the front a little bit under ribs. Seemed to be the place that moved/was rubbed on the least when I tried bending a few different ways! So far it's comfortable but we'll see how well it fares over the course of the 3 days. Meanwhile have been given instructions to further tweak basal into 3 separate rates, a higher one for morning and afternoon, slightly lower for evening, and lower still for overnight. She also said that the next step will be to raise I:C ratio so that I'm taking less insulin at meals, but one thing at a time!

Personally I expect to have 4, perhaps 5 rates across an average day, but admittedly this is based on the patterns I was used to expecting with MDI. None of which necessarily applies now, of course! So I'm happy to wait and see. CDE said to me today that things are actually going remarkably smoothly, and they rarely get such stable numbers so soon (to which I said oh good! I'm glad you said that, because it certainly doesn't FEEL smooth to me! haha) But actually it has been all somewhat less frustrating (touch wood!) than I expected. I do see what you all mean though about it being like starting over. Things like...I'm not really confident right now about how aggressively to treat lows, because I no longer have any way to know whether this will be a mild one or a big one. Eventually I'll get that back, but right now it's like anything is likely to happen, so my predictive powers are lost - and managing BG on insulin is very much a game of predictions and expectations!
T1 DX 1995
Omnipod since 06/04/18 (Novorapid)
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline Pattidevans

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Re: Omnipod is GO!
« Reply #14 on: 08 June 2018, 07:51:50 AM »
I can see thT it would have been a trying day without the added stress of the pump. Just wondering what insulin you are using in your pump and how long a pod is supposed to last.  i’m Using Apidra and I know the same goes for Novorapid, but it’s OK in my pump for 6 days.  Unless of course it’s very hot and I’m sunbathing, in which case I generally change it every 2/3 days.


I’m kinda surprised too that you only expect to harve 4/5 rates throughout the day.   Mine ramp up hour by hour from about 4am and drop sharply afte lunch, only staying the same from 4pm to 7pm (3 hours on next to nothing) then vary up and down until 4 am.


Pity Paul isn’t around a bit more, he’s the only person I know on a pod.


Sorry for any inappropriate capitalisation.. iPad rules!



Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 Sept 2017.  45 (6.3) April 2018.


© 2015 Patti Evans