Author Topic: Omnipod is GO!  (Read 1946 times)

0 Members and 1 Guest are viewing this topic.

Offline himtoo

  • Member
  • Posts: 2,887
  • Prince of Protein
Re: Omnipod is GO!
« Reply #15 on: 08 June 2018, 11:58:57 AM »
Hi Nyt ........sorry missed your start --

after reading through this topic ..... it does seem like your whole team are moving quite quckly ............and also your start was on the high side for  a flat basal rate
my start was 12u ( divided by 24 hours so flat 0.5u ) but i was on 32 lantus

my first think to ask / say is have you looked at basal testing.....this was how all of my rates got adjusted and it took about 3-4 weeks of testing and then tweaking rates by .05u up or down in the time period being checked / followed by further testing to keep making adjustments link here https://mysugr.com/basal-rate-testing/




it is time consuming but it has given me a solid base to work from and i have a total of 13 rates across a 24 hour period -- but i know we are all different
i have pretty much eliminated my dawn phenomenon with an ever rising until 4am basal that falls back over the morning to hit my lowest rate at 3pm - 4pm


 
T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6) 04/18 46 (6.4)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Offline nytquill17

  • Global Moderator
  • Posts: 6,769
  • It's all in the balance.
Re: Omnipod is GO!
« Reply #16 on: 08 June 2018, 01:10:35 PM »
Patti: Pods only last for 72 hours, this is programmed into them and they will alarm when it's time to change them. You can prolong them for up to 8 hours past their expiry time, but it will alarm every hour during that time to remind you that it has expired and you need to start a new pod ASAP. The reason for this fixed time setting is that the pod is both your infusion site AND your insulin cartridge. So you need to move infusion sites every 3 days anyway, and the insulin in your pod is likely not going to last much more than 3 days given that it's been in close proximity to your body heat that whole time.

I did say that I expect to have *at least* 4 different rates, just going off of how my insulin needs seem to vary on MDI. Certainly it may end up being more than that! Clinic was acting as if I might balk at the idea of having 3 ("if you make the suggested changes, you will still only have 3 basal rates which is very reasonable") although I'd never suggested it bothered me at all and in fact I was quite expecting to have more than 3.


Paul - Yes, I expect to do plenty of basal testing, but right now  clinic are checking in with me by phone every day with suggestions, so it's not quite the time to be rocking the boat. I mean, I could strike off on my own if I wanted! But right now I'm happy for them to be making the decisions (although they are good to always phrase it as a suggestion and "if you want to/feel comfortable, you could...") because I really don't feel like I know what I'm doing yet! I've only been on it since Monday morning, after all! So right now we are still doing more "big chunks" type changes than the fine-tuning stuff, but that will come.


Woke this morning to a BG of 18 with 0.6 ketones, and Libre shows a steady rise all through the night. Now it MAY have been the pizza I had for dinner last night, but given yesterday's events with insulin gradually going off as the pod stayed on longer and longer, I'm also concerned that the new pod is actually getting some, uh, underboob body heat when I am in certain positions and the insulin in it might already be going bad. I've checked that the cannula is in (it is) and I've tried a correction through the pump first and watching to see what will happen. It seems to be coming down a bit but it's only been an hour. If it doesn't seem to be working well in the next hour or two, or if it seems ineffective throughout the day, I'll manually correct again and try a new pod in a site that hopefully won't get quite so warm. Too bad, cause this site is actually pretty comfortable so far.

*sigh* There go my plans for exercising this morning, though.
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 himtoo

  • Member
  • Posts: 2,887
  • Prince of Protein
Re: Omnipod is GO!
« Reply #17 on: 08 June 2018, 02:58:02 PM »
hi nyt --just a quick pic of my current basal profile...........

i was getting calls everyday for the first week as well  -- my bloods were pretty constantly high the first week
T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6) 04/18 46 (6.4)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Offline nytquill17

  • Global Moderator
  • Posts: 6,769
  • It's all in the balance.
Re: Omnipod is GO!
« Reply #18 on: 08 June 2018, 03:07:05 PM »
Nice! Thanks for sharing.

Now 3 hours since correction has gone in and BG has come down to 13ish. Hm. Correction did do something, but not nearly what it should have done. Pump says still 1.25u IOB so I'll let that play out first, and then see what my CDE has to say about it when I speak to her later on.
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 himtoo

  • Member
  • Posts: 2,887
  • Prince of Protein
Re: Omnipod is GO!
« Reply #19 on: 08 June 2018, 03:20:47 PM »
i know this sounds really stupid to say ..... but remember the old "Diabetes is a marathon... not a sprint ""

it is really hard to remember when we are in the "wars" so to speak..................
T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6) 04/18 46 (6.4)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Offline nytquill17

  • Global Moderator
  • Posts: 6,769
  • It's all in the balance.
Re: Omnipod is GO!
« Reply #20 on: 08 June 2018, 03:50:35 PM »
Think I'm mainly paranoid after yesterday's experience of the site/insulin going completely off and me ending up with ketones and having to whip out an old-school syringe in the middle of lunch! Especially as, on the way in to the restaurant, I had been explaining to my companions what a pump is and what it allows me to do that I couldn't do on manual injections. Bit awkward  ;D


So then to wake up this morning with another high + trace ketones my first thought was "oh no, another failure?!" And the thing is there ARE so many more possible points of failure with a pump, and it IS a bit more awkward at first ("yes sorry I'm going to beep about 15 minutes in to your conference talk and I'm afraid there's nothing I can do about it", "ummm yeah would you mind actually if before we left I could just take 15 minutes in the hotel bathroom and put a new pod on?"), and when you have yet to see any real benefit because BGs are all over the place and WORSE than before (lows that take nearly 50g to correct! terrifying! highs and the constant looming risk of DKA if anything has gone wrong - terrifying!) while you adjust settings and work out how best to place sites and all of that...well you just have to take it on faith that pumps are an improvement, don't you?
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 himtoo

  • Member
  • Posts: 2,887
  • Prince of Protein
Re: Omnipod is GO!
« Reply #21 on: 08 June 2018, 04:31:58 PM »
i am not sure if this will be of any help to you but you are soooooooooo not alone .............i was crying my eyes out after the 3rd day and ready to chuck the whole lot in the garbage............... plus i was totally freaked about actually turning over my control of my life to this little gadget that seemed to be doing me no favours at all........................when in my mind i had been doing perfectly fine doing MDI the last 18 years............

reading your posts Nyt.............it just sounds like your settings arent right yet ......and definitely too high in some places ---------i didn't have a hypo or go below about 9 ( 162 ) in the first 10 days at all.........


it takes time...................do you have support over the weekend ) contact number or anything ?? )  -- if not message me and i can give you skype , or messenger or email or instagram details




and finally ---- i stuck to basic ( i know exactly what the carbs are type stuff the first couple of weeks to improve my  trust ) foods
it was a good 3 months before i ventured into restaurants
T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6) 04/18 46 (6.4)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Offline nytquill17

  • Global Moderator
  • Posts: 6,769
  • It's all in the balance.
Re: Omnipod is GO!
« Reply #22 on: 08 June 2018, 04:58:52 PM »
Ohhh thank you so much for sharing, Paul. Yes it does help!

I'm not yet to the point of crying, but it's early days yet ;) It does feel like I've been in a near-emergency state for almost all of my active pump days so far, which is wearing in the long run for sure. Thank goodness for you and all the rest of the forum pumpers, I did have SOME idea that it would be like this and so I can just hang in there and trust!

I have my NP's cell phone number if there's an emergency, but I won't have daily contact over the weekend while the clinic is closed. I'll definitely be in touch if anything comes up that is between the levels of "I don't know how to handle this" and "emergency, call it in!" Thank you so much, that's very kind :)
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

  • Administrator
  • Posts: 24,774
  • It's ONLY Diabetes. It could be something worse!
Re: Omnipod is GO!
« Reply #23 on: 09 June 2018, 08:43:03 AM »
 Nyt


sorry I’m not being much help right now.  I just wrote a long message and lost the lot.  Sometimes the iPad is a curse and not a blessing!
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

  • Global Moderator
  • Posts: 6,769
  • It's all in the balance.
Re: Omnipod is GO!
« Reply #24 on: 09 June 2018, 03:13:11 PM »
Don't sweat it, Patti - you're on vacation!

Latest news - sorry, I suspect it's not very interesting to read a blow-by-blow account of every day, but it helps I think to be able to talk about it with people who can personally relate and not just sympathize!

I've not been helping myself lately with my choice of meals. Have to do better about that this weekend. Anyway last night had delivery restaurant food. I used the restaurant's online nutrition info to work up the carbs, which ended up being something like 120g. This is the sort of thing I would likely need an extended bolus for but I haven't yet had the training for that (not that I would need training to figure it out necessarily, but I want to do things by the book for now! Especially as my confidence is not the greatest just now. It will all come in time :) )

BG had been at 11-12 most of the day and never below 9, in spite of doing several corrections. After that meal, BGs rose to 19-20, but no ketones thankfully. About 2 hours after eating when I saw that there was no hint of downward movement beginning, I went ahead and did a correction through the pump (so that IOB could be taken into account). 2 hours after THAT, still no sign of BGs going down, so I did another correction. And again 2 hours after THAT. Went to bed on a 17. By 6 a.m. this morning had gone down to 14. Woke up again at 9:30 at 16, Libre shows a nice straight line overnight, so basal does seem to be working, but corrections and meal boluses are having almost no effect at all.

I'm really concerned that this site or the insulin might be a problem, but then basal rates do appear to be working, so maybe it's just the bolus calcs? Weird that it seems to only have started when I changed pod though, but could just be a coincidence. Clinic said if it were the site or a problem with the insulin I'd be in the 30s within a few hours, and when I don't eat BGs are reasonably steady and flat, they just don't go DOWN when I want them to. Certainly I haven't had any ketones since before I changed pods, so clearly I am getting SOME insulin I have heard of it taking 4-5 days for Tresiba to be fully out of one's system so perhaps it's just that - in the intervening time we'd made adjustments that were based on BGs I was getting with the tail end of my last Tresiba dose still having some effect, and now it's not, those adjustments are "off" again.

So this morning, BG being 16.1, I have checked for ketones again (still none, thankfully, although I feel pretty rotten and symptomatic!). Then I had an idea. So I ran the bolus calculator on the PDM for a BG of 16.1 with no carbs, and got a suggested bolus of 3.35u. Then I backed out of the bolus calculator and instead injected 3.5u (closest approximation I could make to 3.35) with a pen. My reasoning is:
- if the pen correction is MORE effective than pump corrections have been for roughly the same dose, then the problem is likely with the pod (site or insulin degradation from body heat)
- if the pen correction is EQUALLY or LESS effective than pump corrections have been, then the problem is likely with the pump settings and I will perhaps dare to adjust the correction factor back to 2.5 (CDE had me move it to 3.0 a couple days ago just as all this was kicking off).

So the next 3-4 hours will tell the story I think!
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

  • Administrator
  • Posts: 24,774
  • It's ONLY Diabetes. It could be something worse!
Re: Omnipod is GO!
« Reply #25 on: 09 June 2018, 06:05:48 PM »
I know you are going to think what I am about to say is rubbish, and it’s certainly counter-intuitive if you are seeing flat lines without eating but I am wondering if you are actually on enough basal throughout the day.  Something at the back of my mind is nagging about when I had a similar scenario and also when Liam first started on a pump.  When I upped my basal, not a huge lot, but tiny bits throughout the day, the situation calmed.
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

  • Global Moderator
  • Posts: 6,769
  • It's all in the balance.
Re: Omnipod is GO!
« Reply #26 on: 09 June 2018, 06:21:31 PM »
I don't think it's rubbish at all! If basal isn't right or close to right, then every bolus is going to go in part towards picking up that basal slack and NOT towards having the BG-lowering effect it's supposed to.

However I do suspect that my correction factor is mightily off. I don't have the full 4 hours of data from the pen injection this morning, so further details yet to come, but so far it looks that way.

The trouble is of course I'm back at a point where NONE of the relevant factors are certain enough that I can exclude them in order to pinpoint the problem. If I knew that basal had been right until now and it's just the corrections that aren't working properly, I could adjust correction factor in confidence. Or if I felt that corrections generally worked correctly only NOW they weren't for some reason, I could rule them out as a trouble source and look at basal. But right now both are probably wrong, so I can't use either to really predict anything about the other! Same goes for carb factor, AND site issues. So there are at least 4 variables all completely mobile with respect to one another, and the only way forward is to dial in each one a little bit at a time and see what happens to all the rest!
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 nytquill17

  • Global Moderator
  • Posts: 6,769
  • It's all in the balance.
Re: Omnipod is GO!
« Reply #27 on: 09 June 2018, 08:47:52 PM »
Alright, time for some math!


Start BGEnd BG
(4 hours)
DifferenceCorrection dose givenCalculated correction factor
Friday a.m.18.412.65.84.1u via pump1.4
Saturday a.m.16.19.0 7.13.5u via pen 2.0


So there are any number of reasons why yesterday's pump correction and today's pen correction ended up having different effects - maybe the pod site not absorbing well or being too warm, maybe the higher starting reading (higher BGs need relatively more insulin to get them down). Interestingly, yesterday BG continued to drop after 4 hours, landing up at 10 or so at 6 hours, and today as well, around 5 now at 6 hours out. But the times of day were different as well, meaning basal rates and IR will be different, and today I had the addition of a short (20 minutes each way) walk in the heat to run an errand. So not really comparable data, plus it's just two days.


BUT I think it does look pretty conclusive that whatever my correction factor IS, it's lower than 3.0, probably at least 2.0. They had me using 2.5 as a starting point, and bumped it up to 3.0 after I had so many lows the first couple of days. I had my doubts that the correction factor was the issue to begin with, and given how the last few days have been, I think I'm comfortable with at least putting it back down to 2.5. I don't want to be overly aggressive either, but sitting for hours at 19+ is not my idea of "relax and enjoy the weekend" (as my CDE suggested I do on Friday afternoon!)
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 himtoo

  • Member
  • Posts: 2,887
  • Prince of Protein
Re: Omnipod is GO!
« Reply #28 on: 09 June 2018, 10:56:08 PM »
i promise i am not laughing reading this because it is serious ...............do remember we are in week 1 of pump..............i sort of like your initiative in giving the pen bolus correction............but clearly the basal is doing the job it is meant to........albeit at the wrong rates.........



once you get used to your pump and what it does and how quickly it works ........ you will pretty much know when it is the pump............the numbers you presented don't show a pump failure.......they show wrong rates .............try and slow down nyt ...........you will get there -- sending positive vibes ..........xxx
T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6) 04/18 46 (6.4)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Offline nytquill17

  • Global Moderator
  • Posts: 6,769
  • It's all in the balance.
Re: Omnipod is GO!
« Reply #29 on: 09 June 2018, 11:31:25 PM »
Oh yes I've been mostly reassured about the pump actually for the past 24 hours or so, once I realized it was holding steady between meals and I was getting no ketones! And the pen experiment this morning just confirmed it. Thank goodness for that because it was quite stressful yesterday morning when I wasn't sure :) Honestly I think it was just the whole experience of the first pod going gradually off as it approached its expiry time, with highs I couldn't correct and then ketones and basically having an urgent medical situation while out to lunch with colleagues that has made me very gunshy about ANY highs that won't come down now. 

And of course nothing is reacting the way I would expect it to. Lows keep going for hours despite eating most of a big jar of dextabs, highs keep going for hours despite repeated corrections, I've spent all week feeling like I'm *thisclose* to some kind of serious emergency. This is probably the most scared I have ever been with diabetes (I have had scarier things happen, like actually going into DKA, but I was a kid and not quite as aware of my own mortality, lol). And physically, I feel like sh*t, of course. I'm kind of exhausted and would really like to start feeling better. Diabetes is ruling my life right now, it's almost all I think about, hard to focus on other things or get any work done, etc. I know it will all pass, so I'm not interpreting any of this as a sign that pumping is not for me or something :) But I think it's important to be honest about how it feels!

I am trying not to get ahead of myself, but I also know that I won't have any contact with clinic until Monday morning and I really didn't want to spend my entire weekend at 19+ unable to do anything but lay on the couch and drink water! But overall I promise I do realize that there is a lot of work yet to be done and it will take time, important not to jump the gun or make too many changes at once.
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."