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Category: Insulin Pump

Starting our 4-Year Old on an Omnipod

Starting our 4-Year Old on an Omnipod

Chris Stocker

Yesterday, I wrote about our decision to start using an insulin pump as opposed to multiple daily injections. If you would like to learn more about why we made that particular decision, please go check out yesterday’s post.

Once we knew that we wanted her to be on an insulin pump, we needed to figure out which one. I pretty much already had an idea which one we were leaning towards.

We had a few options to choose from:

  1. Medtronic
  2. Tandem
  3. Omnipod

Medtronic

I personally used a Medtronic for 13 of my 16 years with diabetes. It was the first pump that I started on in December 2004 after my diagnosis in April of 2004 (couple days away from 16 years since diagnosis).

I was very comfortable with the Medtronic insulin pump and how it worked and how to use it. I also liked their low suspend technology that could detect a low blood sugar coming on and automatically shut the insulin delivery off.

However, that would require using their CGM, and I wrote last week about our reasoning for choosing Dexcom immediately for our CGM of choice.

The last, main reason, was I know our daughter. I know she runs around a lot and also bumps into plenty of things. I have also walked past a door and got my tubing snagged and had an infusion set rip out, and let me tell you…. it hurts!

Tubing was a no-go for us.

Tandem

Even though Tandem has tubing, it is integrated with Dexcom and offers their Basal-IQ technology, which was pretty appealing to me. If you’re not sure what technology I am talking about, you can check out an old post I wrote on it (and I’m also going to link to their site because they have had a bunch of updates since I last wrote about it).

In the end, we just knew we needed something without tubing.

So, that led to the choice of Omnipod.

Omnipod

After my 13 years with Medtronic, I chose to use MDI for a year. It worked out pretty well for me. I wrote about my decision to give up an insulin pump for MDI in the past.

When I decided that I was done with MDI (again), I wanted to go back onto an insulin pump, but I felt like it was time to give up Medtronic. Primarily because I switched over to Dexcom during my year of MDI.

I decided to use an Omnipod.

I tell you that story, to further explain why we chose Omnipod.

90% of the decision was because of it not having any tubing. It was a pretty clear cut decision for us to make.

90% of the decision was because of it not having any tubing. It was a pretty clear cut decision for us to make. Click To Tweet

The remaining 10% was a little bit of the fact that I currently used (and still use) asn Omnipod, so there was the comfort level of knowing how to troubleshoot it if needed.

Daddy, Daughter Diabetes Bond

daddy daughter omnipod

The other was purely mental.

My daughter has seen me put an Omnipod on 100 times. She’s even helped me do it. She decorates them by coloring or putting stickers on them.

She would love to be just like Daddy and share this bond with him…..right?

Well, that’s what we were hoping.

The first few times we put a new Pod on, I would do mine just before so that she could see me do it and get comfortable with it.

Six Months Later

We are now over 6 months with the Pod and we absolutely love it. It can still be a battle every so often on putting a new one one, but we know these struggles are going to happen. It simply comes with the territory of having a child with type 1 diabetes.

I will write in a future blog post about our tips for keeping the Omnipod on, how we take it off, how we rotate the sites and many more cool ideas that we have learned over the last 12 months of managing not only my own Type 1 Diabetes, but also our daughter’s.

I hope you are enjoying this content, if so, please leave a comment below or go share the love on Facebook and Instagram.

Insulin Pen vs Insulin Pump for our Child with Type 1 Diabetes

Insulin Pen vs Insulin Pump for our Child with Type 1 Diabetes

Chris Stocker 1 Comment

When our daughter was first diagnosed, we started on insulin pens. This is also how I started giving insulin injections when I was diagnosed in 2004. The pens are good for training and learning the basics of diabetes and forcing yourself to do math and think about sliding scales and correction doses.

In the long-run, for our family at least, we knew we wanted our daughter to be on an insulin pump.

Discussing with Our Daughter

This is something that we discussed with our daughter also so that she didn’t feel like it was being forced on her, but it was a simple conversation with her.

4 shots a day or one “shot” once every 3 days.

Her answer was pretty quick.

Giving her insulin early on after her diagnosis was difficult at times. We didn’t want to make too many changes to our life. We wanted her to continue to do the same things she was doing before she was diagnosed.

Eating Out

One of those things was eating out. We ate out usually 2-3 times a week. Usually one night for dinner, and 1-2 times a week for lunch. We did this because we were always out on the weekends and then we try to enjoy one night out a week together as a family.

Eating at a restaurant was tough because we never knew exactly how many carbs she was going to eat. We would look at the menu beforehand, and by before I mean, my wife would be looking on her phone in the car about 5 minutes before we pulled into a restaurant because it took us 30 minutes debating on what restaurant we were going to go to.

We also could never tell when the food would come out, so pre-bolusing was tough, but that is the same no matter if you are doing MDI or using an insulin pump. The difference is that we could just give her insulin at the table and not have to go to the bathroom and leave the table.

If she wanted to be able to eat a little bit more than what we initially bolused for or if we decided to all share a dessert, we could do it much easier with an insulin pump. It wasn’t going to require the trauma or getting another shot, but a simple few button pushes on the insulin pump.

Corrections

Another reason we wanted to use an insulin pump was for corrections. We found ourselves waiting until the next meal time in order to give a correction. If it was a large correction, we would do it, but we avoided giving extra shots as much as possible.

Waiting until the next meal to correct a blood sugar that was not too high, but something that we would correct now with an insulin pump, was not good management. Her A1C was higher and we knew we couldn’t continue on that path for the long run.

Snacking

Luckily, even before diabetes, our daughter was not much of a snacker. She didn’t just randomly eat throughout the day. She ate breakfast, lunch and dinner and sometimes would have a little snack somewhere throughout the day. But, she never just randomly was given food to eat all throughout the day.

That was a big plus for being on MDI, because we didn’t need to bolus any additional shots.

On her insulin pump, if she wants a snack, it’s easier to give a snack. Now, we don’t just give a snack because we can quickly bolus for it, we still follow our same rules. But, it is easier to go for ice cream after the park or having some cracker and cheese between lunch and dinner.

Check back for future blog posts on how living with an insulin pump has been for her.

Please go follow along at Facebook or Instagram

initial thoughts on omnipod featured image

My Initial Thoughts on Omnipod – 1 Week of Usage

Chris Stocker 3 Comments

I’ve been using my Omnipod for one week at this point and I wanted to collect and share my initial thoughts on Omnipod after one week of using.

Last Tuesday I had my endo appointment and afterwards had my Omnipod training in order for me to start using the Omnipod. I’ve had the Omnipod box at home for a little over a week and before I went to the appointment, I opened everything up and did a little set up video for you that you can see later this week over on my YouTube Channel.

Going into this endo appointment, I already knew that my A1C was going to be one of the highest it’s been since being diagnosed. How did I know this? Simple, my Dexcom 90 day average glucose report from Clarity told me. I have a full post later this week dedicated to just my A1C.

My weight was actually up 3 pounds since the last time I saw him in August. Not what I was hoping for. Everything else from the appointment went well. My blood pressure was perfect, as were all of my important labs. When I first came into the office, my heart rate was a bit high at 115, however, after the doctor did it again about 10 minutes later, it was down to about 85, which was better.

I do have a problem with high heart rates throughout the day, which is part of the major need to lose weight. Speaking of, I did a search on my site here, which I launched in 2009, and I’ve been talking about losing weight since about 2010 and all I’ve done since then is gain about 60 pounds. I’d say that’s not good.

Directly after my endo appointment, I was scheduled to meet with the nurse to do my Omnipod training.

When it comes to training for insulin pumps, I typically already know how 90% of it works. I don’t typically know the troubleshooting tricks and that’s what I like to learn in these trainings. However, when I go into the trainings, I act like I’ve never seen an insulin pump before and let the trainer do what they need to do. I do tell them that I am pretty advanced with technology and understand diabetes and was on a pump for 13 years. This way, they don’t waste either of our time talking about what a bolus is or temp basal, etc.

I understand it.

I’ve watched videos of people filling their Pods, but I never actually did it myself, so I asked for help to ensure that I was doing it the right way. I went through the setup process and once I was ready to put the Pod on, I decided to go on my left arm. Of course, when I put it on, I couldn’t see the viewing window, so couldn’t tell if the cannula was in properly, but I guess time would tell anyway.

My Unique Omnipod Insulin Management

Something that I have written about since I first started writing is the amount of insulin I use and how much of it I go through. I am on a 1:4 (insulin:carb) ratio and my average basal rate is about 2.5.

That’s a ton of insulin.

In order to not have to change out my pod every single day or every 36 hours, I recommended to my endo that I stay on Tresiba for my basal insulin and just utilize a 0.1 basal rate on my Omnipod. If I see that at certain times I may need an increased basal, then I do that. I don’t see a lot of lows, so the need to decrease my basal is not something that I utilize often.

However, if the Tresiba is already in my system and I’m low, then I correct the low, and if it becomes a pattern, I lower my Tresiba.

As of now, it’s worked pretty damn good.

Big Bolus Injections

I’ve still not cut out all horrible foods, so when I have eaten a high carb meal, I’ve injected insulin from an insulin pen for the extra dosage as opposed to taking the insulin from the Omnipod. I’ve decided to do this, so that I don’t dump too much insulin into the infusion site too fast.

Also, I’ve already had one Pod start to leak insulin because I dosed too much at one single time.

Lesson Learned on First Pod

The Pod that I inserted at the training session only lasted 24 hours. The next night at dinner time, I needed to take about 20 units of insulin. So, I dialed up the 20 units on my Omnipod PDM and hit the bolus button. The PDM started to do its thing and deliver the bolus.

Next thing you know, my arm felt a little wet and I smelled that awful smell of liquid gold, aka insulin.

I did the ole rub the site, then smell (did this far too often with Medtronic, which is one of the primary reasons I ultimately stopped using a pump), and I could smell it. Soon after, my wife said that she could smell it from where she was sitting.

I did the first thing that I always do when something happens, I went straight to Twitter. I wasn’t complaining, I was more looking for a solution, and luckily I found some.

One idea was to extend the bolus of anything over 3.0 units. So, that’s what I’ve been doing and it seems to have been working pretty well so far. I’ve had 2 other Pods on and neither has leaked since extended boluses out over 1 hour, on average.

I have my next follow up appointment already in a little over a week. My endo wanted me back in 2 weeks to look at Dexcom data to determine if we are going to stay with using Tresiba 100% for my basal insulin or if we are going to make it 75% of the basal insulin, plus 25% basal coming from the Omnipod.

Diabetes is all about testing, looking at the data, making an educated guess and testing all over again until you find the perfect management solution for yourself.

Overall, my initial thoughts on the Omnipod are great. I must say, I do hate the PDM. That is my only downside and flaw to the Omnipod system. The buttons are hard when I try to push them, which could be from it being so new and needing to break the buttons in.

Not being able to utilize a touchscreen for me is just brutal. Here’s the looking forward to the Omnipod Dash system.

omnipod delivered featured image

My Omnipod Has Been Delivered

Chris Stocker 2 Comments

Towards the end of the year last year, I’d say the final 10 days of the year, I went from thinking about going back on a pump to somehow being on the phone with Omnipod ordering my new insulin pump. It all happened pretty quickly, but here’s the story.

I recently wrote about my thoughts of going back on an insulin pump. I was torn between a t:slim and an Omnipod. I’m not going to go into full details of that thought process again, you can read the article.

The final decision for me came down to the fact that I have loved not being connected to a device with a wire for the last year after going back to MDI. I still do not want to be connected to a wire. So, I sat down and outweighed the two most important options, Basal IQ from Tandem or no tubing from Omnipod.

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omnipod or tslim

Is It Time to Give Up MDI? My Omnipod or t:slim Possibilities

Chris Stocker 1 Comment

Back in January of 2018, I went off my Medtronic insulin pump that I wore for over 12 years and went back to MDI mixed with Dexcom. During this past year, I’ve had ups and downs with loving and hating MDI. I’ve been asked so many time, “how could you give up a pump to go on MDI?” and the answer has always been simple:

I love the freedom of not being attached to something and my A1C is pretty much the same as it is when I was on a pump.

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I’ve Ran Out of Infusion Set Placement Sites

Chris Stocker 2 Comments

My infusion set sites are becoming more and more difficult for me to keep fresh. I can’t wear an infusion site on my stomach. I’ve explained this in the past, but basically, I’m too fat. I have too many “rolls” in my stomach that when I bend or stretch or exercise, the rolls do what they do and roll up. When this happens, no matter what kind of adhesive is being used, the site falls off.

I’ve tried different infusion sets over the years with the trials of all the pumps that I’ve used and they are all the same. So, I just don’t think there’s much that can be done about it.

So, I’m stuck with the upper portion of my buttocks and the mid to top area of my quads. There are only so many spots in these areas that I can inject an infusion set. This is why I take so many insulin pump breaks because I just need to allow these areas some time to “heal”

The other issue is that I use too much insulin. I’ve decreased my usage compared to the last several years, but it’s still not where I want it to be. This leads to the area under the site filling up with insulin too quickly and then pushing up on the cannula which then leads to the infusion site leaking.

This then leads to frustration, which leads to pump breaks, which leads me to not want to be surrounded by all this diabetes technology and just taking it old school to no pump or CGM. That can sometimes lead to bad news, however, I’ve had some success in the past with using Tresiba and Novolog, but that’s a different story for a different time.

All that being said, I am still excited for the MiniMed 670G and can’t wait to get started on it (don’t know when I will yet).

Any recommendations from y’all on some more interesting places to try the infusion site?

Any and all help is totally welcome.

Endo Appointment Review – Another Great Discussion

Chris Stocker

Last Monday was my endo appointment. Unfortunately, I didn’t realize it was my endo appointment, so I didn’t get any blood work done before hand. This would usually be a waste of an appointment, but I’m thankful for the 630G and a lot of great data that we could discuss anyway.

First, we started with an in-office A1C, for whatever that’s worth. 8.1. Not very good. I knew it was going to be high because I spent 45 days without going to the gym and visiting my family in PA, which I tend to eat pretty bad while up there. My weight was down, but only about a pound, not too happy about that.

We couldn’t go over any labs, which I was curious to know where my triglyceride numbers had gone to. Previously, they were amazing, 6 months after being at “heart attack” levels. I’m going to get my blood work done this week, so I am lucky to have an endo that is willing to review my reports after an appointment and send me an email with any recommendations or updates after viewing that.

I had two main concerns going into the appointment, which is how we start out, her asking me, what’s been going on? Morning and after meal spikes. In the morning, as soon as I wake up, my blood sugar just starts to shoot up. Without eating, without drinking anything, just as soon as I wake up, it just shoots up. I do drink coffee pretty soon after I wake up, but I’ve purposely held off on the coffee for a little while and the same thing happened.

What I’ve done in the past is just take a 5-7 unit bolus as soon as I wake up. No real rhyme or reason behind it, just give a little extra insulin to combat that spike that I know is coming. Then, I need to cut out all carbs during breakfast, well as many as I can. I typically eat a 3 egg omelette with cheese or ham in it. When I do this, it definitely helps stabilize my blood sugars until lunch.

But, then that’s when the next issue happens (depending on what’s for lunch). If I eat what I’m supposed to which is a salad with no croutons and a vineagar based dressing, then it doesn’t spike that bad. I can usually control this lunch spike. 

On a good, normal day, I will then hit the gym. This brings down any high that I had and usually drops me pretty low. This is where I see a fun amusement park looking slide on my CGM. This is followed up with a nice, cold Gatorade that also puts back into my body 120 calories that I just burned off.

Dinner is my biggest problem and my biggest spike. Dinner is where I tend to slip up. When I am on my healthy eating habits, none of this happens. So, that is the root cause of the problem. Eating healthier. Unfortunately, I eat unhealthy way too often. When I do, I eat a lot of carbs. Those carbs then cause a spike. I have tried all of the different times to take insulin before eating my meal. I’ve taken insulin 15 minutes before and pre-bolused… same thing. I’ve taken it 30 minutes before, same thing. I’ve taken it the same time I eat, 10 minutes after…. it doesn’t matter.

We discussed that it seems like an insulin sensitivity issue. Where I place my infusion sites is the same areas I’ve been doing it for 11 years. I also use a lot of insulin, so within 2 days there’s nearly 250 units of insulin that has been delivered through that cannula. This is where the problem exists… too much insulin.

We felt that all of these spikes can be resolved with less insulin. So, like I try and do with any problem, we reverse engineered it. I’m using a lot of insulin because of lack of exercise and poor eating habits. So, if we change these two items, I will need less insulin, which will have an effect on my insulin sensitivity. Less insulin being delivered in a short period of time, will allow my body to absorb this insulin and allow the insulin to do what it needs to do.

We also discussed several other things. The use of Metformin as an additional treatment to people with type 1. Invokana being used as an additional med used also.

She knows that I do not like adding additional medications to my list of ones that I’m already using. This is why she will make a recommendation, tell me to do my own homework, talk with people in the DOC and then come back with a decision. So, for now, the goal is to accomplish this all naturally with better eating habits.

There is also the idea of quitting pumping all together and just doing MDI again, but I don’t know if I’m ready for that.

Taking Insulin Pump Breaks

Chris Stocker

I don’t think that I have ever written about my pump breaks on here, but I know that I have mentioned them on Twitter before. Basically, at least once a month I like to take a break from my pump.

The first question that you may ask is, “does this have an impact on your blood sugars?” You’re damn right it does. But, I don’t care.

Let me explain.

I don’t care because sometimes I get frustrated by my pump. I may have 3 consecutive days of needing to change infusion sets for whatever reason. Maybe one fell off doing hours of yard work in 90 degree weather. Maybe I decided to take a nice, long, hot relaxing bath which made the infusion set adhesive wear away and easily fall off afterwards. It may even be possible, that I just don’t feel like inserting a new infusion set that night, so I just go a couple of nights without wearing one.

Warning….if you live your diabetes life on label and the thought of people doing crazy, off-label stuff makes you upset, then please do not read any further, because the following is definitely not prescribed, nor approved of by my doctor (and not really me either, but sometimes, I don’t care and my sanity means more to me.)

I always have a full supply of syringes as backup. When I am off the pump, I just use a vial and a syringe…take it back old school. When it comes to basal insulin, well, here is where we trail off that on-label track.

I have two options during these times. My doctor gives me samples of Levemir every so often. If I have a sample pen of Levemir at home, then I use that. I know what your next question is…. “Aren’t the pens only good for 30-ish days after you open them?” Yes, but like I said, if there is still insulin in it, I’m going to use it. One pen only gets me through about a week, which is about all the time that I need for my break. If there is some leftover for next month’s pump break, then I will use it again. If the insulin isn’t effective, then I won’t continue to use it. I will either open up another sample that I have, or, just not use any basal insulin at all.

What?

Yes, during majority of my pump breaks, I don’t actually use any basal insulin at all.

During the day, I keep a close eye on my blood sugar, but when I eat a meal, I will be sure to take what I need for the bolus, and then check again in an hour. If I determine I need more, then I will take more. Basically, I will give myself the 3.5 unit basal amount that I use per hour. During these times, my goal range is a bit higher, I am satisfied with anything under 220. I know that sounds like a crazy idea, that I would be happy with a blood sugar of 220, but remember above when I said, I’m willing to sacrifice an hour or two of a higher blood sugar in order to have sanity and not drive myself crazy having to put in another infusion set that just keeps seeming to fall out.

I do NOT recommend this for anyone. Don’t even talk to your doctor about this method. If you need to take a break from your insulin pump, then do so, but make sure you speak to your doctor about how exactly it would be best for you. Be sure to have an equation figured out to determine what your amount of Levemir or Lantus would be based on what your total daily basal usage is.

I have a tricky calculation, but it never seems to work, so I usually just use the calculation every time, then adjust the next night and then the night after that. Then when I go on the next pump break, I start off where it was working before.

How do you handle breaks from your insulin pump? I would love to hear your stories. Please share in the comments below or on Facebook.

A Pump-cation Leads to Reviewing Logging Apps

Chris Stocker

 

Does that word make you cringe too? Just when I hear it or think about it, I instantly think, “Ugh, so annoying” Even though I know in the back of my head it is worth it and the data I am going to get from it will be so much more beneficial then if I don’t do it. Why am I even bringing this up?

Last month I had a lot of vacation time with my parents then with in-laws, so there was a lot of time going in the pool and constantly being on the go. For a week, I decided that I was going to take a pump-cation also, which means no insulin pump, no CGM. So without the CGM that meant that I had no real-time data to let me know what my blood sugars were like.

I remember when I was first diagnosed, I used to like in a notebook like I was the World Blood Sugar Logging Champion. Now, I don’t even remember how I used to do it or what I used to write in that notebook.

I decided that I was just going to log them in my notes in my phone and just look over the data when I had a chance. I didn’t care to have a graph or chart or see trends, I knew I was taking a little vacation from all of that stuff. I just wanted to test, see what my number was, correct if need be, then move on and wait until the next time came, but I wanted to be able to have the info in case I needed it for some odd reason.

After that week experience I decided that I was going to start reading a bunch of reviews from others in the community about the many diabetes logging apps available. After reading a bunch, I knew that I had to just try them out myself and see which one worked the best for me.

I’m still in the process of figuring that out and reviewing a few of them myself, so I will definitely share my thoughts once I actually collect them.

What is your favorite diabetes logging app?

My Denial and Approval Process of the Minimed 530G

Chris Stocker 2 Comments

As some of you may know, I was offered a free trial of the Minimed 530G (Disclosure Post) and have been using it ever since. Once the trial was over, I made the decision to stay on the 530G system and the process of getting it covered by insurance was about to begin. And it was a long process.

After the first submission to UnitedHealthcare, it was denied. I received a phone call from my local Medtronic rep, as well as the marketing team at Medtronic who was working with me throughout the trial process and my endo. They all explained to me that this was a very typical response the first time around, but that they were going to submit a letter to the insurance company to get an approval the second time around.

However, the team already knew that the second claim was going to be denied as well. They explained to me that usually it takes three attempts and then after that third attempt is when it finally gets approved.

Long story short, that’s exactly how it happened.

Normally, I would have been pretty upset and irritated that every time I received a letter from UHC, it was a denial letter. But, for the fact that I already knew I would receive these denial letters, it made it a lot easier. Also, the fact that I just had to sit back and do absolutely nothing and that my healthcare team and Medtronic themselves were working for me, was pretty comforting.

After that initial denial letter, I was sent the following PDF from the Medtronic team that outline the documents needed from your healthcare professional and the appeal process and what you can do to speed up the approval process.

Download the MiniMed® 530G with Enlite® Coverage Tool Kit

Now that the process is over and the system was approved and that I have received the product in the mail is very exciting. I can’t wait to get it all set up and start using my own instead of the trial demo product.