Regime Du Jour

A few notes today on what’s up with my personal diabetes regimen:

I restarted the Guardian RT continuous monitor a few days ago. I find that I have to take breaks because my poor belly is scarring up fast due to long-term OmniPod and other sensor wear. As a result, I’m getting many more frequent occlusion errors — which means a clog or blockage at the infusion site. In this case, it’s not a tubing or even cannula problem, just a problem of too much thick skin (scar tissue) in the areas where Pods and sensors actually stay on my body. I do wear the OmniPod on my arm in-between, but I haven’t yet figured out how to get the Guardian MiniLink sensor placed there. And here’s why:

Guardian_rt_inserter

The most gi-normous needle I have poked into myself since getting diabetes (or ever). Not liking that thing! Also, see that big blue device in the background? That’s the inserter-doohickey. You have to hold it a pretty exact 45-degree angle to get that big fat needle in right. How do people manage to use this inserter succesfully on their own shoulders or back, I wonder? I might need to call my friend’s husband, the ICU nurse, to help me out here.

btw, the Medtronic folks requested that I note they have customizable early warning alarms to prevent highs and lows, too, just like Abbott’s new Navigator (finally coming to market later this year). The Guardian gives you a choice of up to 30min. in advance, with alerts that can be set for 5 min. increments. There’s also a snooze function, that works just like the one on your alarm clock. Sometimes I think the finer details of certain features are more important to the engineers than the patients, no?

In any case, have I mentioned the Apidra? Yup, I started on Sanofi’s new faster fast-acting insulin about two months ago. I “waited it out” since the first month was rough going for me — running high a lot in part due to illness and infection. Now that things have settled down, I still have to honestly report that I haven’t noticed any dramatic differences in my post-meal BG levels. What has changed, however, is how rapidly the corrections kick in, which is a nice plus. I won’t be going back to “slower” insulin any time soon (unless I run out of money — all that surplus Novolog is still chillin’ in my fridge). Securiteeblanket

And here’s something neat: I discovered that my little Securitee Blanket insulin cover is just the perfect size for the Apidra vial! Very handy. Although I really do wonder if it hasn’t occurred to Sanofi how potentially dangerous it is to make Lantus and Apidra vials the exact same size and shape. I almost mixed them up more than once.

I’m still loving the OmniPod, except for aforementioned occlusion issues — a problem that plagues all pumpers at times, I suppose. Oh, and that episode about 10 days ago when my PDM suddenly died just as I was attempting to bolus in a tiny little chic French creperie in San Francisco. When I say “die” I mean it let out a piercing beep that wouldn’t stop and flashed a message to call Customer Support asap. No delivery – Yipes! Of course I had no backup supplies along.

Luckily, all we’d ordered was a salmon & feta cheese omelette with salad, so I figured I’d be OK until we got home. Except for the beeping. No matter how many times I pushed buttons, it just wouldn’t stop. “Is that you, Mom? Is that still you?!” my 10-year-old daughter asked sheepishly, as the persnickety French cafe owner glared us down. I yanked the battery, ate fast, and drove home like a demon.

Thus, the rediscovery of my Securitee Blanket to start carrying extra insulin and supplies around, even when I’m not officially travelling. You just never know. Insulet did FedEx me a new PDM right quick, I might add. Still, lesson learned.

Thus, this week’s seven words of wisdom for people with diabetes:

Eat carefully. Test your sugar. CARRY BACKUPS.

Advertisement

14 Responses

  1. Mary
    Mary March 17, 2008 at 8:20 am | | Reply

    My first pump, many years ago, was a Disetronic. The company gave you two pumps at a time. One to use and one as a back-up. Every two years, one pump was sent to the company for rehab and was then returned. It was great – you never had to worry about being without a pump. I only recall returning my pump for a malfunction once. But still, it was something I really liked about the company.

  2. Lyrehca
    Lyrehca March 17, 2008 at 8:34 am | | Reply

    I always tuck a vial of insulin and a syringe into my Ultra meter kit and it’s come in handy many times, particularly when my pump supply of insulin is low and I can’t refill it right away. (Plus, a syringe is less bulky than carrying the reservoir and infusion set and IV prep wipe to do a set change when I’m out and about. The syringe helps me tide things over til I get home and can do a full set change.)

  3. Jana
    Jana March 17, 2008 at 8:49 am | | Reply

    Amy, I wanted to ask you a long time ago. You once wrote you have used the Mastisol for your POD to stay in place, Insulet recommended the same thing for me, but I am having irritation on my skin from that product. Do you use anything different? I have troubles for the POD to stay on my arms without Mastisol, but I can’t stand that itching!
    BTW.: LOVING OMNIPOD THE SAME WAY AND EVEN MORE EVERY DAY!

  4. Elijah M
    Elijah M March 17, 2008 at 1:18 pm | | Reply

    My one gripe about the OmniPod that I can’t get over is that you can’t turn off the alarms no matter what. You should be able to suspend any noises coming from the pod and PDM for a set period of time. Occlusion be damned, it’s not going to kill me to wait until the end of a movie to find out about it.

  5. Karen
    Karen March 17, 2008 at 3:50 pm | | Reply

    Amy,

    I wonder if you are getting more scaring than the norm because the POD is rather large and hangs on to your skin. With other pumps the infusion site is very small and after 5 years I really still do not have issues. Now for the Medtronic CGM which I started in January, that needle is honking big, but I have moved passed that and it did take me about a month to not be freaked out by it. I did my tummy, my back, and it left scarring and I think like the POD it is attached to you all day causing irritation and movement to the canula, which does not happen with the site of the pump. The best place I have found so far is my outside thigh and then I put IV 3000 over it, cup it with the warmth of my palm and bam it stays and causes minimal irritation, but still a bigger opening than the normal pump, probably like the POP. I noticed the Navigator CGM also is rather large and I will worry about scaring with that as well.

    So my point is, I think it is the bigger appliance sticking to you that is causing you grief, but I know you are not in love with pumps, but it is something to thing about for less scaring.

  6. Carly
    Carly March 17, 2008 at 7:41 pm | | Reply

    To Jana: I am also an OmniPodder and I used to use IV Prep before applying the pod, but found it didn’t help the adhesiveness. I have the best luck with plain old alcohol wipes. I’ve been wearing the Pod on my arms all this week and haven’t had any unsticking!

  7. Laura G.
    Laura G. March 18, 2008 at 6:41 am | | Reply

    Amy, I’m sorry to hear you’re starting to get some occlusion errors and scarring from CGM and pod! After 10 years of pumping and nearly 30 years of injecting insulin that’s something I’ve gradually experienced more and more often, though I try to stay ahead of it with creative site placement and site changes at the first sign of trouble.

    I’m surprised people don’t talk about this issue more when choosing to wear a CGM full time. I feel like I have only one set of skin and subcutaneous tissue and it has to last my whole diabetic life. I want to keep my skin uninjured, unscarred, and healthy enough for insulin infusion forever (sigh.)

    Try more sites and don’t wear out your belly, OK?

  8. Bernard Farrell
    Bernard Farrell March 18, 2008 at 7:13 am | | Reply

    Amy

    I’m surprised about the occlusion errors. In nearly 10 years of pumping with three different models, I’ve never had an occlusion problem. I wonder whether it’s related to Apidra (I think this is unlikely). Have you tried a different insulin?

  9. Jana
    Jana March 18, 2008 at 7:44 am | | Reply

    Carly,
    I tried everything, IV prep, Alcohol swabs, everything, but my skin is so oily or I don’t know what, that after a day, the pod is getting off my skin. Mastissol helps, but about a month ago I started to have irritation, and that itching is unbearable! Sometimes I have to change the POD every other day, because of the cannula getting out of my body. I love Omnipod, I would never go back to the needles, but this is the major issue, I have to watch all day if the POD is in place.

  10. Jana
    Jana March 18, 2008 at 7:51 am | | Reply

    Amy, I try to rotate the infusion sites for Omnipod and it makes 14 days to return to each infusion site. Also I always move the pod inch up or down or to the side, so I don’t stick it into the same place. I am on the Pod only 4 months, but don’t have any issues with scarring as I had when I was using the needles. I also use APIDRA since on the pump(before used Novolog pen) and I think it works great. I will never thank you enough for your blog, you were the reason why I didn’t give up after my old insurance company denied me the omnipod and today I have one! Thank you!

  11. AmyT
    AmyT March 18, 2008 at 8:35 am | | Reply

    Just a note to say thanks, and that I also found the Mastisol unbearable. I have very sensitive skin (a curse!), so that stuff practically gave me hives.

  12. Brent
    Brent March 18, 2008 at 11:21 am | | Reply

    Amy,

    I agree with Bernard that occlusion should not be more of a problem with the OmniPod than it is with any other pump (of course this is your first pump I think). You also should be able to go far more than 14 days between mountings at the same site, even if you only use your abdomen. Remember, only the cannula needs to be 1 – 1.5 inches from the last delivery point, not the entire pod.

    I know you have a tiny waist; so does my 16yo daughter (100lb). I’ve sort of made a map of all the possible sites on her stomach and we have a specific order that we use, and we can get about six sites on each side of her stomach. So that should be at least 36 days before you get back to the same site. If we wanted to get even more rigid about site placement, I would make a schedule and we would log dates onto it, just so we’d know when that site was last used.

    We don’t have any of the CGMs, but I didn’t think that they were supposed to have scar tissue issues since they weren’t depositing anything on the tissue, so that’s a new issue to me.

    Good luck!

  13. Paul Sorensen
    Paul Sorensen March 29, 2008 at 3:11 pm | | Reply

    Amy

    I started the MiniMed pump in Jan and the CGM in Feb.. My diabetic trainer instructed me to insert the sensor at a 60 degree angle.
    Less pain, more effective. Of course the blue inserter has a 45 degree base, so it takes some guess
    work. My trainer said these were the latest instructions from Medtronic. The outcomes have been good so far. Good luck with yours.
    Paul

  14. Brian
    Brian August 19, 2008 at 11:06 am | | Reply

    I am an OmniPod user and I have had many problems with the adhesion of the pods and also the occlusion errors. Through the times, I’ve found that the occlusions occur when the pod is placed on an area that is sensitive to the touch (an area that feels like it has an invisible bruise) or areas where pressure is applied down on the pod. So site changes are a good thing for that. As for the lack of adhesive power, I have noticed that the pods seems to have less stick to them these days. I tried mastisol but it was itchy, sticky, and just a mess to put on. But, I’ve found that if you stretch the skin before you put the pod on (like if it is on your stomach, you stand up and stretch up, and while stretching, attach the pod), it seems to hold up a lot better. If you put it on when you are sitting or leaning forward, the adhesive adheres to the skin while it is bunched, so when you stand up, the adhesive comes loose. So those are just some tips that I’ve noticed along the way.

Leave a Reply