Post Pump Change Highs

by Leighann on May 18, 2011

Princess Pod

Have you ever put a tattoo or sticker on a pod to fancy it up? Here's a princess pod.

(Remember, none of this constitutes medical advice.)

We almost always change Q’s pump out at 4:00 pm. It’s the best time for us given our schedules. I can get it done before gymnastics or whatever other activity we might have. The “change pod” alarm is set at 1 hour, so it reminds us at 3:00 pm and doesn’t go off in the middle of the school day.

We frequently have high blood sugars, not at dinner, but at bedtime after a pod change.

When I asked Insulet’s customer service, they told me that this does happen for some people and some people choose to give a bolus at the time of the pod change to help offset it.

For a while I was giving 1 unit before changing the pod. My thinking was that I knew the old pod was working, so why not use it and make sure the insulin is getting delivered and absorbed.

But then I found that 1 unit was sometimes too much. So I started giving a correction based on her blood sugar at the time of the change. Again, this was with the old pod. Sometimes this worked, sometimes it didn’t.

When I was chatting with the CDE, I bounced these ideas off of her. She said that they have a young patient who used to have big highs after pod changes, but doesn’t any more. The nurse said that none of their staff knows why this is working for this child, but that it works for them. This family has been leaving the old pod on after the new one is put on and taking it off at bedtime.

So we’ve begun leaving the old one on for the rest of the day, most of the time, unless it needs to come off. We apply baby oil at bedtime to loosen up the adhesive and let it soak in. At some point in the night the pod slips off or Q takes it off in the morning.

If I think about it, I put an “X” on the old pod with a Sharpie so there’s no question which one is the new one and which is the old.

2 pods

I also realized that maybe the high might be from poor absorption right after the pod is changed. What if it takes a couple of boluses to really get the insulin flowing? So I tried giving giving 0.5 to 1.0 units after the change with the new pod.

Some of these may be old wives tales, but they are worth a try, right?

The bedtime highs after pod changes are at this point not every time, but if we have an unexplained high at bedtime, it is almost always on pump change day.

Does your child have post pump change highs (regardless of which insulin pump you use)? What have you done to try to head them off? Is there a certain time of day that works best for you? I would love some suggestions.

Further Reading

Scott of Arden’s Day’s response to this post: Bravery

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{ 15 comments… read them below or add one }

1 rodney shippy May 18, 2011 at 9:07 am

Yes!!!!!
happens all the time for my daughter also.
It always happens very late at night,we do bolus before change but like clock work,it happens anyways.She is on the Omnipod also.But I have heard of this happening with other tube pumps…

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2 Lorraine May 18, 2011 at 9:27 am

I’ve heard of this being effective and agree it has everything to do with absorption. We don’t have this issue fortunately. (But of course have others :))

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3 Scott May 18, 2011 at 9:58 am

Your post really made me think and blog – my thoughts are there if anyone is interested. Can I post the link?

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4 Leighann May 18, 2011 at 10:12 am

Definitely!

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5 Scott May 18, 2011 at 10:14 am

Very kind!

Here are the thoughts that I had after reading your post this morning. They were too lengthy to post in your comments.

http://t.co/SjMCadL

Hope everyone has a great day!

Scott

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6 Lani May 18, 2011 at 10:12 am

This happens to Taylar as well with the pod. We change it around 6pm after the dinner bolus. We’ve tried bolusing a unit with the old pod too if she is in range but it only helped temporarily and still goes high. What works a little better is doing a +50% basal for a couple hours leading up to bed time and then give a full correction, if needed, before bed. She used to be in the 300s at 11pm on pod change days. (her basal doubles at bed time because she goes high anyway) Doing this it’s more like 200 which is an improvement but we are still working on it.

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7 Tonya May 18, 2011 at 10:27 am

Thank you so much for this post and this question, Leighann! We change Charlotte’s pod around 5pm and we usually see a higher than usual bg at our first nighttime check. I have found that if I give her one unit from her old pod before we remove it, it has helped, but not always. I love the Princess pod and decorating idea! 🙂

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8 Sarah May 18, 2011 at 10:35 am

We use the animas ping and within the last few months we have had this issue as well. We usually change sites in the morning and have been getting phone calls from school mid morning with huge numbers and my response has been we just changed sites this morning. Very frustrating. Any ideas for ping users?

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9 Stacey May 18, 2011 at 10:56 am

I like when you say it might be an old wives’ tale – this technology is so new I think we’re creating the tales!! (and no, I am not referring to myself or to anyone reading this as an old wife. we have enough going on!!)

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10 Leighann May 18, 2011 at 12:12 pm

I couldn’t decide between “old wives tale” or “urban legend.”

Maybe it should be “tired d-moms tale.”

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11 Penny May 18, 2011 at 1:38 pm

We don’t seem to have this issue, but I do bolus .50 on the new pod that I have changed. So I take off the old pod, put the new one on and immediately bolus .50 for Grace. We don’t run any highs related to pod changes this way. It seems to work for her.
And it seems everyone has pod/pump change set times?! I never knew! We change whenever it runs out, honest. Could be 8 am, could be 5 pm, could be 10 pm. I do always check to see if she ‘expires’ overnight as we don’t do pod changes then. Interesting folks.

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12 Christine May 18, 2011 at 1:48 pm

Yes, it totally happens for us. One thing we started doing was changing the pod about 30 minutes after eating. That way the meal bolus (and correction, if needed) has been delivered with the old pod. Also, we want to make sure that the insulin from that bolus has been given time to absorb entirely. We always try to change pods after breakfast, but as we all know with this disease, you can’t truly “plan” these things. Our thinking is that when you insert the canula, you are essentially creating a small “injury” in the body. Therefore, the body’s defensive mechanism takes over and does things like send white blood cells to take care of the invader. (I actually have no idea if that is exactly what happens, but sounds good.) We feel like if we “rest” the canula by giving the body time to realize there is no invader and things are just hunky dory then the next bolus will be absorbed better. Since we have done this, we only get post-pod-change highs maybe 8 out of 10 times, instead of most of the time. I have wanted to try the leaving the old pod on trick, but my 7-year old will not have it! Who knows if any of these tricks truly work, but it definitely is an absorption issue.

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13 Sarah May 18, 2011 at 1:49 pm

We don’t change at the same time always but we always check before sending her to school so she doesnt have an alarm go off in the middle so we do often change in the mornings.

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14 Denise aka Mom of Bean May 18, 2011 at 2:10 pm

We always add at least 0.5u to Bean’s first bolus with a new pod…usually changed right before dinner.
We’ve experimented with different ‘add on’ amounts and at one point we were up to 0.9u. Then that started to be too much and we went down to 0.75u, and now 0.5u seems to be doing the trick.
If we don’t ‘add on’ to that first new pod bolus, we 99% of the time see a high. It’s like it needs an additional prime with the first bolus, not just the priming that happens during the activation process.

We heard this first from a podding friend and then our CDE confirmed that she’s seen the need for it with pretty much all of her podders.

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15 Sandra May 18, 2011 at 9:44 pm

We run into that every Pod change too. Frustrating. I usually have my daughter bolus .50 before she changes to the new Pod, the first blood sugar check is usually ok, it is always the second check we see a high. I like the comment about trying the bolus .50 on the new Pod. I am going to try that.

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