# First 3 days on the Omnipod.



## Pattidevans (Jan 22, 2022)

I just thought this account might be of interest to anyone thinking of going onto the Omnipod.

I was nervous about starting the Omnipod  as  I have been on the Accu-chek Combo for 8 years and was so used to it.  However the training was absolutely amazing.  It was done by video conference  on Wednesday  between myself, the Omnipod rep and the pump nurse.  In advance I had supplied the pump nurse with my basal rates, which apparently don't  conform with most people's in as much as  they rise little by little from midnight to noon and then slowly drop until I am barely on any insulin from 18:00 to 20:00 when they begin to rise again until midnight, when they halve.  In contrast the nurse said that generally the format to follow a circadium rhythm is to start at a rate then a slight increase from 3-4 am then a drop from 8 am till mid afternoon and then a gentle climb until midnight and then from midnight a drop.  The combo allows for 0.01 increases, but the Omnipod only does 0.05u.  So the nurse had sent me a proposed schedule which looked very reasonable to me and conformed to my personal rhythms.

 I had watched the videos on the Omnipod website twice, which did help, even if I only retained about 50% of what they said.  The training with Emma (the rep) followed the format on the online videos, ticking off each item to ensure I understood it at every stage.  We went through all the functions of the PDM  and set all my basals before she supervised me filling the pump and starting it.  To give you some idea I attach a  form which shows what the  training encompassed.  At the end she explained how many boxes of pods I could order and that the 0800 number was available  24/7 in case of needing tech assistance, or even ordering.  She also explained about their recycling programme, and  told me to ask to be included in this recycling project.  It did help that I understood the basic principles of pumping.  I wondered how anyone new to pumping  would get on.

I put it onto my arm, above the elbow at the back of the arm.  I had never used  arms  for injections and Emma warned that absorption may be much increased  and faster on "virgin" territory.    In total the training lasted 2hrs 15 minutes.  By this time it was lunchtime and  due to the fact we had received  a delivery of goods which needed to be frozen, we had removed some left over Christmas "party food" from the freezer  to have for lunch.  Mistake... 3  Bao buns and 3 duck "straws" (85g carb)  gave me a huge spike during the afternoon! Now I know why I like to restrict carbs  somewhat. We'd arranged to have an  early dinner at the local pub with some friends and I bolussed as I  normally would for the meal, although BGs were  still higher than I'd  have  liked at 9.9.  We were home by 8pm, at which time my BG had dropped to 6.1... it then continued to drop, despite toast, honey, tea  with sugar, numerous Dextrose tabs, skinny whip bars, suspending insulin for two separate half hours etc etc.  At 3.29 I set an ongoing temp basal of 30%  and finally slept.  So Emma's warning regarding absorption was very apt!  However, after that first day things settled back to normal and I have had no further trouble.

In relative terms the Combo  was a good workhorse but had nothing like the sophistication of the Omnipod.  Yes, I could set extended/dual wave boluses, put on temp basals  etc etc... but the Omnipod PDM is amazing and provides so much more information, all of it useful in managing your diabetes.  I also like the feature where it keeps a record of your infusion sites so you don't repeat them too soon.  I am really quite smitten with the Omnipod.

Things I don't  like:  I don't like filling the syringe from the vial.  I feel as though 3 hands would be useful during this process!  It seems  rickety  and I'm afraid of dropping the vial which wobbles  around on the needle.  I'm sure I will become adept... but for anyone with arthritis or  shaky hands it might be a permanent problem.   

I'd prefer that the PDM incorporated a BG  meter, but that's minor.  At the moment the only strips I have are for my Combo handset which is quite large and heavy.  The nurse has suggested I get Freestyle  Optium strips so I can use the Freestyle Libre 2 reader as a meter since it also reads the Optium ketone  strips.  It's smaller and lighter so will work better.  I've  spoken to the surgery and should have a script in process to pick up next  week.  During the training I discovered my Ketone strips were only a year out of date and my back-up Levemir a a mere 4 months out of date!

Today I changed the pod successfully!  Woo hoo...


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## SB2015 (Jan 23, 2022)

Thanks for this @Pattidevans 
It is so useful to read of people’s experiences of changing pumps.
Always difficult as we get so used to our old ones, also good to hear that the training is so good.

Is the PDM much the same as our old Combo handset controls, apart from the blood test bit?
I shall be interested to hear how you find having the pump on your arm rather than a cannula, as well as what this offers that the Combo didn’t.


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## Pattidevans (Jan 23, 2022)

SB2015 said:


> Thanks for this @Pattidevans
> It is so useful to read of people’s experiences of changing pumps.
> Always difficult as we get so used to our old ones, also good to hear that the training is so good.


We do get used to our old ones.  4 days in I am still feeling round for my pump and tubing when I wake in the night to go to the loo!  I couldn't actually feel it on my arm.  I just felt completely free.


SB2015 said:


> Is the PDM much the same as our old Combo handset controls, apart from the blood test bit?
> I shall be interested to hear how you find having the pump on your arm rather than a cannula, as well as what this offers that the Combo didn’t.


It's nothing like the old PDM.  I've attached some pictures.  Basically it's a modified mobile phone (doesn't make  phone calls though).  When you turn it on, before entering your pin it shows how much active bolus you have on board - something I don't think was ever available to view on the Combo.  Actually with the Combo if you look at "my data" all you can see  are the times you tested, what your BG was then, what carbs you entered and how much insulin you took then.  The Omnipod home screen shows your current basal profile in detail, last bolus, last BG.  With a button if you want to bolus.  If you go into "settings/History" you can see a lot more detail and if you scroll down further it tells you what time you put a temp basal on, when it finished and your basal reverts to normal.  You can ask for just today, 7 days, 30 days etc or you can set your own time period.  You can also see notifications and alarms that have happened.  There's so much info in "settings" I haven't yet got to grips  with.

What is slightly worrying (though I expect I'll work it out eventually) is that when I put the first pod on and had been warned about virgin territory I experienced that long low.  I  just thought it was having it on my arm.  Yesterday I put it on 
a site on my midriff where I have had  cannulas a million times.  I had the same low  hooha  after dinner, which went on until  3 am, despite suspensions, biscuits, dextrose etc.  The Libre alarm was waking me  every time I dropped off to sleep.  Eventually a -25% temp  basal  for 6 hours stopped it. (-20% earlier hadn't).  I am wondering if I'm experiencing quicker absorption because the cannula is going into a different subcutaneous level of my skin. I was using 6mm cannulas which went into the skin at 90deg i.e. perpendicular, thereby releasing insulin further in than the Omnipod .  The cannula of the Omnipod  goes in at a slight angle of approximately 45degrees  to the skin i.e. some 45deg from the perpendicular.  In other words almost  sideways.  So suspicion that the insulin is being dispersed in a different manner.  I could be  wrong.  The last pod normalised  levels on day 2 so I'll see what happens with this 2nd pod.  I'd be interested in hearing from other users.


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## m1dnc (Jan 23, 2022)

Yes, I think that the different cannula size and angle affects absorption. With my old tubey pumps I used 9mm straight-in cannulae and when I started on the Omnipod I noticed a similar change. Over the first few weeks I fiddled with my basals and carb ratios and got it to work as intended. According to my Dexcom weekly report today I was 90% time in range, so I think it is OK.

I use the backs of my arms most of the time now, and I have to check to remember which arm it's in, it is so comfortable. 

BTW don't take much notice of the bolus on board figure on the sleep screen as (I think) that is the BOB figure for when the PDM and pod last communicated with each other. The 'real' BOB is the one shown on the dashboard screen when you've woken the PDM up with your PIN


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## Pattidevans (Jan 23, 2022)

m1dnc said:


> Yes, I think that the different cannula size and angle affects absorption. With my old tubey pumps I used 9mm straight-in cannulae and when I started on the Omnipod I noticed a similar change. Over the first few weeks I fiddled with my basals and carb ratios and got it to work as intended. According to my Dexcom weekly report today I was 90% time in range, so I think it is OK.


Ah, thank you for that!  I am wondering if it will settle tonight though.  if it does then I may have to have a basal profile for day one of a new pod only!  Gordon Bennett... diabetes can sometimes be such hard  work if you want decent control can't it?

I think I will be using the backs of my arms quite a lot!


m1dnc said:


> BTW don't take much notice of the bolus on board figure on the sleep screen as (I think) that is the BOB figure for when the PDM and pod last communicated with each other. The 'real' BOB is the one shown on the dashboard screen when you've woken the PDM up with your PIN


Thanks, that is very useful to know!  I was wondering last night why I still had 0.8u active when it was more than 4 hours after my last  bolus.


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## SB2015 (Jan 24, 2022)

Pattidevans said:


> Gordon Bennett... diabetes can sometimes be such hard work if you want decent control can't it?


I think any switch to a different pump takes a lot of work, and maybe we have forgotten how hard our first pumps seemed, even though they were a lot more basic.  I know that I ditched my new one for a month and went back to the combo for Christmas and New Year 20 as there was no time to get things sorted.  ThenI set aside time to start again with the new one.  It certainly tempts me to stay with the same manufacturer at the next switch but who knows what will have changed by then, and I still miss the remote bolusing which I have lost.

I hope that you had a better night and that things settle down soon.


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## Pattidevans (Jan 24, 2022)

Hi @SB2015 

I think I’m just mildly surprised.  I had thought that ‘a pump is a pump and if I put the same ratios in I’ll get the same results’.  The only reason it dawned on me about possible sub-cutaneous levels being a factor is due to knowing about embedding the Libre in advance and issues related to that.

I had another nasty low after dinner last night.  Took quite some correcting, then putting on -25% basal for 5 hours.  So today I’m going to reduce basal from about 7pm to midnight by 20% and see how it goes.  I’m willing to put in the work to get it right.  Still I think this is a very useful discussion for anyone considering switching from a tubey pump to the Omnipod.

I appreciate the handset, even though it has no inbuilt meter (you would have thought that they’d have thought of that wouldn’t you?). Also being tubeless is a delight!


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## helli (Jan 24, 2022)

Pattidevans said:


> Still I think this is a very useful discussion for anyone considering switching from a tubey pump to the Omnipod.


I am finding this thread interesting. I went from a tubey pump (Animas) to a tubeless one (Medtrum) a couple of years ago.  I did not experience any of the issues you are finding. 
Are you using different sites to what you did previously? I find different sites react differently and I find the tubeless has more flexibility. 
I also found the minimum dose on the Medtrum was greater than for my previous pump so had to play around with the basal patter a little. Annoyingly for my DSN, I found the best way for me to handle it was to alternate my dose just over and just under my previous levels every 30 minutes. This gives me lots of basal changes but as I am quite insulin sensitive, the average balances out. 

Like you, I love being tubeless and not having to get my pump out. I am grateful the Medtrum has a phone app, especially as I am comfortable bolusing from my (xDrip calibrated) Libre so everything is on my phone. 

Prior to the phone app, I had a small PDM about the same size as a glucose meter and was disappointed I had an extra gadget to carry around. The excuse given was that it gave me more flexibility to chose the meter I want. I did not buy this.


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## Pattidevans (Jan 24, 2022)

helli said:


> I am finding this thread interesting. I went from a tubey pump (Animas) to a tubeless one (Medtrum) a couple of years ago. I did not experience any of the issues you are finding.
> Are you using different sites to what you did previously? I find different sites react differently and I find the tubeless has more flexibility.


The arm was a different site to any used previously, but I deliberately put the second pod onto a site I used frequently in the past.  I'm convinced it's the depth of the cannula that's causing the problems.  Certainly there's more flexibility for different sites to be used, one of the reasons I wanted a non-tube pump.


helli said:


> I also found the minimum dose on the Medtrum was greater than for my previous pump so had to play around with the basal patter a little. Annoyingly for my DSN, I found the best way for me to handle it was to alternate my dose just over and just under my previous levels every 30 minutes. This gives me lots of basal changes but as I am quite insulin sensitive, the average balances out.


Yes, the minimum on the Omnipod is 0.05 whereas it was 0.01 on the Combo.  I balanced it out and ended up with just  0.03 higher total with the Omnipod. That may be making a difference as I think I am quite insulin sensitive too.   It all needs tweaking though, which I intend to do today.


helli said:


> Like you, I love being tubeless and not having to get my pump out. I am grateful the Medtrum has a phone app, especially as I am comfortable bolusing from my (xDrip calibrated) Libre so everything is on my phone.


I think I might have to think seriously about xDrip.  It would be nice to trust the Libre.  Having said that, I find most sensors are actually quite close to BG tests, though I wouldn't trust all of them.


helli said:


> Prior to the phone app, I had a small PDM about the same size as a glucose meter and was disappointed I had an extra gadget to carry around. The excuse given was that it gave me more flexibility to chose the meter I want. I did not buy this.


Ha ha... what an excuse!  One presumes they actually consult real people with diabetes?  None of us wants to carry anything extra.  My bag is heavy enough as it is and if I have to carry it for any length of time it pulls my back out and is painful as I have a fractured vertebra.  Hubby bought me a smallish leather back pack, but the straps slip down nylon anoraks and won't stay on my shoulders.  In summer I've been able to hone  stuff down and use only a  bum bag most of the time, but if going out for the day I need more stuff.


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## rebrascora (Jan 24, 2022)

Just want to say that I am really finding this thread interesting and illuminating despite not being a pump user, so thanks for documenting your journey with your new pump Patti. 

Just a query.... As I understood it, tubed pumps with separate cannulas were supposed to give you more options/flexibility for sites than a patch pump..... Correct me if I am wrong in that understanding please. Just wondering if that is the case, you couldn't use your upper arms with a tubed pump? Obviously in summer with sleeveless tops you might want to avoid that area but would it be a problem in winter? Is it just the movement involved with arms which would make it difficult/uncomfortable/vulnerable?


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## Pattidevans (Jan 24, 2022)

rebrascora said:


> Just want to say that I am really finding this thread interesting and illuminating despite not being a pump user, so thanks for documenting your journey with your new pump Patti.


I'm glad the thread is proving helpful at least  I did wonder if it was a bit self-indulgent.


rebrascora said:


> Just a query.... As I understood it, tubed pumps with separate cannulas were supposed to give you more options/flexibility for sites than a patch pump..... Correct me if I am wrong in that understanding please. Just wondering if that is the case, you couldn't use your upper arms with a tubed pump? Obviously in summer with sleeveless tops you might want to avoid that area but would it be a problem in winter? Is it just the movement involved with arms which would make it difficult/uncomfortable/vulnerable?


Well, I used to keep the pump in my trouser pocket so the length of tubing I had (60cm) rather prohibited arm use if I wanted to move freely.  You can get longer tubing (80cm) but that's a heck of a lot to accommodate in your clothing.  Some people clip the pump to their bra - I really couldn't as I have an apple shape and it would have meant a huge lump at midriff level - so arm use may be possible in that case I suppose.  I currently have my pod on my midriff, but it's soooo much smaller than a tubed pump.  You can put a pod pump on your back.  I tried putting cannulas on my back, but as you have to unclip them when showering It was difficult to re-clip them in place on your back - had to use the help of hubby which annoyed me as I prefer being independent.  I also tried cannulas in my thighs, but again I found it restricted movement somewhat.  Personally I think the pod is more versatile.  I'd be interested in what other pump users think.


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## Pattidevans (Jan 24, 2022)

PS I will be happy to wear the pod on my arm even in summer clothes.


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## helli (Jan 24, 2022)

Pattidevans said:


> PS I will be happy to wear the pod on my arm even in summer clothes.


If Lila Moss was happy to expose her OmniPod on the catwalk last year, I see no reason not to wear it your arm.


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## Pattidevans (Jan 24, 2022)

I have just made "Basal 2" and reduced insulin for several different hours by 20%.  I've gone from 10.85 on Basal 1 to 10.4 on Basal 2 which I am now using.  On the  Combo  I was on 10.87.  In the scheme of things such tiny tweaks, but I have found in the past that these tiny tweaks make one heck of a difference.  Will see how I get on later today!


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## everydayupsanddowns (Jan 24, 2022)

Pattidevans said:


> I have just made "Basal 2" and reduced insulin for several different hours by 20%.  I've gone from 10.85 on Basal 1 to 10.4 on Basal 2 which I am now using.  On the  Combo  I was on 10.87.  In the scheme of things such tiny tweaks, but I have found in the past that these tiny tweaks make one heck of a difference.  Will see how I get on later today!



Really interesting thread! I’m sure lots will find it useful.

Good idea to keep your original pattern to one side Patti. Particularly if your diabetes is as annoying as mine, and sometimes does a u-turn after a few days of improvement, so that you need to go back to your earlier version!


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## helli (Jan 24, 2022)

rebrascora said:


> Just a query.... As I understood it, tubed pumps with separate cannulas were supposed to give you more options/flexibility for sites than a patch pump..... Correct me if I am wrong in that understanding please.


That is often said but my experience was definitely not the case.
A tubed pump requires you to be able to find a location to put the pump like a waist band to clip it on to or a pocket to put it in. Some women clip it on or put it in their bra. To put it at delicately as possible, if I put it in my bra, I would be very lopsided. Plus most tubed pumps require you to extract the pump to bolus. Fiddling around in my bra is not something I would do in polite company.
A tubeless pump requires no clipping and bolusing is done via remote control. Plus a tubeless pump is typically smaller so my “Pump bulge” is smaller.
When I switched from my tubey to tubeless pump, I was able to wear a dress and worry far less about the way tailored outfits laid.
Plus I was able to return to polite company again


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## SB2015 (Jan 25, 2022)

I have always been averse to a patch pump thinking they were a bulky lump and worried about dislodging it, but good to read this thread and I shall wait and see in three years time.

I have only used tube pumps, and do tuck it in my bra, but ‘have enough spaced’ so that it is hidden.  I also tuck it away under my arm pit in a sleeveless dress. Other times wearing jeans skirts I just clip it onto my bra and it hangs happily.  I preferred having a pump where it was tucked away and left all day and managed via a pdm, but At my last changeover there were none for closed loop unless I wanted to do that diy.  

At every pump change it is a case of identifying your own priorities, and this forum is great for practical experiences of each.  As @Pattidevans and @helli have shown already experiences are so different, and that also helps To see how we are so individual.


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## Pattidevans (Jan 25, 2022)

So this is my overnight, which I am cautiously pleased with.  I could do without the drop from about 7 am so have added a couple of reductions from 05:00 (for those not on pumps, you need to change insulin 2 hours before the time you want to change the result i.e. start reducing at 5 am if your line is dropping from 7 am).


helli said:


> . Fiddling around in my bra is not something I would do in polite company.


 I went to a couple of weddings before lockdown... at the first I was seated next to a "frightfully up-himself" uncle of the groom.  I think he might have fainted if I had groped down my bra where pumpy was hiding!  Fortunately the tubey pump I had at the time allowed me to bolus discreetly.  At the 2nd wedding, due to the design of my dress I was able to safety pin a little "pocket" to the lining of the dress, so the pump hung at the same place it would be if in a trouser pocket.  Unfortunately (and for probably the only time ever) I had forgotten to take my PDM in my teensy ornamental bag.  I had to repair to the ladies and remove my dress to do a manual bolus!  That decided me - NO pump without a PDM.

I'm looking forward to wearing a couple of dresses on holiday. 


SB2015 said:


> At every pump change it is a case of identifying your own priorities, and this forum is great for practical experiences of each. As @Pattidevans and @helli have shown already experiences are so different, and that also helps To see how we are so individual.


Exactly!  I am intrigued by the closed loop systems, but really quite happy just having a pump.


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## Pumper_Sue (Jan 25, 2022)

rebrascora said:


> Just a query.... As I understood it, tubed pumps with separate cannulas were supposed to give you more options/flexibility for sites than a patch pump..... Correct me if I am wrong in that understanding please. Just wondering if that is the case, you couldn't use your upper arms with a tubed pump? Obviously in summer with sleeveless tops you might want to avoid that area but would it be a problem in winter? Is it just the movement involved with arms which would make it difficult/uncomfortable/vulnerable?


You can use longer tubing which enable you to use your arm if you so please  Just run the tubing under your shirt.


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## helli (Jan 25, 2022)

Pumper_Sue said:


> You can use longer tubing which enable you to use your arm if you so please  Just run the tubing under your shirt.


I found I got tangled up enough in my tube, especially overnight, when it was a normal length. I am sure there are ways of handling longer tubes but, as I mentioned, you still need to find somewhere to attach your pump. And for most tubed pumps, it needs to be a place you can easily access for bolusing.


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## Inka (Jan 25, 2022)

I used my arm with my tubey pump for a short while. I can’t remember how long my tube was but it was the same length I always used and so would have been medium and not super-long. The reason it was a short while is that I found the absorption poor.

I ran the tube up my arm and had my pump either in my bra bag (clips on the side of bra under arm) or in my Hid-in waist belt. I didn’t get tangled because the tubing was under my clothes.


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## Pattidevans (Jan 26, 2022)

I wasted a pod yesterday as I attached it to my left arm too far round, so it was on my inner arm and I found it really irritating so I had to take it off (how you could wear your pump there @Inka I don't know - but kudos for being able to as it gives you more options). This morning I forgot the pod was there and pulled it with the towel after my shower.  The backing which attaches the pump seems a bit vulnerabe when it's wet and I pulled a tiny hole in it which meant the pump was pulling away.  I've stuck a load of Micropore tape over it which seems to be holding it fine.

Last night was nowhere near as flat as I went to bed with a BG of 8.4 due to eating very late - by 7ish I was woken with 4.1.  Fixed that and went back to sleep, then overslept, when I finally surfaced I was 6.4.  I can live with that though.... time in Target is stil 94% with only 1% below 3.9.


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## Inka (Jan 26, 2022)

Mine was on my outer arm @Pattidevans Kind of where you’d put a Libre. I also tried more towards mid-arm. Hard to describe arm bits but if you reach out your arm with the back of your hand facing the ceiling, I put it in the bit of the upper arm you can see, more towards the edge. 

As I said, apart from a few flukes, most of my arm sites were rubbishy absorption anyway. My thighs are my favourite site, but short of growing a few extra legs I’m forced to try new body areas after so long pumping. 

Just another fun little thing that diabetes likes to throw in


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## Pattidevans (Jan 26, 2022)

Inka said:


> I ran the tube up my arm and had my pump either in my bra bag (clips on the side of bra under arm)


Sorry I wasn't clear, I meant where you were wearing your pump, not the cannula.

You're right about the fun little things diabetes likes to throw at you!


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## Inka (Jan 26, 2022)

Pattidevans said:


> Sorry I wasn't clear, I meant where you were wearing your pump, not the cannula.
> 
> You're right about the fun little things diabetes likes to throw at you!



Ah, ok - got you My little bra bag is actually one I got when I first started pumping and it was so useful, I kept it. Its very comfortable and secure, really well-made. Perhaps I find it comfortable because my arms are always waving around and rarely still by my sides


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