1. 1. Rotate Your Sites: Since you have to change your pod every three days, it is important to rotate through a number of different pod sites.  We have 4 sites that we prefer – each side of belly and each side of upper buttocks.  In addition we rotate having the cannula facing out or in, so in effect we have 8 different placements.  This ensures that our son doesn’t create any hard tissue where we place the pod.  Such hard tissue can affect the ability of the pod to release insulin.
   2. Pinch When Inserting The Cannula: We always pinch the skin around the cannula when it is about to insert into the skin.  This helps to ensure the cannula is inserted into the skin layer and not down into muscle.  Not only does inserting into muscle really hurt, but it also will cause a blockage of insulin and likely bend the cannula, thus causing an error.
   3. Insulin At Room Temperature: We store our insulin in our refrigerator.  Not entirely sure this is needed or not, but we’ve just gotten into that habit.  However, we store our pods in a cupboard at room temperature.  Because the two items are at different temperatures, when we add the insulin to the pod we’ve sometimes experienced immediate errors.  Nothing like destroying a pod before you even get to use it.  Now what we do is either leave the insulin out for 30 minutes before injecting it into the pod or simply hold it in our hands for a few moments to bring the temperature down.  This seems to have eliminated these early errors.

Are there other tips that we should be following?  We still certainly get the occasional error but we haven’t yet figured out why.

Overall, it takes us between 2-4 minutes to change a pod, depending on how organized we are.

You’ll need 4 items on hand to make the change:

• Your Omnipod Personal Diabetes Manager (PDM)
• A new Omnipod packet (comes with a new pod and a new syringe)
• Your insulin (we use Novolog)
• An alcohol wipe

Here are the steps we take:

• Deactivate and remove the old pod:  By turning on your PDM and going to Home>Actions>Change Pod you’ll be able to deactivate your existing pod.  Make sure the PDM is close to the body and wait for the 2 little beeps that tell you your pod is deactivated.  Once deactivated, remove the pod from your body.  We find starting at the back of the pod is easiest so that the cannula comes out smoothly.

• Fill the new pod:  You’ll now want to fill the new pod with your insulin.  Just take the alcohol wipe and clean the top of your insulin.  Then, on your PDM, given your old pod is deactivated, it will ask you if you want to activate a new one – select yes.  Use the syringe that came with your new pod pack and fill it with the correct amount.  The minimum is 100 milligrams.

With the insulin in the syringe, make sure your PDM is on (sometimes it auto shuts off) and insert the syringe into the fill spot on the pod and pump the insulin in slowly.  With the PDM right next to the new pod, once the insulin is in, you’ll again hear 2 small beeps, letting you know you’ve succeeded.  At this time, hit Next on the PDM and it will ‘prime’ the new pod – essentially making the necessary connection between the PDM and the new pod.

Here’s a tip:  We store our insulin in our refrigerator and keep the new pods at room temperature.  Sometimes this difference causes errors with the pod.  When we load the insulin into the new syringe, we simply wrap our hands around the syringe for a minute to warm it up a little before placing it into the pod.

• Place new pod: Once your PDM says that it is done priming, you’re ready to place the pod onto your body.  We tend to rotate through 4 different spots:  each side of the tummy and each side of the upper buttocks.  Choose your location and clean it with you alcohol wipe.  Make sure it dries and then remove the cover to the new pod’s cannula area and the sticky tape and position the pod.  Make sure you smooth out the edges and press them down so you have a nice seal between the pod and your body.

• Activate new pod: This is the only part where you may feel a little pinch.  This is when the cannula gets inserted into your body.   Your PDM will guide you and ask you if you’re ready.  Say yes.  It is recommended that you pinch the skin around the area of the cannula so that you give it an easy entrance.  You’ll hear a couple of clicks from the PDM and then WHAM, the cannula will be inserted.  At first this was a bit shocking for our son and it hurt a little.  He’s now well used to it.  The PDM will finally ask that everything is inserted ok.  To be honest our eyes are good enough to see if the cannula is properly in there, but as long as we don’t see anything strange (blood, bent cannula, etc.) we press OK.

You’re now good to go.  Feel free to head out and go swimming if you want.  The Omnipod will allow you to do that.

Enjoy.

Though we are all hopeful for an eventual cure for Type 1 diabetes, the continued wins researchers are seeing in their quest to create an artificial pancreas is heartening.

Most of the focus in the news recently is on recent improvements in combining insulin pump technology with continuous blood glucose monitoring.  Intuitively it would seem simple.  Have a single device that measures blood glucose on a continuous basis and based on readings release insulin into the body.

Ah, but nothing is as easy as it seems.  Numerous challenges exist, but a key one is the lag between food consumption, what a glucose monitor measures, and the ability to get insulin into the system.  What needs to happen is to be able to predict glucose levels based on types of foods being eaten and immediately release the insulin to welcome the food. (Our body’s ability to do this is simply remarkable)

There are folks working on this problem luckily.  A recent article in US News and World Report describes the effort of a team of mathmaticians, let by Boris Kovatchev, that are developing algorithms based on specific individual’s insulin requirements.  So far they’ve had some luck.

Another group attempting to tackle this are out of the University of California Santa Barbara.  They recently released results of a study of a software program that they have developed to do just this kind of anticipation and ensure that not too much insulin is released.

Soon enough (in the next year or two? maybe?) all-in-one devices will be on the market to help manage this disease.

Oranges are great for hypoglycemia

We’ve tried lots of different foods when our son suffers from low blood glucose levels (hypoglycemia).  Depending on how low he is and what activities he’s about to undertake we’ve gotten comfortable with a good variety of different choices.

The obvious goal when treating hypoglycemia is to get some food into the body that will quickly turn into glucose and raise those levels.  If you’re really low (typically below a reading of 60) you want to act quickly and so you’ll go for something with a faster-acting sugar.

If you’re just a little low and you know you’re going to be exercising soon (and so likely to go lower) you may choose to eat a more complex carbohydrate that will digest and turn into glucose over a longer period.  Managing diabetes and sports is complex and this will help sustain you through your exercise.

Old school diabetes treatment was to pop some kind of candy into your mouth and chew.  Obviously, our son loves this.  Post Halloween we caught our son out running on our treadmill (which he’s not allowed to do).  When asked “why?”, his response was that he wanted to get low so he could enjoy one of his candybars.  Pretty saavy for an eight year-old, but we obviously gave him a bit of a scolding and explained to him why that was a bad idea.

We do try to monitor his intake of sugars (including high fructose foods) and so tend to stay away from using the traditional candy and fruit juices to combat lows.  Here are a few of our favorite foods to use:

• Natural Orange Juice – 4-8 oz.  Great for when he is really low and we need to raise his levels quickly.
• Apple – Also good for a relatively quick rise.
• Tangerine – Natural sugars work great.
• Dried Apricots – Good natural sugars.
• Dex 4 Glucose Tablets – 2-3 tablets.  These act quickly and perfect though for a kid they’re not as ‘fun’.
• Whole Wheat Toast – 1/2 slice.  Better for a bit of a longer digestive cycle.  We’ll use this when he’s not too low and is still active in the day.
• Milk – 8 oz.  This is good when he’s not too low but also hungry.  Helps to fill the stomach and is a bit slower acting.

We’re always trying new foods though as we’re eager to have our son enjoy the variety of what the world has to offer.

Tell us about the foods you use…

Hyperglycemia is primary reason behind long-term complications of diabetes

Hyperglycemia occurs when blood glucose levels rise beyond normal levels. Unlike hypoglycemia there are typically no immediate negative side-effects, however it is hyperglycemia that tends to be the long-term battle of most people with diabetes.

Because those with Type 1 diabetes are not able to produce insulin, there is the constant danger of rising blood glucose levels, especially after meals. Over the long run (years) if you suffer consistently from hyperglycemia you are at more danger of nerve and organ damage. All of those nasty side-effects of diabetes (blindness, heart disease, amputation of limbs, etc) are all a result of long term hyperglycemia.

On a more immediate front, if someone is suffering from extreme hyperglycemia over the course of days, they are very likely to contract ketoacidosis, which can have very serious complications.

Hyperglycemia in people with Type 1 diabetes is almost always a result of either missing a dose of insulin or miscalculating the number of carbohydrates they just consumed and thus taking an insufficient dosage of insulin.

How can you identify Hyperglycemia in your child?

Everyone will be slightly different in their symptoms. However, hyperglycemia is typically associated with either headaches or stomach aches. What we’ve found in our son is that if he starts to complain of an upset stomach, it is likely a case where we’ve mis-calculated our recent insulin injection. He’ll come to us and say that he feels like he wants to throw-up, but in all other aspects is feeling fine – no headache, no aches or pains, no fever.

If you recognize these kind of symptoms it is best to test their blood glucose levels and get a reading on where they are at that moment.

How to manage Hyperglycemia

Because there are no immediate negative impacts, you need to first determine how high your child really is. With all the different insulins you’ll find that there are different potency curves and at times after a meal your child will just naturally have a high blood glucose reading. This is due to the fact that their glucose has risen quicker than the potency of the insulin. If you think the insulin has not yet kicked in and they are not extremely high, it is probably best to wait things out and look at how you need to adjust your insulin dosage calculation for the next meal.

On the other hand, if you feel your insulin should have already balanced out their carb intake, and they are significantly higher than what you would expect (e.g. over 200 on a blood glucose level), you may want to provide them with another small dose of insulin to bring them back down. If you do this make sure you keep this in mind when they next consume food. Should you adjust your insulin dosage down?

Overall, hyperglycemia is not as immediately dangerous as hypoglycemia, however, over the long run it is the primary reason why those with diabetes contract more serious health issues. As such, it is critically important that you manage blood glucose levels so that your hyperglycemia episodes are subtle and infrequent.