Caleb has been pumping with Apidra® for over two years. Prior to that, he used Novolog®.
Shortly after that post, things went a little sideways and I didn’t know why. He had unrelenting highs at night. I would correct mid 200s all night long to no avail and end up with a wee hour Pod change. Then two nights later it would happen all over again, just like Groundhog Day.
I’ve brought you right to the punchline, so the problem is probably crystal clear to you. It was anything but clear to me at the time. This is why:
– Caleb had been pumping with Apidra® for about two months with no issues at all. His Pods would last the full three days and even up to eighty-hours with the 8 hour grace period.
– The “sideways” path started around the holidays. The variables were greater at this time. Timing of meals, content of meals. Schedules in general were off. BG control can easily be less than optimal in these circumstances.
– The pattern of highs every other night had not quite established itself. We were still getting some Pods through the full three days without an issue.
– Not a single person I knew who was Podding and Apidraing had this problem. All sailed smoothly through their full three days.
– Then there was the night when he actually did correct and I convinced myself that it couldn’t be the insulin clogging in the pump. Remember, I was not sleeping much during this time, so my reasoning was less than optimal.
I tested EVERYTHING. Food. Activity. Basals. Site locations. Moon phases. I called EVERYONE. Users. Insulet. Sanofi. Insulet again. Sanofi again. More users.
I thought Caleb might have to change pumps. If you know us, you know Caleb has only pumped OmniPod®. It’s been six years. We’ve never considered anything else. But Apidra® had been so effective, I was considering a pump change rather than an insulin change.
Finally, I tested the insulins. I put Caleb back on Novolog®. He went a couple of weeks and managed through day three without a problem. I put him back on Apidra® and the second day highs came right back.
It was clear. At right around the 48 hour mark, insulin seemed to have trouble getting through.
The photos in this post are of different cannulas from problematic Pods with what seems like obstructions. I had seen many a cannula before this issue that looked much the same. These other cannulas had been delivering insulin freely according to Caleb’s BGs. So even the visual evidence found in these photos didn’t convince me right away.
So we had to decide whether pump changes every two days would be worth it. I look back now remembering how difficult a decision it was, yet today it’s no big deal. It’s a slight nuisance to change Caleb’s Pod 15 times a month instead of 10. Nothing more.
And it’s worth it.
He’s using his pump of choice and my insulin of choice.
There are some benefits to more frequent site changes:
– Caleb’s sites heal MUCH more quickly. His scarring is greatly reduced. I noticed this almost instantly.
– He almost never has a kink, failure or delivery issue in any way, shape or form. This has been HUGE. When we were changing his sites every three days, that third day could be rather suspenseful. I only realized this in retrospect, now that the suspense is gone. I used to wonder more about what might be causing an unexplained high and take a gamble on whether it was just diabetes being diabetes or if there was a delivery issue. Many a time I took the wrong bet and took off a kinked or clogged Pod. Now it’s almost always diabetes just being the PITA that diabetes is, and we can correct and move on with confidence. To me, this has really had a great impact on Caleb’s overall diabetes management: increased confidence = better decisions.
Although this doesn’t seem like a prevailing issue, I know we aren’t the only ones experiencing this. If you’re having a similar challenge and haven’t quite decided what the problem is, I hope this post may help a little.
Next up: Eliminating Another Insulin Variable.
This is Caleb... 
I have the exact same problem with Animas Understand. We use Humalog but were using Novolog with the same results. He just can’t wear them pas about 1 1/2 days. I had to keep logs for a long time to show the Endo before they beloved my theory. He had consistent highs on day 2 and 3 right after a site change. We ended up having to switch to steel cannulas to get a full 2 days. I really think its something about his body that maybe it starts healing too fast around the teflon cannulas or something. Now we HAVE to change on day 2 due to the steel cannula, but numbers are better. Such a constant puzzle.
Interesting. I never thought to track bgs as they relate to day of pod wear.
We aren’t quite a year into diabetes. I didn’t realize there were differences between insulins. When we were on shots, lantus burned going in so we switched to levimere. But I never considered different absorption rates, tails, etc. So much to learn…
Hi Jessica. There is a LOT to consider. It’s why diabetes can be so complicated and unpredictable. Thankfully though we have many options to consider to help each of us manage diabetes the best way since everyone is different. It can be intense trying to figure it all out though! I just try to take it one step at a time. 🙂
After reading this story, I think this has hapened to us as well. There have been multiple times when my daughter’s numbers were high with no explaination and I have had to change the pod early. I can’t say that it happens all the time but definitely worth tracking when it does. She has had diabetes for 5 yrs now and we are always learning something new. Thank you for sharing your story.
We have had the exact issues, coincidentally happening at night also (its amazing how most issues occur while we are trying to sleep!)… I too have thought of every variable and agree it has to be the insulin. Apidra actually recommends not using over 48 hours in a pump. I have (maybe) found a work around for us to get through three days that I thought may be worth sharing- I keep his vial of insulin in the fridge up until it is time for a pod change, at which point I warm, use and then put back in the fridge. He still travels with a vial in his pump bag, but I do not use it for pod changes. I noticed in comparison to new vials, opened vials that traveled with my son seemed to get cloudy before the end of the 28 days. We have been trying this new method for about a month and have had success (knock on wood).
Now if we could only find a solution for the post pod change highs (as there is NO consistency on that for us!)
Interesting thought, Amber! I had tried to keep the vial in the fridge, but it wasn’t practical to put it in the fridge, take it out when we left the house, put it back in the fridge, etc. I didn’t think to have a different vial with him than to fill from. Hmmmmm…..
I have NEVER been able to do more than 48 hours on a set, and I’ve only done Humalog or Novolog. (And even hours 46-48 can get a little hairy as my BG slowly drifts up.) I gave up trying to get any more time and just acknowledged I’m an every-other-day kind of girl. Caleb is in good company!
My husband has type 1 and he has been pumping with a One Touch Ping for 5 years. He switched from Novalog to Apidra and loved how it worked for him. Unfortunately we are now dreading site changes every third day because he goes high immediately after he changes his site. It takes several hours of corrections, new cartridge fills, and additional site changes to get him back in range. We’ve even tried being proactive about it by giving extra insulin prior to changing the site. His endo is not sure why this keeps happening. I’m thinking it’s time to change insulin. Any ideas?
Wow – every time he changes a site? I can understand dreading this. Have you eliminated scar tissue as an issue? I had thought that might be Caleb’s problem. I knew it wasn’t when arm sites had the same results (he never uses his arms). Sometimes it seems like Caleb’s highs are from a new site, but I suspect it’s more the old site petering out right before we changed. That’s not your issue either, eh?