Wednesday, February 15, 2012

Detecting Pod Issues

When we gave a review of the OmniPod in a recent post (here), we mentioned that things can happen with the pods that are not necessarily technical failures and that these can be relatively easy to detect depending on BG consistency.  In our case, the types of things that can affect pods are they’re being banged into things (yes banged – the normal bumping into or rubbing against things that we all go through every day certainly don’t cause problems), and the cannulas becoming slightly kinked, either from being impacted or even the initial insertion.  Both of these occurrences can result in insulin delivery becoming less effective, but not in a way that triggers an alarm.

If a pod is affected by being hit or pressed against something, it might not necessarily result in the pod looking or feeling as though the adhesive is becoming loose.  Since we have been using Skin Tac the pods remain secure no matter what.  What can happen though is the impact, which will likely force the pod against the body, can result in the cannula becoming loose.  Think of it like a candle in a cake.  If you were to push down or against the candle it will force it down further in the cake.  When the force is removed the candle will now be loose from the hole being made bigger.  We believe this can potentially result in a portion of the insulin not making it into Emerson’s system and creating high BGs.

We had this happen just this past week so wanted to outline it here as an example to illustrate what we were talking about in the prior post. 

BGs for a couple days prior:

AM Snack
PM Snack

You can see that there are some out-of-range readings, but none of those were particularly alarming to us the overnight period has been a challenge for us all along (her desired range is 100-200).  However, now have a look at her BGs the following day…

AM Snack
PM Snack

Things remained relatively consistent through breakfast, but then a significant spike occurred.  Emerson’s pre-school calls us every day at lunch to tell us what she is eating so that we can tell them how many carbs to dose for.  They told me she was at 331 at her pre-morning snack check.  They were a little surprised but I was very surprised.  We wondered immediately if something had happened to her pod but decided to see what future readings showed before determining if we needed to go to school and change it.  We ended up not going to change it and decided at dinner that she was close enough to her desired range that we would see if another bolus got us back in business (during the week her mid-morning and mid-afternoon snacks are covered by brief increases in her basal rate that we estimate based on the snacks they eat – so this was going to be her first real correction since lunch).  We never made it to the next check to see if the dinner bolus did the trick.  Emerson was playing and at one point layed down on her back, where her pod was at the time.  She got up quickly and said her pod hurt.  She then told us that early in the morning she ran hard into a chair with it and that it had been sore all day.  A quick look revealed that the cannula was a bit loose.  When we removed the pod, there was a small bruise on her back which indicated that she did bump into something with it.

After the change it didn’t take long for her BGs to get back to where we wanted them.  Her readings to start the following day were 144, 131, and 185.  Obviously our early suspicions were correct.  This was the first time that her BGs didn’t stay extremely elevated so it was a little bit more difficult to be completely sure until Emerson complained of the discomfort.  Normally you would see the BG be much less responsive to basal and boluses and even continue to creep up or maintain its elevated level.  We assume this is much easier to detect in little ones that have very low basal rates, as higher rate doses probably result in more insulin being delivered even when there is a problem.

We hope this provides a better sense of what types of things can happen and how the BG can quickly be an indicator of a problem.  Sometimes you may wait a bit to be sure, but you are quickly aware of the need to take a close look at the pod for any evidence of a problem.

1 comment:

  1. I like the analogy of a candle being lose in a cake! We usually see a little blood around the cannula, and the cannula's a little lose in the skin. Luke's very active, too - makes sense all the jostling might cause this. Knock on wood - we haven't seen highs yet because of this.