Advice, suggestions and input

bkit

bkit

Member
Relationship to Diabetes
Type 1
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Hello everyone,
I've put this in here as I'm not really sure where to put it!
I'm using the Omnipod (the excuse for it ending up in pumps & tech forum) with limited placement options due to scarring and lipo issues, and for the most part, having whittled down the placements to the few that work, it seems to work fairly well for me. Night hypos are no longer a thing, and I used to get them a lot!

One major issue at the moment that I'm having trouble pinning down the cause of, is sudden drops of BG from minimum activity, that have seen drops of 6 points in 20mins (the worst example) but more commonly 3 points in that time, and that's from just walking a short distance.
Interestingly the drop tends to stop and given 10mins sit down even return to it's previous level entirely, if not go up beyond it, without any additional carbs required.

It's making most basic activities feel like land mines waiting to go off...

I've worked as many theories as I've been able, such as:
I thought I saw a correlation with large amounts of fibre intake resulting in the following few days seeing excessive numbers of these drops with and even without light activity, so I cut fibre out as much as I could, ate at exactly the same time each day, and tried to see if it would remove the drops. The results have been inconsistent.

There's a fair number of variables, the Pod being one of them.

For a little background, I've had a similar issue of large sudden drops for quite a while and the Omnipod was an attempt to try and help. The theory (ever changing) at the time was the scarring and lipohypertrophy was causing inconsistent insulin absorption and delayed absorption so I'd see no benefit (randomly depending on injection site) for hours then suddenly get it all like a tidal wave, but the pod and it's scar safe placements should deal with that side of the theory, leading me to believe it's also at least partially, perhaps, digestion related?

Anyway, has anyone had any similar experiences of drops from little activity that might point to something else being a cause? Or know of anything about the Omnipod that I don't that I could tweak?

Really anything at this point.

I've requested an appointment with a dietician to ask them for help regarding the possible digestive side of the issue, given there's two sides to the BG balancing act, insulin absorption and carbohydrate absorption, but god knows when or if that'll happen, so yeah in the meantime,
Anyone have any thoughts?
 
How long after your bolus do you drop? Have you had a recent coeliac screen? Are these sudden drops always related to your bolus?

My thoughts are that it’s more likely to be an absorption issue. Have you tried splitting your bolus and/or extending it?
 
Inka said:
How long after your bolus do you drop? Have you had a recent coeliac screen? Are these sudden drops always related to your bolus?

My thoughts are that it’s more likely to be an absorption issue. Have you tried splitting your bolus and/or extending it?
Click to expand...
The drops are often 3+hours (I've been waiting for around 3hrs to walk the dog say after evening meal) but I've seen them an hour afterwards too.

I've never had a coeliac screening, at all.

I'm not sure if they're always related, we've seen some quite late in the day many many hours later (but these could be unrelated and more a lipo absorption issue, or not! the joys of variables)

The Omnipod is in automatic mode and extending is a bit odd but I do for potentially problematic foods like pizza or ice-cream (not that I've eaten them for a while, been keeping everything very similar and simplistic during this experiment and data gathering)
 
The idea is to split the bolus so you also split the drop. Yes, it might mean your control is a little worse to start with, but it should help the big, sudden drops.

Get a coeliac screen too. That would be something to rule out, and should be done at intervals anyway as Type 1s are at much higher risk of it (6x greater risk if I remember correctly).
 
Inka said:
The idea is to split the bolus so you also split the drop. Yes, it might mean your control is a little worse to start with, but it should help the big, sudden drops.

Get a coeliac screen too. That would be something to rule out, and should be done at intervals anyway as Type 1s are at much higher risk of it (6x greater risk if I remember correctly).
Click to expand...
Thanks for all the advice,
I've requested an appointment to...make an appointment for a screening and will try to extend for more meals than just the problematic ones and see how I get on.
 
Hello @bkit

I've had absorption problems from pump cannulas & lypoatrophy over the past few years and have no go areas where insulin doesn't get absorbed at all and some on the edge areas where it doesn't seem insulin is absorbing then I get a quick drop. I haven't used Omnipod, my pump is a tubed one.

I've recently changed insulin from Humalog to Lyumjev which has a much quicker onset to Humalog. I can see from my cgm that it is being absorbed because its onset is so fast. This has helped me so much to know when a cannula is absorbing, how much insulin is still active and has helped me avoid unpredictability and hyper/nhypo rollercoasters and rapid drops.

I was initially really worried about using an insulin with a faster onset as I was terrified of more dangerous hypos but it has pretty much stopped hypos & helped me see what is working and what isn't & get more stable results. May not be of use to your situation but it has helped me in a number of unexpected ways - especially seeing that insulin is onboard and what I 'should' expect to happen.

I hope you can get help to find out what is happening.
 
@Inka

I was waiting untill I had something a little more substantial to add, before updating, but it's been well over a month by this point, and I really shouldn't wait any longer, without being really rude lol

I'm still waiting on that dietician appointment, it should be happening midway through next month - so not really anything to update there, other than I do believe the issue is mainly related to digestion.

The Coeliac screening came back negative, or rather "Negative IgA tTG antibodies make Coeliac disease highly
unlikely if individuals have been on a diet containing
adequate gluten (e.g. 4 slices of bread daily) for 6 weeks"

which should be noted, I hadn't been told anything about the prerequisites by my doctor, and had actually had several days of no gluten at all prior to the tests, so might be something to revisit.

Anyway, the extending of all evening meal boluses is working for the most part, however there's been numerous occasions where the 2nd half of the bolus hasn't been necessary at all. I take the first half (or in some cases third) of the bolus and that's somehow enough to keep my BG stable for the rest of the night.
Rather eye opening really!

Anyway that's all I have as far as updates. The somewhat fluctuating insulin requirements on an evening will be something I'll be bringing up and focusing on if and when my appointment ever comes round with the diabetes dietitian nurse. For now it's a roll of the dice daily on if I'll need all the bolus or not.
 
Which bolus insulin are you using?
 
I just wondered if Fiasp's "quirkiness" was adding to this problem but obviously not.
Sorry I can't offer any other thoughts.
 
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