First Few Days on the Dash

[Tom1982]

Hello all. First few days on the Dash have been great. Josie has been in range 80/90 in range. Not so good today though. Anyone get any absorption issues on last day? The other thing I’ve noticed is if she’s had a snack or correction the insulin on board feature is dramatically reducing the main meal bolus. Any way to adjust this?

 

[Inka]

I wouldn’t adjust it to start with @Tom1982 See how things go for a little while. But yes, presumably the Omnipod is like any other pump in that you can increase or decrease the suggested bolus amount. On my pump, you’d just add/minus some before pressing the confirm button.

 

[Tom1982]

I wouldn’t adjust it to start with @Tom1982 See how things go for a little while. But yes, presumably the Omnipod is like any other pump in that you can increase or decrease the suggested bolus amount. On my pump, you’d just add/minus some before pressing the confirm button.

So just use experience so to speak? For example her dinner was chicken casserole, mash and peas. Roughly 40 carbs worth (although that also seemed a bit low to me, but the boss knows best!) the control suggested 2.5 unit bolus because she’d had a correction about 2 hours before and still had insulin on board. That sound right?

 

[Inka]

Yes, the correction dose would still be working so the pump made an allowance for that in its calculations.

 

[soupdragon]

Hello all. First few days on the Dash have been great. Josie has been in range 80/90 in range. Not so good today though. Anyone get any absorption issues on last day? The other thing I’ve noticed is if she’s had a snack or correction the insulin on board feature is dramatically reducing the main meal bolus. Any way to adjust this?

Glad to hear that Dash has been working well for Josie so far. I'm really pleased with it.
I've had issues on day 3 with a few pods, generally with about 12 hours to go. Most work well for the 3 days for me, though. Hope the next one works well for all 3 days for Josie.

 

[nonethewiser]

Not had issues with poor absorption on day 3, just same as injections its best not to overuse sites & when poor absorption occurs leave area alone for a while to recover.

Could imagine for anyone on a high total daily dose of insulin cannula site could have issues, anyway at 80-90% in range it looks like your daughter is doing extremely well on pump.

 

[Thebearcametoo]

We haven’t used that pump but have has issues with cannulas on the tslim at various points on day 3. Skinny legs are harder to keep good absorption for 3 days. We have more success on the belly. It was fairly common for us to change cannulas every 2 days but that also caused a lot of upset because of more frequent changes. We mostly rotate around various sites on the belly now as he gets upset if the cannula needs changing more frequently.

 

[PattiEvans]

Also if your daughter is on very small doses of insulin watch out for the insulin "going off" towards the end of the vial since it's been open so long. I use less than 20u per day and have found that on day 3 I can go high for what seems like no reason, but I have learned that it's when I have filled the pod with insulin from a vial which is getting low.

 

[Finn]

Also if your daughter is on very small doses of insulin watch out for the insulin "going off" towards the end of the vial since it's been open so long. I use less than 20u per day and have found that on day 3 I can go high for what seems like no reason, but I have learned that it's when I have filled the pod with insulin from a vial which is getting low.

I use between 20-30u per day and have been prescribed penfills rather than vials.

I fill my T-slim with 100u and it lasts me three days. One penfill lasts me three pump reservoir fills and the penfill (kept in a reusable pen) doubles as my backup.

Since each penfill is only open for about 9 days, I don't worry about it going bad. I would worry about that with vials since one vial would last me about 30 days at the rate I use insulin.

For pump users on low doses, penfills can be a better option than vials.

 

[Inka]

I was told never to withdraw insulin from a pen cartridge - is that what you’re talking about @Finn ? I use small doses of insulin in my pump (usually less than 20 units per day) but have always used vials for that reason (apart from an early pump that took pen cartridges) I haven’t had any vial ‘go off’. I keep my in-use vial in the fridge between pump reservoir refills, taking it out a little beforehand so it can come to room temperature.

 

[Bloden]

Yes, the correction dose would still be working so the pump made an allowance for that in its calculations.

Just trust the pump to do its thing, especially since you’ve just started using it. When I’ve got IOB I let the pump decide how much to subtract from the bolus - it’s a great feature.

 

[PattiEvans]

I was told never to withdraw insulin from a pen cartridge - is that what you’re talking about @Finn ? I use small doses of insulin in my pump (usually less than 20 units per day) but have always used vials for that reason (apart from an early pump that took pen cartridges) I haven’t had any vial ‘go off’. I keep my in-use vial in the fridge between pump reservoir refills, taking it out a little beforehand so it can come to room temperature.

I keep mine in the fridge too, except when I travel and there isn't a fridge available, these are usually the vials that go off (even though I keep them in a Frio) and of course when they get to the end of their lives they then are living close to your body and I have found that body heat can just tip them over.

 

[Finn]

I was told never to withdraw insulin from a pen cartridge - is that what you’re talking about @Finn ? I use small doses of insulin in my pump (usually less than 20 units per day) but have always used vials for that reason (apart from an early pump that took pen cartridges) I haven’t had any vial ‘go off’. I keep my in-use vial in the fridge between pump reservoir refills, taking it out a little beforehand so it can come to room temperature.

Yes, that's how I was shown in my t:slim pump training. The diabetes educator (also a t:slim user) was there and confirmed penfills were better for me when I switched to a pump. I'm in Germany, so it's possible the recommendations are different in the UK.

I keep the in-use penfill in the reusable pen, insert the syringe into the penfill, dial up the number of units I want (I have a half unit pen, so I do 30+30+30+10 to get 100u), then continue just as you would with a vial. I don't inject air into the penfill as you would a vial, I just dial up what I want. For the final use of a penfill, I just pull the insulin out with a syringe and it comes to a bit more than 100u.

I very rarely need to give a manual injection with the pen, but if I do, it's only had a syringe go into it twice at the most and it's not something I'm worried about. My endo confirmed the penfill would act as my backup insulin. A syringe would leave a larger hole than a pen needle, but since I use such a low dose and I rarely do manual injections, the penfills are what's been suggested to me.

I keep my pen with in-use penfill at room temp in my D-bag along with a complete site change and a few pen needles in case I need a manual injection. Extra penfills are kept in the fridge.

 

[Inka]

I forgot you were in Germany @Finn That might well explain it.

 

[Finn]

I forgot you were in Germany @Finn That might well explain it.

Ah, yes. This may be one of the many diabetes-related things that differ between the countries.

We also are taught to treat hypos with 10g glucose tabs, rather than 15g. Luckily our Dextro Energy tabs come in convenient 5g tabs and taste much better than the glucose tabs I tried in the UK on my last trip. I am not a fan of the UK Lift tabs, but I love the Dextro Energy lemon (or, when I can find it, blueberry or 'multivitamin', which is tropical flavoured) tabs here in Germany.

 

[Inka]

I always get Dextro energy tablets too 🙂 I like Blueberry, Tropical and Blackcurrant flavours best. The shops in the U.K. usually only have two or three flavours of Dextro tablets on the shelf, but I just order online. I don’t like the Lift tablets either but their GlucoShots are useful and taste fine.

You can usually find Dextro tablets in the U.K. in Boots, Superdrug, other pharmacies, supermarkets and newsagents sometimes. Some of the larger chemists have almost the whole range of flavours.

 

[Finn]

I always get Dextro energy tablets too 🙂 I like Blueberry, Tropical and Blackcurrant flavours best. The shops in the U.K. usually only have two or three flavours of Dextro tablets on the shelf, but I just order online. I don’t like the Lift tablets either but their GlucoShots are useful and taste fine.

You can usually find Dextro tablets in the U.K. in Boots, Superdrug, other pharmacies, supermarkets and newsagents sometimes. Some of the larger chemists have almost the whole range of flavours.

I got orange Dextro Energy tabs in Sainsbury's when I was in the UK. That's one flavour I haven't seen here. We've also got peach, raspberry and cherry here.

There's one brand of glucose tabs, Vitalp, here that are dual-flavoured and really good. They have mango-passion fruit, raspberry-apple and cherry-banana. They're a bit more crumbly than Dextro Energy tabs and dissolve easier, so they're my bedside tabs of choice for overnight lows. 🙂

 

[Tom1982]

Also if your daughter is on very small doses of insulin watch out for the insulin "going off" towards the end of the vial since it's been open so long. I use less than 20u per day and have found that on day 3 I can go high for what seems like no reason, but I have learned that it's when I have filled the pod with insulin from a vial which is getting low.

Oh that’s interesting, we were told to bin them off after one withdrawal. Thought that seemed wasteful!

 

[Tom1982]

So that was last night. Obviously the basal dose is way out. Where do we even start?

 

[PhoebeC]

So that was last night. Obviously the basal dose is way out. Where do we even start?

I was told small changes 0.05 of a unit, at set times of the day, same as when on pens. But again this was based on my insulin requirements.
Now I am a few months in a bit braver / know myself and the pump better and I might change more than that. Main thing is give yourselves time.