Omnipod 5 suspending for over 5 hours

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Evergreen

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Relationship to Diabetes
Type 1.5 LADA
Something strange happened and I’m basically wanting to figure out if this is normal or not 🙂

I started the omnipod 5 about a month ago and enjoying it so far. Last afternoon I decided to have a glass of wine (well 2 small glasses), I don’t normally drink so this was a first on the pump for me.

I know from past experiences alcohol can continue to slowly drop my blood sugar throughout the night so I decided to put activity mode on and see what happened. All went ok and it did a good job avoiding hypos. However, I woke up around 2am and noticed that the pump had suspended insulin for 5.5 hours! Blood sugars were very steady between 5.5-6 mmol so that’s obviously why it didn’t give me insulin but I got a little worried about being at risk of DKA?!

I ate something just to be able to give myself some insulin, but I’m basically wondering, was I at risk of DKA or is it entirely normal or not receive insulin for that long after a couple of drinks?

Thank you!
 
I've no experience and it's an interesting question. afaiu the pumps use novorapid, though perhaps yours is different, and this has an activity time of ~5h, so from that point of view I'd have thought you'd be ok. Anyone with any relevant experience?

Might be worth getting a ketone test kit to satisfy your (and our!) curiosity the next time
 
I don't know how OmniPod works but my Medtrum pump and CGM combo has an auto suspend function which will kick in when my BG is below a certain levels and restart the basal when my BG returns to acceptable level. This could be a suspension of a few hours (not sure if it has ever been as long as 5 hours) and the lack of basal for that time is no concern provided my BG is not high. To my understanding there is no risk of dka due to this if your BG is stable.
I believe @rebrascora , who is on mdi, often finds she needs no overnight basal. This is the same.
 
helli said:
I don't know how OmniPod works but my Medtrum pump and CGM combo has an auto suspend function which will kick in when my BG is below a certain levels and restart the basal when my BG returns to acceptable level. This could be a suspension of a few hours (not sure if it has ever been as long as 5 hours) and the lack of basal for that time is no concern provided my BG is not high. To my understanding there is no risk of dka due to this if your BG is stable.
I believe @rebrascora , who is on mdi, often finds she needs no overnight basal. This is the same.
Click to expand...

Yes, I thought about my situation when I first read this, but there is no real way of knowing exactly how long my morning basal lasts/overlaps into the night to know how long I go without any at all in my system and I still often go low even at 5am sometimes and have to eat jelly babies, so injecting insulin would be the last thing I would consider doing in that situation. Maybe I am slightly naive with regard to ketones and DKA, not having ever experienced it, but I never worry about it and certainly not when BG levels are in range.
Following a low carb way of eating I also consider ketones as something normal rather than something to fear.... again this may be naivety on my part. High BG levels are my big concern and if I go high, I am prepared to inject as much insulin as it takes to bring them down and keep injecting with stacked corrections until it does come down. Ketones really don't feature in my thinking although I do have ketone test strips, which I never use, mostly because I don't let levels get to mid teens and stay there. This attitude of using as much insulin as it takes to bring levels down, and I can be very heavy handed when the need arises, probably negates the need for me to worry about ketones, but I could be wrong.
 
Evergreen said:
Something strange happened and I’m basically wanting to figure out if this is normal or not 🙂

I started the omnipod 5 about a month ago and enjoying it so far. Last afternoon I decided to have a glass of wine (well 2 small glasses), I don’t normally drink so this was a first on the pump for me.

I know from past experiences alcohol can continue to slowly drop my blood sugar throughout the night so I decided to put activity mode on and see what happened. All went ok and it did a good job avoiding hypos. However, I woke up around 2am and noticed that the pump had suspended insulin for 5.5 hours! Blood sugars were very steady between 5.5-6 mmol so that’s obviously why it didn’t give me insulin but I got a little worried about being at risk of DKA?!

I ate something just to be able to give myself some insulin, but I’m basically wondering, was I at risk of DKA or is it entirely normal or not receive insulin for that long after a couple of drinks?

Thank you!
Click to expand...

Device uses smartadjust tech, so my guess is even though it said insulin was suspended for 5.5 hours it would kick back in & start delivering insulin once it spotted bg levels starting to climb again.

Recently started on Omnipod 5 myself & it does take some getting use to pump doing automatic adjustments but it's a great piece of kit.
 
I don’t think there’s any risk of DKA as your blood sugars were normal. Your pump detected that you were dropping, turned the basal off, and you obviously didn’t need any basal for those few hours as your blood sugar stayed stable. The pump would turn the basal back on as soon as it detected blood sugars rising again.
 
Thanks everyone, that’s reassured me a bit! I’ve seen the pump suspend insulin overnight before but definitely not as long as this, 5.5 hours did seem quite a long time!

Obviously the alcohol kept my blood sugar down, even though I didn’t drink that much, and I just worried that could potentially end up in DKA. I’m not sure how to explain it, but that my body wasn’t getting the insulin needed because the effects of the alcohol were masking it if that makes sense?
 
I think the way to look at it is that your body simply didn't need any insulin during that time. Your basal insulin covers the glucose release from the liver, so if your liver is too busy removing the alcohol from your blood, that it can't release glucose, then you don't need any basal insulin during that time.
 
Sally71 said:
I don’t think there’s any risk of DKA as your blood sugars were normal.
Click to expand...
You can still get DKA when bgs are normal.
 
rebrascora said:
Can you explain under what circumstances this can happen and why?
Click to expand...

This is something I go on about @rebrascora I resisted for this thread because I thought people would be rolling their eyes with boredom. It’s called euglycaemic DKA - ie DKA with normal blood sugars.

Let me find some information for you…

Here we are. I’ve copied the links from a previous post of mine so I hope they work. There are a number of causes, medication being just one.

There’s lots about euglycaemic DKA on the internet, but here are a few pages:

www.ncbi.nlm.nih.gov

Euglycemic Diabetic Ketoacidosis Precipitated by a Keto Diet: Importance of Dietary History in Diagnosis​

Diabetic ketoacidosis (DKA) is one of the serious complications of diabetes, especially type 1. It is defined by the triad of hyperglycemia (>250 mg/dL [>13.9 mmol/L]), high anion-gap metabolic acidosis, and increased plasma ketones. Euglycemic ...
www.ncbi.nlm.nih.gov
www.ncbi.nlm.nih.gov

Euglycemic Diabetic Ketoacidosis - StatPearls - NCBI Bookshelf

Euglycemic diabetic ketoacidosis: A missed diagnosis​

Euglycemic diabetic ketoacidosis: A missed diagnosis
www.wjgnet.com

edm.bioscientifica.com

Euglycemic diabetic ketoacidosis: a diagnostic and therapeutic dilemma

Summary Euglycemic diabetic ketoacidosis (EDKA) is a clinical triad comprising increased anion gap metabolic acidosis, ketonemia or ketonuria and normal blood glucose levels <200 mg/dL. This condition is a diagnostic challenge as euglycemia masquerades the underlying diabetic ketoacidosis. Thus...
edm.bioscientifica.com edm.bioscientifica.com


@rebrascora People without diabetes can occasionally get it too - sometimes because of alcohol problems, due to reduced calorie and carb intake, when pregnant or breastfeeding and not eating sufficient carbs, etc etc.
 
Evergreen said:
Thanks everyone, that’s reassured me a bit! I’ve seen the pump suspend insulin overnight before but definitely not as long as this, 5.5 hours did seem quite a long time!

Obviously the alcohol kept my blood sugar down, even though I didn’t drink that much, and I just worried that could potentially end up in DKA. I’m not sure how to explain it, but that my body wasn’t getting the insulin needed because the effects of the alcohol were masking it if that makes sense?
Click to expand...
Sounds to me like your pump system did it’s job. Alcohol can mask hypos. You also drank responsibly. I’m not a pumper, but have delayed my basal if drinking. (I can be awake all night.) you even bolused for a snack?
I’m not a doctor. Sounds like your pump system did great if you were kept stable into the following day?
 
Inka said:
This is something I go on about @rebrascora I resisted for this thread because I thought people would be rolling their eyes with boredom. It’s called euglycaemic DKA - ie DKA with normal blood sugars.

Let me find some information for you…

Here we are. I’ve copied the links from a previous post of mine so I hope they work. There are a number of causes, medication being just one.

There’s lots about euglycaemic DKA on the internet, but here are a few pages:

www.ncbi.nlm.nih.gov

Euglycemic Diabetic Ketoacidosis Precipitated by a Keto Diet: Importance of Dietary History in Diagnosis​

Diabetic ketoacidosis (DKA) is one of the serious complications of diabetes, especially type 1. It is defined by the triad of hyperglycemia (>250 mg/dL [>13.9 mmol/L]), high anion-gap metabolic acidosis, and increased plasma ketones. Euglycemic ...
www.ncbi.nlm.nih.gov
www.ncbi.nlm.nih.gov

Euglycemic Diabetic Ketoacidosis - StatPearls - NCBI Bookshelf

Euglycemic diabetic ketoacidosis: A missed diagnosis​

Euglycemic diabetic ketoacidosis: A missed diagnosis
www.wjgnet.com

edm.bioscientifica.com

Euglycemic diabetic ketoacidosis: a diagnostic and therapeutic dilemma

Summary Euglycemic diabetic ketoacidosis (EDKA) is a clinical triad comprising increased anion gap metabolic acidosis, ketonemia or ketonuria and normal blood glucose levels <200 mg/dL. This condition is a diagnostic challenge as euglycemia masquerades the underlying diabetic ketoacidosis. Thus...
edm.bioscientifica.com edm.bioscientifica.com


@rebrascora People without diabetes can occasionally get it too - sometimes because of alcohol problems, due to reduced calorie and carb intake, when pregnant or breastfeeding and not eating sufficient carbs, etc etc.
Click to expand...
So this is basically what I was worried about. I’m very happy with the pump preventing hypos after drinking, but with suspending insulin for over 5 hours I know I had literally 0 IOB.

I have actually had dka before with normal blood sugars (this was due to gastroenteritis and vomiting where I ended up severely dehydrated).

I know it’s possible to get DKA with normal blood sugars, rare but possible. I’m just wondering if I was at risk last night due to the alcohol keeping my levels down and therefore not receiving enough insulin. I just don’t know enough about dka to say if this was a possibility. Maybe it’s a question for my Endo!
 
I think the concern people have about DKA and ketones is rather blown out of proportion in general (and the numbers the NHS advice page gives seem very very conservative). Similarly to @rebrascora I simply never think about it and only got a working ketone monitor recently as I wondered what all the fuss was about and was curious as to what happened after a long ride. I quite happily survived for the preceding 25-odd years since I last had some test strips, and I don't recall ever using those.

But I was also wondering about euglycemic DKA as @Inka explained with the link.

I'm assuming that in either case (high BG or not-so-high BG) there is a gradual build up of ketones, it would be interesting to know how long this takes to build to a level that is potentially dangerous as this might then set people's minds at rest re pump suspension and exercise without requiring bolus insulin. From the link above, one of the papers (in fact the first reference) goes to this paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699725/ and if one scrolls down to the section entitled "History and physical examination", there is the following:

"The process of HHS usually evolves over several days to weeks, whereas the evolution of the acute DKA episode in type 1 diabetes or even in type 2 diabetes tends to be much shorter. Although the symptoms of poorly controlled diabetes may be present for several days, the metabolic alterations typical of ketoacidosis usually evolve within a short time frame (typically <24 h)."

So while 5h is <24h, it is significantly less, and I think as such isn't something to be worried about (nor is lack of overnight basal if BG is stable for that matter). It would be interesting to see if there are any papers that contain more detail on just how quickly DKA does occur for a given set of conditions.
 
rebrascora said:
Can you explain under what circumstances this can happen and why?
Click to expand...
Not right now, I’m tired and hopefully inkas post answers it but happy to explain tomorrow if not. You definitely can have euglycemic (normal bgs) DKA though, I’ve had it and researched it at the time.
 
Inka said:
When I first got my pump @SimonP i was told that DKA could develop in as little as 4hrs with a pump (if not working/removed). Apart from that, I think vomiting can cause it to develop quite quickly too. One reason why I hate stomach bugs.
Click to expand...

Yes I was told that too. But once again I think it’s one of those YDMV things. I think some people are much ‘better’ at producing ketones than others, in all circumstances.

Personally, my metabolism appears to be very tardy on the Ketone front. Even if I have raging high BGs for a day or more, whenever I check for ketones I only ever seem to have a trace (so far).

I didn’t experience DKA at diagnosis either, though my BGs were off-the-BM-scale and I did have substantial ++++ ketones.

I think it’s right for everyone to be aware and cautious (because DKA is so serious), but it’s also important for me not to get bogged down in worry over extended overnight suspends where I’ve had them several times with no ill effect.

Perhaps I have some smidge of residual insulin production, so my IOB never truly reaches zero?
 
Lucyr said:
Not right now, I’m tired and hopefully inkas post answers it but happy to explain tomorrow if not. You definitely can have euglycemic (normal bgs) DKA though, I’ve had it and researched it at the time.
Click to expand...
Inka's links are fine thanks, so don't trouble yourself further.

There clearly has to be something else to trigger the acidic conditions which trigger the EDKA rather than just the typical high BG causing them with a normal DKA.
Maybe some of us just naturally have slightly more alkaline blood and that is why we are less prone to DKA or EDKA.
 
I don’t know @rebrascora As @everydayupsanddowns says, some people seem to be more prone to make ketones. I don’t really understand the mechanism of it all, but I’ve had ketones at a normal blood sugar (tummy bug) and at diagnosis. I don’t really get them at other times. However, after that tummy bug incident,I’m always super-careful with any vomiting bug now. I only tested to rule ketones out and because I thought I should, even though I almost never get even a trace amount, but suddenly they were there in pretty large amounts. My blood sugar was in the 9s.
 
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