It’s said that good things come in small packages – and, at 5 foot, 3 inches, I’m inclined to agree in most cases.
But when it comes to diabetes devices, I’m not sure that saying still rings true for me.
When Tandem recently announced FDA clearance of the Tandem Mobi pump, which boasts the title of being the world’s smallest and most durable insulin delivery system, I started wondering about device sizing and best practices. As someone who tends to misplace things like my car keys and cell phone on a semi-regular basis, I usually appreciate it when my belongings are large enough to be easily visible from a distance; thereby, making them instantly locatable when I forget where I last put something down. I totally get that, as a tubed insulin pump, it’s almost impossible to misplace a Tandem Mobi (especially when it’s physically attached to a body), but I still think it’s worth thinking about the practicality of sizing for diabetes devices.
Yes, at first glance, smaller size likely means greater convenience and levels of discretion – two things that people with diabetes undoubtedly appreciate. But a pump that’s so small that it can fit inside the tiny coin pocket of my blue jeans (yes, that pocket that really serves no other purpose than to home a quarter or two) just seems like it’s begging to be lost or forgotten somewhere. Again, I’m fully acknowledging that the Mobi isn’t like my Omnipod due to the tubed versus tubeless design, but I’m imagining any component of my Omnipod system (the pod or the PDM) shrinking down in size and finding myself cringing rather than rejoicing. I just know that if either were smaller, I’d definitely be more likely to misplace my PDM more often, or fret over a teenier pod reservoir because logic dictates that a smaller pod would mean a smaller reservoir, causing a need for more frequent pod changes due to size alone.
So this begs the question: Is smaller really better when it comes to diabetes devices? Or, does small translate to convenience or annoyance for other people with diabetes? One thing’s for sure, smaller seems to be the way of the future for medical technology in general, so I may just have to get used to the idea that my diabetes devices are going to shrink over time and that I will just need to keep an open mind about that.
This was originally published on Hugging the Cactus on May 7, 2018. I’m sharing it again today because for as long as I continue to wear an insulin pump and CGM, I know that this is a question that I’ll be asked. Wearing these pieces of medical technology almost all the time has certainly changed how I feel about my body and my body image, and I elaborate on that below…
A question I’m often asked is: “Can you feel your CGM or insulin pump on your body?”
The simple answer to that is: usually, no. It’s something that you just get used to. You grow accustomed to seeing a lump underneath your clothing. You adjust to putting clothes on (and taking them off) carefully to avoid accidentally ripping a site out. You acclimate to showering without being completely naked.
And, of course, you get used to the questions from strangers asking about that device stuck to you.
But the more honest answer to that question would be that there are times that I feel it more than others. For example, sometimes I forget where I’m wearing my pump until I hit it against something (I’m a major klutz who constantly runs into doorways and trip over things, almost always managing to catch my pod on whatever it is), resulting in pain at the site and a curse word or two to fly out of my mouth.
I feel it the most, though, when people stare. Whether unconsciously or purposely, people do ogle at it in very not subtle manners. Which makes me feel extremely uncomfortable. It’s worse when they don’t even ask me what it is – I’d rather have a chance to use it as a teaching moment than to have someone walk away not knowing what the device does. This tends to make swimsuit season a little less welcome for me. Nothing will stop me from donning a bathing suit at the beach or by the pool, and I do so as much as possible in the summertime. But it’s just not as fun when I’ve got to cope with lingering looks, especially when I’m an admittedly insecure person in the first place.
So it’s a more complex question to answer than you might realize. Wearing a medical device 24/7 is humbling. It keeps me alive. I’m privileged to have access to it. I’m grateful for the ways it’s improved my life. I’m always wearing it, but it’s not at the forefront of my mind – unless it chooses to make its presence known by alarming, or I’ve got people blatantly checking it out. It’s kind of like diabetes itself. It can make you feel a gamut of emotions, but no matter what, it’s always there. It’s just a part of me, and I can deal with that.
As someone who was so stubbornly resistant to the idea of switching from multiple daily injections (MDIs) to insulin pump for my entire childhood with T1D, I surprised myself quite a bit when I finally decided, around age 21, that I was ready to start using a pump.
And I haven’t looked back since I made that choice – that’s how much of a difference it made for me.
In my almost 10 years of pumping, I’ve realized that there is one, major piece of advice that I’d share with anyone who is looking to make a similar switch, or even go from one pump to another. It doesn’t matter if that person is newly diagnosed, a diabetes veteran, or somewhere in between. Or if a person is a pro at adapting to new technology, or wary of any kind of electronic device… because in my humble opinion, this advice applies to all. So what is it?
Don’t do it alone.
When I started using an Omnipod back in 2015, it was with the help from a team that included my endocrinologist, a diabetes care and education specialist, and a more experienced Omnipod user who I actually lived with – my mother. It was the guidance that all three of these people gave me that ensured a fairly easy transition to pump therapy.
My experience was starkly different when I went on the Omnipod 5 late this past summer. In a word, I was too cocky about it. I thought I knew enough from my prior pod experience, and had enough exposure to all the literature that had come out about the Omnipod 5, that I could make this upgrade just as seamless as it was to start up pump therapy in general. And that was most definitely not the case. I struggled for the first 8-10 weeks of life with the Omnipod 5, and it was such a rollercoaster that I seriously questioned whether or not I’d made the right decision to try out a more advanced pump.
Of course, I don’t regret switching to the 5 – not at all – now. That’s because I did finally get help, first from the nurse practitioner at my endocrinology office, and then from an educator at Omnipod who was really able to explain the 5’s algorithm to me and suggest changes that ended up working wonderfully for me within days of our conversation. It just goes to show that it’s okay to reach out for help when I’m feeling stuck with my diabetes (or when I need it in any other facet of my life, to boot), and I’m here to remind you of that, as well. Don’t do it alone. Lean on your community. Get support from healthcare professionals. And you’ll be amazed by the outcome.
My PDM (Personal Diabetes Manager) is more than just a medical device. It’s basically an extension of my body at this point.
Much like people treat cell phones as a must-have-on-me-at-all-times sort of item, that’s how I feel about my PDM. I carry it (and my cell phone, TBH) around as a small but mighty stack of technology. When I set it down somewhere and struggle to recall where I left it, I panic and can’t focus on anything else until I’ve found it. I make sure to keep the battery charged, and would argue that I get more concerned if the battery is low on that device than I do with my phone. And I’d sooner give my phone over to a toddler to play around with than consider handing off my PDM, even to a trusted family member or friend.
It’s more than just my PDM, it’s a lifeline.
In a world that remains ever-increasingly reliant on technology, there are times where I certainly wish I didn’t have to depend on my PDM so much. It would be nice to not have to carry it around all the time and fuss over it, making sure it’s charged and working properly. But just when I start to grow resentful of the device, I remember how much easier, overall, it’s made my life. It’s given me freedom that I wouldn’t have discovered if I’d chosen to stick to multiple daily injections. I also believe that, combined with my Dexcom CGM, it’s responsible for my improved blood sugars and time in range into my adulthood.
So even though I didn’t exactly wish for a PDM to be an extension of my very being, I’m glad that it is, because it’s proven to be a valuable piece of equipment in my diabetes care toolkit.
Earlier this year, I wrote a post about my dissatisfaction with my Omnipod DASH PDM’s battery life. Basically, I was frustrated that the dang thing needed to be recharged practically every day. But what bothered me even more was how suddenly the battery life would seem to drop – it would dip from 100% charged to 40% in the matter of a few short hours, and worse, it would do this totally inconsistently so it was nearly impossible to predict when my PDM would need a sudden charge.
I thought my PDM problem would be solved when I got my new Omnipod 5 PDM; however, it persisted. And that’s what indicated to me that there was some type of user error going on that I needed to get to the bottom of before I resigned myself to having to charge my PDM everyday.
So I called customer support and told them about what I was experiencing, and explained that on paper, I was doing all the right things to preserve battery life: using the dedicated charger, using minimal screen brightness, hitting the power button to shut off the screen when it wasn’t in use…I wanted to know, could they offer me any battery-saving tips?
Little did I know that a simple solution to my battery blues was just one phone call away!
That’s when I was informed that disconnecting my PDM from Wi-Fi would be a good starting place; after all, the Wi-Fi connection only comes in handy when uploading my data via Glooko. I was amazed, but the moment the customer support rep said this, it made total sense. This whole time, I’d been connected to my home’s Wi-Fi for essentially no reason because it has nothing to do with how my insulin is delivered (the system uses Bluetooth for all communications). I only ever entered my Wi-Fi information in the PDM because silly me thought it was needed for effective operation, but nope, turns out the only thing it’s good for (besides uploading data, of course) is sucking the life out of my PDM battery.
As soon as I ended the call with customer support, I turned off my PDM’s Wi-Fi settings and charged it to 100%. Nearly 24 hours later, it’s sitting pretty at 80%, a much better battery life than it was displaying previously. Problem solved, and proof that I definitely have more to learn about how to best utilize all aspects of my Omnipod 5 system!
While busy at work one afternoon, I was listening to a Spotify playlist (as I often do), when I could’ve sworn I heard my Omnipod beeping to alert me to a failure.
Oh noooo…I thought. I remember sitting in my chair, with my head cocked and music blaring, as I tried to confirm that the beep was indeed emitting from my pod.
I was so certain that my pod was failing that it didn’t even cross my mind (at least initially) that it could’ve been my music playing a little too loudly.
And then I realized…it wasn’t my pod after all. It was the song that I’d been listening to. Roughly 2:45 into the song “Honestly” by Cartel, the music rose to such a crescendo that I could’ve sworn that it was my pod failing, but nope, it was just the pitch of the sound emitting from my speakers.
What a relief! But also a stark reminder that this phenomenon occurs on the regular. I mistake beeps from standard household appliances, alarm clocks, television commercials, and the outside world in general for Omnipod beeps. And I’m struck by it every single time.
The sounds of diabetes, just like diabetes itself, are just something I’ve come to accept – in the many unique forms they appear in.
As of this writing, I’ve been wearing my new Omnipod 5 pump for about 2 ½ days. I will be changing my first Omnipod 5 pod later this evening, but before then, I wanted to jot down my initial impressions of the system as a whole so far.
The PDM: A bit larger and more brick-like compared to my Dash PDM. Actually, the size is pretty on par with my iPhone. I like that the screen is larger and it seems more sensitive to touch than my Dash – all good things. Except I can’t figure out why it makes chiming sounds only sometimes after I enter my PIN! I’m sure I’ll learn the cause of that eventually…
The pod: Basically indistinguishable from my Dash pods – the only difference I’ve spotted (or rather heard) has to do with the mechanical ticking sound my pod makes when it’s delivering my basal insulin. The old pods had a set frequency, whereas the 5 pods seem to go “tick, tick, tick” in bursts of three or so. Not sure why, but I know I’m still getting my basal rate delivered, which is what counts.
The set-up: Inputting all of my settings into the 5 only took me about 15-20 minutes. It was so easy that it likely would’ve taken me less time if I wasn’t so thorough and careful about triple-checking my settings. I also think it was relatively seamless for me because I was already familiar with 90% of the PDM’s functionality – the only thing I had (and still have to) explore further is automated mode…see below.
Baby’s first automated insulin delivery system!
Automated vs. manual modes: I can go back and forth between automated (insulin delivery is automatic and the system responds to highs and lows based on data it receives from my Dexcom) and manual (I have to make my own adjustments, just like I did with the older versions of Omnipod). This was a helpful feature for me because I inexplicably got scared of automated mode the first night I wore the pod. I didn’t know what to expect from it – should I trust it right away? Would I notice it working? What if it didn’t? Ultimately, I decided I wasn’t comfortable going to sleep in automated mode, so I kept manual mode on because I wanted to have more control. I waited until the following morning before I turned it on, and since then, I’ve been on automated mode and I’ve spent a solid chunk of my time in range. A few highs here and there, but all my lows seem to be detected before I drop too much, which is just awesome.
Dexcom integration: Similar to the overall set-up of the system, it was extremely easy to get my Dexcom synced up with my Omnipod. All I had to do was enter the 6-character transmitter ID into my PDM and give it a few moments to pick up my Dexcom’s signal. And that was it! I’m sure things will get a little more dicey on days that I have to do both a pod and CGM change (coincidentally, I’m going to do just that in a few hours for the first time…eek), but I do have confidence in my ability to time the changes well so I don’t go without automated mode or Dexcom data for too long.
Let’s talk about sleep: The indisputable best part of this system so far is that I’ve slept soundly the past 3 nights. No CGM alarms going off and waking me up, no frantic shoving of food in my mouth from my bed or late night bolus delivery. And best of all, no waking up in the morning out of range. Now it’s not like that before the 5, I was waking up every night to do something diabetes-related, nor was I starting off each day with a high or low. But I was getting to a point where these things did happen at least on a weekly basis, and naturally, I was getting tired of it. So while I’m acutely aware that I need more time to get to know the system (and it also needs to figure me out), I have hope that it will help me make a major improvement in my diabetes care and management.
All in all, it’s been a relatively smooth start for me and my Omnipod 5. I totally expect some bumps down the road, because that’s normal when starting up any new piece of diabetes technology. But for now, I remain grateful for a comfortable transition to the system.
This was originally published on Hugging the Cactus on September 7, 2020. I’m sharing it again today because my mom and I were recently talking about pod placements and the places where we would (and would not), hypothetically, feel comfortable wearing a pod. It got me thinking about how I’ve had to work up the courage to try new sites over the years, which inspired me to write this post to hopefully help others who feel the same way about navigating new pump sites and nerves. Read on for more…
Am I the only T1D out there who feels incredibly nervous about trying new insulin infusion sites?
I’ve been this way as long as I can remember, now that I’m thinking about it. Throughout my childhood, I stubbornly stuck to injecting in my arms, legs, and upper buttocks (tee-hee) because those were the areas I felt comfortable with. I don’t think I even considered jabbing myself in my stomach until I was in my teens, and it was only after I realized the importance of site rotation and reducing scar tissue.
So it’s kind of funny that when I went on the OmniPod just over five years ago, I only used my stomach and my lower back (just above the upper buttocks region, tee-hee) for pod placements. It was partly because my guinea pig – I mean, my mom – used those areas for her pods with success, and also because I was hesitant in the beginning to wear my pods on my arms or legs because of their increased visibility.
It went that way for a couple of year – four basic sites ’round my abdomen – when it occurred to me yet again that site rotation was also important for insulin pumpers, not just MDI-ers (multiple daily injection…ers). So I added my upper arms into the mix, and soon after, my upper thighs followed.
The little diagram (courtesy of Insulet/OmniPod) above only shows a few of the sites that people with diabetes use…over the years, we’ve gotten a lot more creative!
But lately, I’ve shied away from wearing pods on my thighs because the area isn’t overly comfortable. When I roll over in my sleep at night, my pod presses up against my leg and the resulting pressure is just enough to disrupt my sleep and make it difficult for me to find a more restful position to sleep in.
As a result, I’ve started contemplating potential new pod sites, and one of the first places I went to for advice was…Instagram! Because…duh.
The DOC (diabetes online community) on Insta is a natural resource for this sort of thing because many people tend to share photos of their sites. It’s kind of a thing. One simple scroll through my feed taught me that people can get very inventive when it comes to finding new locations to place their CGMs and insulin pump infusion sites.
I saw people wearing Dexcoms on their forearms and calves. I saw pods on backs, calves, and even the upper chest area, the latter of which I found most intriguing. For men, it seems like a very accessible spot that causes little irritation, but for women? How the heck did the T1D ladies I saw with pods on their chest deal with it?
The general consensus, it seemed, was that women wearing pods on the upper chest agreed it was a site with great absorption and minimal discomfort.
I was still skeptical, though. I was worried about how it would look if I was wearing a v-neck tank with my pod poking out of, well, my bra! Then it hit me that my pod garners questions from strangers regardless of where it’s located. Furthermore, people will (probably?) be less likely to ask about it if it’s located on my chest because, um, that’s really awkward. My eyes are up here, people!!!
Then I remembered: I could give the site a try without wasting a pod because I have a demo pack that I got from a diabetes conference awhile back! The demo pack comes with a dummy pod that looks and feels just like a regular pod, but there’s no reservoir built into it, so insulin can’t be injected into it.
So right now, as I’m writing this, I’m wearing two pods: one on my upper arm that’s actually giving me insulin, and a fake one on my chest just to see how I like it. I must admit, so far, so good! I slept comfortably with it on last night and I haven’t had any issues wearing clothing or undergarments with it. I even went for a jog with it on and got pretty sweaty, but it stayed secure/I didn’t feel it bouncing around at all (thought the adhesive got a bit too damp for my liking…it stayed on but if I wasn’t careful I totally could’ve knocked it off).
While I’m still having a hard time wrapping my head around an actual cannula piercing my skin at this location (eeeek), now that I know I can handle the pod itself living there, I’m one step closer to trying (and liking) a site that’s more intimidating to me – a win in my book.
Imagine receiving the same notification on your phone every 5 minutes…over and over again…nonstop until you actually do what it’s demanding to you.
Sounds maddening, right?
Well, that’s exactly what I experienced with my Dexcom app recently. Every 5 minutes on the dot, I got a “Calibration Alert” push notification that told me to “enter new blood glucose reading to maintain your sensor accuracy”. Doesn’t sound like too big of an ask, right? Why not just do it?
Of course I just did it – the first handful of times that it asked. But when this alert persisted to appear on my phone each day, around 24 hours after I’d calibrated my Dexcom sensor, I started to get super irritated. But I was also confused. I shouldn’t have to calibrate my Dexcom, like, ever. The G6 was designed to make it so calibrations are a thing of the past. I only ever even bother to calibrate it within the first few hours of wear if I feel that the blood sugar it’s reporting is really off, and that usually forces it to correct itself and show far more accurate readings fairly quickly.
So why was my Dexcom being so forceful with the reminders for me to calibrate?
Imagine seeing this alert pop up on your phone…every 5 minutes…for an hour…or 3. That’s a few dozen reminders too many.
I knew that my best shot at finding the answer to this question was by going to the people who are intimately familiar with the ins and outs of Dexcom devices – no, not the manufacturers themselves. I’m talking about my colleagues, of course. (One of the best parts about working at a diabetes nonprofit is that my coworkers and I collectively have 100+ years of diabetes experience under our belts and constantly ask one another for advice or wisdom regarding various diabetes scenarios.)
When I asked them if they’d ever encountered anything like this, one person explained that the CGM can get a little confused if, when after the initial two-hour warm-up period, a super high or a super low blood sugar can trigger the system to get stuck – almost like it’s unsure of what it’s reading. This tracked for me because when I started up this particular sensor, the two-hour warm-up period collided with a particularly nasty low blood sugar of 35. That blood glucose value is low enough that the system can’t even pick up the number “35” – instead, it just shows that I’m “LOW”.
So as a result of this, my sensor was likely just in need of calibrations every 24 hours just to make sure it was working properly. It’s probably in the code of the software or something to prompt users to calibrate every day until the system feels more confident about what it’s reading. That makes sense and all, but dang, is it annoying. Sure, I could’ve silenced the alarms a lot faster if I just calibrated whenever I got the first alert of the day, but my schedule didn’t always allow for that. And besides, after 4 or 5 years of using the Dexcom G6, this T1D has gotten used to no more finger pricks; because of that, it’s hard to go back to old habits.
But hey, it has wound up being another diabetes scenario that I hadn’t experienced yet and just another lesson learned, so while it may have been a bit of a nuisance it was also educational. And I’m okay with that.
This post was originally published on Hugging the Cactus on June 3, 2020. I’m sharing it again today because I have seriously benefited from learning the “true” length of time that a single OmniPod lasts on my body. Read on to learn more…
When people notice my OmniPod insulin pump, the first question that I’m asked is “what IS that?”
After I explain that it’s my insulin pump, and it’s called a pod, the second question I’m asked is some variation of “how long does it last?”
The canned answer that I provide is something about having to change it every three days, because that’s how the OmniPod is advertised.
But I’ve used this pump for years now and never bothered to really test this three-day limit. I’ve known for a long time that my pod works a handful of hours after the expiration alarm starts chiming, but I wasn’t sure about exactly how many hours I had before a pod expired for good.
So, the other day, I decided to find out.
Have you ever made your pod last longer than 80 hours? If so…are you a wizard???
My pod expired at 10:22 A.M. Since I prefer to change my pods in the evening, I figured it was the perfect time for this little experiment, assuming that the pod really would last me for the majority of the day.
And, well, it did! At 10:22 on the dot, the pod beeped at me to notify me that it was expired. And in the six hours after that, it would alarm every hour (on the 22nd minute) to remind me, time and time again, that it was expired. In the seventh hour – beginning at 5:22 P.M. – my PDM started chirping at me on and off every 15 minutes or so. First it was because I was running out of insulin, but then it was to really get the point across that my pod was expired!
I was determined to use every last drop of insulin in the pod, though, so I bolused for my dinner around 5:45 and I was pleased to discover that I got my full dose of insulin without any issues. As I was cleaning up after dinner, that’s when the signature OmniPod BEEEEEEEEEEEEEEEEEP went off as one blaring, unceasing alarm. I checked the time: 6:22 P.M.
So there was my answer. An OmniPod can last precisely 80 hours after you initially activate it for the first time (or in other words, 8 hours after you receive the first expiration message)…as long as it still has insulin in it. It’s definitely something good to know for sure now, because in the future, it might come in handy and help me avoid wasting precious insulin.
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