When Carbs Collide with a Bent Cannula, Chaos Ensues

Sushi. Wine. Not one, but two slices (I swear they were slivers, honest) of cake. A pod with a cannula that got bent out of shape accidentally due to clumsiness.

The above sounds like some sort of weird laundry list, but it’s really just all the factors that contributed to a night of high blood sugars and relative sleeplessness.

Let me explain what happened: The night started out fabulously! I got sushi for dinner from a local spot that I was trying for the first time. I was excited about it because sushi is a rare treat for me, and I figured the occasion warranted some wine – my first glass(es) that I’ve had in about 2 months (I gave it up for Lent).

Those two things right there are definitely a “dangerous” duo that can cause carbohydrate calculation errors or prolonged blood sugars, but I tucked that in the back of my mind because I wasn’t done with indulgences for the evening.

I want to say I regret nothing about this carb-o-licious evening, but…

That’s right, I kept up with the carb-loading by enjoying some cake (white chocolate blueberry cake that I made myself that is just as decadent as it sounds) soon after dinner was done. My problem is that I thought I’d curbed the impact of the carbs by setting a temporary basal increase and stacking a small amount of my insulin, but no such luck. I’d destroyed my second piece (it was just a tiny sliver, people) and noticed that I was creeping up. I took more insulin and soon forgot about my high blood sugar as I immersed myself in episode after episode of Impractical Jokers, which, side note: It’s a series I just discovered and it’s hilarious cringe comedy that is the perfect thing to watch after a long day.

A handful of episodes later, it was time for bed. Or so I thought…because soon after I was settled in bed, I twisted around in just the right – or in this case, wrong – manner that was rough enough to loosen my pod from its allegedly secure location on my back. The smell of insulin was pungent and indicated to me immediately that the pod would have to be ripped off completely and replaced. And the sooner, the better, because my blood sugar was getting closer and closer to 300…definitely not a level I want to see before I go to sleep.

By 12:30 A.M., the new pod was on my arm and a temp basal increase was running to combat my lingering high blood sugar. I also gave myself yet another bolus and crossed my fingers, hoping that the combination would be enough to bring my levels down overnight.

At around 2 A.M., my PDM started beeping to let me know that it’d been about 90 minutes since the new pod was activated, so in response I woke up to silence it and glance at my CGM. My blood sugar barely budged! Frustrated, I gave myself more insulin and fell back into a restless sleep.

Several hours later, my alarm was blaring, far sooner than I wanted it to. I hit the snooze button, also taking care to check out my CGM yet again before I made an attempt at 15 more minutes of sleep. And guess what – I was still high. Quite high. Not 300, but in the mid-200s.

It was official: My blood sugar was punishing me for my night of careless carb consumption and reckless pod-handling. I shouldn’t have been surprised by the resulting chaos, but at least I was able to restore peace again the next morning…eventually.

How Long Do AAA Batteries Last in an OmniPod PDM?

How long do AAA batteries last in an OmniPod PDM?

The answer to this question has subtly haunted me for years.

My PDM is the only device in my diabetes management kit that actually runs on batteries. Everything else, such as my Dexcom receiver and my blood sugar meter, can be recharged, which is highly preferable over batteries. But until I make the transition to the OmniPod DASH system (which uses a rechargeable lithium battery in lieu of AAA batteries), I’m stuck with replacing the AAAs in my PDM whenever they drain.

But it was never overly clear to me…how do I actually know when the batteries are out of juice?

Just by looking at the battery display, you’d think that I’d need to swap out the AAAs A.S.A.P…but I discovered that isn’t the case.

There’s a battery icon on my PDM, of course, that shows roughly how much life my batteries have left in them. When new batteries are put into the PDM, it shows a fully charged battery. Some time after that, the battery icon is half full, and then after more time, it goes down to a tiny sliver to indicate the batteries are running low.

Ever since I became an OmniPod user, I always assumed that the batteries had to be replaced as soon as the display ran down to that itty bit of battery life. I just figured that was the signal. Plus, I didn’t want to run the risk of delivering a bolus or changing my pod only for my PDM to completely die halfway through, leaving me to figure out how much insulin I had left to deliver – or worse, with a pod not fully activated that I’d have to scrap.

For a long time, though, I’ve been wondering if I’ve been changing the batteries prematurely. Maybe they had more life past that little sliver. So I put my theory to the test: Last month, my PDM displayed the low battery icon. Instead of changing the batteries immediately, I decided to wait and see what would happen.

And I can report that my batteries did last much longer after that initial low battery icon appeared. In fact, they lasted an addition 7-8 pod changes (I lost track after the first handful). I was pleasantly surprised to discover that my PDM could make it almost an additional month past that first indication of a low battery! And even better, I learned that the system does give a warning that makes it crystal clear when the batteries should be changed: The battery icon goes from having a tiny bit of life left to a flashing display showing a completely empty battery. I forget what the exact message was on my PDM, but I also got a system notification telling me to change my batteries soon.

I wish I remembered exactly when I changed the batteries last, but if memory serves me correctly, then it was sometime in November. So the AAA batteries in my OmniPod PDM lasted roughly three months.

Not too shabby, and now I know exactly when I can expect to change my PDM batteries.

A New Pod in 5 Minutes Flat

I literally just got off the phone with OmniPod/Insulet as I’m writing this post.

I jumped on the computer right away because I was so impressed with the speediness of their customer support team.

Normally, I only call customer support to report the occasional pod failure. I had my first one of the year over the weekend, so I made some time during the week to give them a call and tell them about it.

I’m used to being hit with all kinds of questions when I call customer support: Where were you wearing the pod? What were you doing when it failed? How long were you wearing it for? What kind of insulin were you using in it? What’s your date of birth/shipping address/Social Security Number? (Okay, they don’t ask about that last one, but they need so much information from me that they might as well get that, too!)

This time, after I verified my shipping address, I was simply asked to rattle off the alarm code that triggered this pod failure, and state approximately how long I wore the pod.

That’s it.

I couldn’t believe how quick and easy it was to get a replacement pod.

Just a couple easy questions that I could answer straightaway because I had my PDM on hand (I always do when calling Insulet because 9 times out of 10, they’ll need information from it). The rep I spoke to on the phone just had one final question for me: Did I mind ground shipping for the replacement they were going to send to me, or did I need them to overnight it?

I let her know that standard shipping was just fine, and then I felt compelled to tell her that I was appreciative of her swift solution and professionalism. She thanked me and also clued me into the fact that Insulet’s worked hard to streamline the number and type of questions asked when customers call in, which made someone like me doubly happy.

I thanked her for her help again before hanging up the phone. Then I noticed: The length of our phone call was just under 5 minutes. It takes me a bit longer than that, on average, to apply a new pod.

In 5 minutes flat, a replacement pod was on its way to this satisfied customer. It’s nice to know that when pod failures happen – they do, and they will happen again – it’ll be much easier going forward to get them replaced.

DASHed Hopes

It’s funny how much I’ve changed regarding diabetes and technology in the last decade.

I grew up not wanting to try the latest and greatest devices. I had zero interest in an insulin pump and was very set in my ways of doing multiple daily injections and finger stick pokes.

My (semi-forced) introduction to CGM technology when I was in my teens, though, changed everything for me. And I haven’t looked back since then. Actually, if anything, I’ve become more curious and excited about new technologies because they symbolize greater freedom from the heavy burden of diabetes.

So imagine how PUMPed (hehehe, diabetes humor) to hear about the redesigned OmniPod insulin management system!

This next iteration of OmniPod is known as the DASH system and it’s freaking cool. The clunky PDM has been upgraded to a sleek, touchscreen format and it’s rechargeable (no more AAA batteries). Plus, it comes with a whole host of upgrades and features that make the first generation of OmniPod look totally outdated.

Naturally, I wanted to give the DASH system a SHOT (LOL look at me, I’m on a roll with the puns).

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I took this image from the Insulet/OmniPod website so you guys could see how awesome the DASH system looks!

So I called Insulet and asked whether my insurance would cover the new PDM and pods, and how much everything might cost me. I learned that the major difference between how I receive pods now and how I’d receive the new DASH pods (because the DASH pods use Bluetooth, I can’t use my old radio-frequency-enabled pods with the DASH system) is that instead of getting pods directly from Insulet, I’d actually receive them through my mail-order prescription service (Express Scripts). That was fine by me – I get the pods in the mail anyway – but I wanted to know how it’d work in case a DASH pod fails on me. I was reassured by the representative that I’d still call Insulet to receive a replacement, just like I do now.

Okay, good information to know. But I really wanted to know about pricing. So I was connected with an Express Scripts representative, who informed me that the cost for a 3-month supply of DASH pods would be about $50 more than I pay now for my current pods.

I did the math. That’s around $200 more each year that I’d have to pay for my pods. That might not seem like a lot of money, but I pay right around that amount for a 3-month supply of insulin. Hypothetically, let’s say that I become financially strapped in the future, and I have to make the choice between paying for insulin or paying for my pods – when it comes down to it, obviously I’d choose insulin – but I shouldn’t have to make that choice.

So it looks like my hopes to go onto the OmniPod DASH are, well, DASHed (sorry, last bad pun, I swear) for now. I’m a little disappointed, but I’ll keep my fingers crossed that prices are lowered for DASH pods in the near future so I can take advantage of a very nicely designed, high-tech insulin pump system.

 

The Best (and Worst) Insulin Pump Infusion and CGM Sensor Sites

Like many other people with diabetes, I wear two devices on my body at all times: my insulin pump (my pod) and my continuous glucose monitor (CGM). And I’m often asked whether or not these little gadgets are painful.

Fortunately, the answer is that most of the time, they aren’t. I rarely feel it when my CGM sensor or my insulin pod’s cannula pierce my skin, which makes the whole experience of wearing them a lot more comfortable – and much less dreadful when it’s time to rotate sites.

Speaking of sites and pain, though, I admit that there are some sites that, for me, tend to work better than others. The following are the different locations I use for my pod and CGM sensors, in order of what tends to be best to the worst.

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My stomach is my preferred spot for my pod AND my sensor.

Stomach: This is the site at which I have the best insulin absorption, so it’s a clear winner for me when it comes to my pod placement. I also find that it almost never hurts when I press up against the pod (e.g., when I roll over in bed in the middle of the night) when it’s on my belly. The same is true for my CGM sensors, which also seem to be the most accurate when they’re placed on my abdomen. I guess there’s a reason why the stomach site is the only one recommended by the FDA for the Dexcom CGM (which is what I use)!

Lower back: I have yet to try my CGM here, but I often place my pod on my lower back without issue. This site can be trickier to navigate because if I forget that my pod’s there when I’m getting dressed in the morning, I can come precariously close to accidentally knocking it off – and I have in the past. Plus, the pod can rub up against me in an unpleasant way when I’m working out; specifically, doing any sort of abdominal exercise on the ground. But it’s not something I can’t tolerate, and the insulin absorption in this location is just too good in general for me to pass over it altogether.

Upper arm: I wear my pod and CGM on my upper arms sometimes, but they don’t always adhere well for some reason. Getting dressed can be even more problematic for me if I forget that my sites are on my arms – I’ve totally ripped off pods and sensors when I’ve been taking off and putting on clothing. And for a long time, my CGM sensors would make me bleed when I inserted them in my upper arm. I never figured out why, and the problem seems to have gone away, but it definitely made me a little more wary about using my arms as a site (PLUS any devices I wear on my arms are highly visible, and I don’t always like it when people stare at them).

Thigh: Hands-down, the worst site for my pods are my thighs. For starters, wearing denim jeans – especially if they’re skinny jeans – are such a feat when wearing a thigh pod. The fabric pushes up against the pod in such a way that I prefer wearing dresses, skirts, or leggings for the three days that I have a thigh pod just so I can be more comfortable. And speaking of comfort, it’s tough for me to get into a cozy sleeping position when I have a thigh pod because I like sleeping on my stomach sometimes, and there’s just too much pressure up against my pod when it’s on my thigh. And for me, it seems that insulin absorption just isn’t great on my thighs (maybe because they’re on the muscular side). BUT, I will say…I recently tried a CGM sensor on my thigh for the first time and I didn’t hate it! The accuracy was good and it wasn’t in the way as much as a thigh pod (I keep wanting to type “tide pod”) would be. I’ve only had it on my leg for a few days now so I don’t know yet how the adhesive will hold up, but I’ll find out.

Spots I haven’t tried yet (but want to): On social media, I’ve seen people wear Dexcom sensors on their forearms (eek), upper butt cheek (tee-hee), and even on their calves. And pod placement can get even wilder with spots in the center of the back (HOW can people reach back there) and, um, the upper-breast area (one word: ouch). While I don’t think I’ll ever work up the courage to try some of those spots, I am curious about others.

The bottom line is, though, that the sites that work best for me might not work as well for you. (The same thing can be said for my worst sites.) But it is important to remember, above all, the importance of rotating sites…even though I’m clearly not a huge fan of pods on my legs, I’ll still suck it up and place them there because I know that I should be careful of scar tissue buildup.

It just makes the pod-and-sensor-change days that much more pleasant when I can move them from a disliked site to a favorite site, anyways.

 

Precarious Pods and Pure Paranoia

Here’s another previously published blog post from October 5, 2018. What nugget of useful information can you find here? Well, it all has to do with trusting your gut when it comes to an insulin pod that’s dangling precariously off your body and the subsequent paranoia that happens when you’re not sure whether it’ll still work properly…

I’d only been wearing my new pod for about an hour when my arm brushed up in exactly the wrong way against a chair. Riiiiiiiip!

My pod tore right off – not from my arm, but it lifted up from the adhesive that it was glued to and dangled precariously from the still-intact adhesive stuck to my arm.

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Would you have kept the pod on, or changed it?

After cursing loudly, I asked my mother for her opinion. I wanted to know if she could see the cannula, because that was the component that made me most concerned. As long as the cannula was still stuck under my skin and delivering insulin, it shouldn’t matter that my pod was a little loose – right?

She tried to peek under and around my site, but it was virtually impossible to tell whether the cannula was where it should be. I thought about it for a few moments, and decided that it would be wise to just change out the pod. The notion of tossing one that had only been in use for an hour was unappealing to me, but I know myself pretty well, and I know for damn sure that I would’ve been super paranoid about the pod functioning properly for the following 72 hours. I also figured that it couldn’t hurt to try calling Insulet to see if they would replace the kaput pod. The odds were slim, but why not try?

So after I changed my pod, I dialed up Insulet and described the situation to the customer support representative. And…I got a replacement! I was pleasantly surprised by the rep’s empathy towards the situation and how easy it was to get my replacement. She reaffirmed that I did the right thing, noting that if she’d been in my shoes, she would have called it in, too. It goes to show that when in doubt, change the pod – and don’t hesitate to call for a replacement.

Losing Patience with Customer Support

The other day, I nearly LOST IT on the phone with an Insulet representative.

I’m not proud of it, but I also was not sure why this particular phone call was taking so long.

I was calling in regards to a pod failure – something I’ve had to call and report many times before, so I’ve become very familiar with how the usual phone call goes:

Me: Hi, I’m calling to report a pod failure.

Insulet Representative: Okay, could I have your first and last name, date of birth, and shipping address?

*I provide the information.*

Insulet Rep.: Thank you for verifying your information. Could you please tell me about the pod failure incident?

*I explain what happened with the pod failure. The rep will ask me a series of follow-up questions, such as where was I wearing the pod? How long was I wearing it before the failure? Did I notice anything unusual about the pod activation? Did I need to seek medical assistance for the pod failure? Typically, this is the list of questions I’m asked, and then I finish my call with the rep.*

Insulet Rep.: We’ll be sending you a replacement pod. We will send it via standard shipping, meaning it will arrive in 7-10 business days. Is that okay with you?

Me: Yes, thank you.

*And then after exchanging pleasantries, the call is over. Standard running time on the phone is about 6-7 minutes. No big deal at all.*

So imagine my surprise, and growing ire, when a phone call that should’ve only lasted a few minutes stretched just beyond 20 minutes.

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I’m sure that all T1Ds can commiserate with me on this one…how many hours, and how much patience, have you lost due to customer support?

I still don’t really know why it lasted so long. The agent I spoke with was asking me WAYYYY to many follow-up questions regarding the pod failure, and what made it especially irritating was that I’d already explained every single detail surrounding the whole incident. It was like she was questioning my reporting abilities. Either that or she was really slow with taking notes, and maybe I was talking too fast for her? Who knows. All I knew was that I was calling in the middle of my workday, and I had to get this wrapped up ASAP so I could turn my full attention back to my work.

That said, it was difficult to stay patient, and I probably slipped up toward the end of the call. Actually, I totally slipped up, because my answers to her questions became very curt in my attempt to expedite the call…which didn’t work, by the way.

I felt a tinge of guilt for my brusqueness. After all, I used to be a customer service representative who spoke with her fair share of irate customers. I knew it would be appreciated if I at least said a sincere thank you before hanging up. So I did, and even though I wasn’t exactly proud of myself for losing my cool, I was glad that I could turn my attitude around in the end.

It’s kind of a metaphor for how I’m trying to handle my diabetes these days…allow myself to feel how I want to feel, but then go about handling whatever situation is in my way using a level head. Because that’s how to make things happen, IMHO.

My New PDM

After four years filled with various highs and lows, I had to say farewell to the PDM that was virtually glued to my side, working with me to manage my diabetes.

Our parting was inevitable. Around the Fourth of July, I noticed that the battery symbol on my PDM was low, meaning that the triple A batteries within needed to be replaced. I put fresh ones in, but upon the system restarting, the PDM asked me to input information such as the date and time. And then…the pod I’d been wearing for less than 24 hours beeped loudly, signaling to me that it had failed. I figured it must be due to the battery replacement, but this definitely wasn’t normal. So I did some investigating.

I consulted with my mom and she told me that this was a sign that the internal battery within the PDM, the one that cannot be replaced, was starting to run out of life. She advised me to call Insulet to get a replacement PDM. That’s how I discovered that the warranty on my PDM actually expired in January of this year, and that I’d have to pay a nice chunk of change (about $500) to get a new one, under warranty.

It was a painful process, as I’ve detailed in recent posts, but I finally did get my new PDM. Fortunately, it only cost me $100 (I guess I should be glad I met my $900 deductible so quickly).

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A very special delivery.

I waited to power up the new system until I was due to change a pod – didn’t want to waste a pod if I didn’t have to – and I’m really glad I set aside a half hour or so in order to input all of my settings into the new PDM. It was a bit stressful, really, and just as I was cursing the PDM for not automatically knowing all of this stuff about me, it was set up and ready for action.

It was a strange feeling, disconnecting myself from that PDM I’d relied on for four years. It sounds dramatic, I know, but that PDM and I have been through a lot. As I powered down the system, I had a little moment and felt gratitude toward the PDM (and I suppose all of its little quirks). I put it inside the box that the new one arrived in, and the old PDM now sits in my diabetes supplies cabinet, neatly tucked away so in the event that I need to consult it for old information or data, I can.

And now I can say I’ve got a shiny, pristine PDM that’s under warranty, which I must admit is a relief.

Why is it so Difficult to Order Life-Saving Medical Supplies?

When it comes to obtaining my diabetes supplies – life-saving pieces of medical equipment – I’ve discovered that it’s not a simple process. It’s not exactly like purchasing something on Amazon with a single click. Rather, it’s a convoluted, head-scratching, infuriatingly long procedure that apparently involves multiple calls to a variety of companies.

As of this writing, it took approximately 4 calls to my endocrinologist’s office, 12-14 calls to Insulet (the maker of my OmniPod insulin pump), 6 or 7 calls to Dexcom (for my CGM supplies), 2 calls to my health insurance provider, and 1 call to Express Scripts just to get everything all straightened away. These calls took place over the course of 2.5 months, and as they grew in frequency, so did my overall frustration and confusion.

The biggest headache was definitely caused by the lack of effective communication between Insulet and my endocrinologist’s office. I needed to get a new PDM, and Insulet’s job was to contact my doctor’s office and get a letter of medical necessity in order to get a PDM shipped out to me. Simple, right?

Why is it so Difficult to Order Life-Saving Medical Supplies_
My call log looked like this for several days in July – so many phone calls to Insulet/OmniPod and to my doctor.

Far from it. About a week after I placed the order for the new PDM, I got an email from Insulet saying that my doctor’s office had failed to return their faxes. I was advised to contact them to determine the delay. When I did, I spoke with a receptionist who, despite my clear explanation of the issue, misunderstood what I was asking for and left me a voicemail to say that she didn’t know what Insulet was talking about seeing as their information showed that I had received a shipment from them. (For whatever reason, she thought I needed more pods, which I did have delivered around the same time that all of this was going on.)

After several more back-and-forth phone calls, I cracked the case wide open: Insulet had the wrong contact information for my doctor. While my endocrinologist hasn’t changed in about a decade, her office location has, and Insulet still had the old one. I felt like an idiot for not realizing this sooner, but then again…why was I the one who was jumping through so many hoops and making so many contact attempts in order to figure out what the hold-up was? It was absolutely ridiculous, but I certainly felt relieved – and satisfied – to have personally solved the mystery.

I wish I could say I had a better experience with Dexcom, but that proved to be similarly headache-inducing. I thought that I was set to receive my supplies after I’d signed a payment plan for a 90-day supply of sensors and transmitters, but when they didn’t show up after a month of waiting, I knew something was wrong. I called Dexcom and discovered that the order, for reasons unknown, just didn’t process, so I had to sign a brand-new payment plan and had my case assigned to a different customer service rep. I was pretty pissed off by the lack of communication, but the one silver lining was that I’d already managed to pay my deductible in full (ha, no surprises there), so my Dexcom supply order would cost me less. Again, it was unbelievable that I never got an update from the company regarding my order’s status, but I did feel a sting of pride in myself for getting it all worked out on my own.

I don’t know why everything about this process is so agonizing. But what I do know for sure is that it seems that the only person I can count on to get my supplies ordered properly, in the end, is myself.

A Pod Failure Won’t Foil my Fun

I had just zipped up my coat when I heard a faint, high-pitched beeeeeeeeeeep emerging from somewhere in the vicinity.

My mom and I exchanged looks. “Uh, oh,” we said simultaneously.

“It isn’t me,” Mom said, patting her pod.

“It can’t be me, it sounds too far. Are you sure it’s not the refrigerator door that was left open?” I asked, as I unzipped and peeled off my coat.

She didn’t have to answer the question, though, because as I took my coat off, the beeping sound grew louder. I looked down at my abdomen and cursed. Yup, my pod had just failed.

I wasn’t totally surprised that it happened. The dry winter air was triggering excessive static electricity that weekend, and the sweater I chose to wear that day seemed to be charged with it. I couldn’t move my arms without hearing little sparks going off. If I was smart, I would’ve changed my top to one that was less filled with static. But I had somehow managed to convince myself that there was no way my pod could possibly fail due to my clothing choices.

I know better than that.

The real kicker in this situation is that we were obviously headed out somewhere – we were hoping to go to our favorite bar for a quick drink. But with the pod’s failure occurring at basically the most inopportune time, we were left with a three choices:

  1. Stay home. Take out the insulin, wait a half hour, and resign ourselves to the fact that it just wasn’t a good night to go out.
  2. Go out, but take a syringe and a vial of insulin with us. That way, I could give myself a shot, if need be, while we were at the bar. We could head home after the one drink and I could change the pod once we were back.
  3. Go out and take a total risk by leaving all extra diabetes supplies at home, and just wait until after we had our drink to change the pod.

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A cocktail by the candlelight.

I like living on the edge sometimes, but option #3 is just way too dangerous. So we went with option #2. If you’re wondering why we didn’t just opt to wait a half hour (insulin needs 30 minutes to come to room temperature before it can be put into a new pod), it’s merely because we didn’t want to stay out late. And yes, a half hour can make that much of a difference to me and my mom!

So we left the house with an emergency insulin vial and syringe in tow. And it’s amazing how much better it made me feel to know that I had both, just in case.

Fortunately, I didn’t need them. I monitored my blood sugar carefully during our hour-long excursion, drank plenty of water, and deliberately chose a lower-carb, whiskey-based cocktail that wouldn’t spike me. And I was able to enjoy every last sip of it before returning home and changing my pod soon after walking through the front door.

I do have to say, though, that under different circumstances, I’d absolutely make different choices. If we weren’t less than three miles away from the house, and if we’d planned on staying out for more than a single drink, then you bet your bottom dollar that I would’ve changed my pod before going out. But in this situation, I made the decision that felt right for me, and felt comforted by the fact that I had backup supplies in case I needed them.