Dodging DKA: What Happened and What I Learned From It

In 23ish years of life with type 1 diabetes, I’ve never really experienced DKA…and I feel wildly fortunate to have avoided it.

But the other day, I came extremely close to it, and it’s something I won’t soon forget.

Here’s what happened: It was the wee hours of a Sunday morning. I woke up because I had to use the bathroom. My pod was on my thigh. I was due to change it that Sunday evening. I noticed that the pod’s adhesive folded up in the exact wrong way (it was crinkled up by the cannula), causing the cannula to bend and dislodge itself from my body…

…except I didn’t make that super-important observation until around 11 A.M., after several hours of tossing and turning in bed, unable to sleep because I was battling both a headache and stomachache.

What’s more is that around 10 A.M., I noticed that my CGM had been reporting a high blood sugar since about 5 A.M., and I simply hadn’t heard it alarming. When I saw that I was high, I took a bolus, but I didn’t bother checking on my pod because to my knowledge at that point, there was nothing wrong with it. Fast-forward to one hour later to when I did discover the dislodged cannula and I was feeling downright terrible: My stomachache turned into full-blown nausea, my head was pounding, my throat was drier than the Sahara, I couldn’t unfold myself out of the fetal position, AND I was feeling incredibly stupid for 1) missing my CGM’s blood sugar alerts and 2) not checking my pod to make sure it was secure to my body.

What bothered me more during this whole ordeal: my headache, my stomachache, or my anger at myself for letting this happen? (If you guessed the latter, then you’d be right.)

Fortunately, I did have a back-up pod and insulin with me, so I went about activating the new pod as quickly as possible. I felt a fleeting sense of relief when it was on me, but that relief turned into panic when I felt a swooping sensation in my stomach that indicated I was about to be sick. I ran to the bathroom and retched once, grateful that nothing actually came up, then sank down on the floor in shame, wondering how I could let myself get to this point of obvious borderline DKA.

The next few hours passed in a blur as I crumbled back into bed. I drank as much water as I could stomach, gave myself bolus after bolus, increased my basal rate, and tried to settle into a comfy position. I was extremely lucky that I wasn’t alone during this whole ordeal: My significant other was very concerned and doing everything he possibly could to help me. I was and am still so grateful for his care and attention. I didn’t admit it to him, but I was a little freaked out by the whole experience, but I took consolation over the fact that it didn’t come down to him having to bring me to the hospital.

By 4 o’clock that afternoon, my blood sugar was finally below 180 again and I was able to eat a little food, though I wasn’t overly hungry. I spent the remainder of the day beating myself up for letting this happen, but I guess that if I learned anything from it, it’s that I need to remember to 1) keep the volume turned up on my CGM so I can hear the alarms going off overnight, 2) check my pod immediately after hearing a high alarm so I can rule out any obvious pod issues, and 3) bring a syringe with me wherever I go so I can inject myself with insulin/get it in my system faster than a pod would be able to.

The experience also taught me a couple of other things…DKA is very real, very dangerous, and should be taken very seriously. The fact that I just barely dodged it is a jarring reminder that I should never underestimate it. On a much lighter note, though, I also proved to myself that I’m able to take control of a situation like that the moment I become aware of what’s going on. Thank goodness I was at least prepared enough that I had an extra pod and insulin on hand. I hope there isn’t a next time, but if there is, I know exactly what to do in order to take care of it as quickly as possible, thanks to this icky experience.

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.

Hello, Highs: Pooled Insulin Under my Pod Leads to Elevated BG

Have you ever tried troubleshooting a problem so much that you start to feel insane, and then like magic, the solution to it becomes clear and you wonder why you hadn’t tried it earlier?

This was the case with me and the mysterious high blood sugars that plagued me for two and a half days.

Based on this image, can you tell what was causing my blood sugar to be stubbornly high?

Once I started noticing a pattern of high blood sugars that got worse every time I ate food, I started doing everything else except changing my pod. I tried taking insulin for double the amount of carbs that I was actually eating, I ran a 95% temp basal increase for 8 out of 24 hours in the day, I cut carbs altogether and ate only 0 carb foods, I skipped meals altogether, and I even tried marching around the house for 15-minute intervals to try to get my insulin pumping through my system faster.

And nothing worked. I was able to get my blood sugar no lower than 180, but for most of that 60-hour window of time, I spent a good chunk of it in the mid-to-upper 200s.

Finally, on the day that my pod was due for a change, I decided that it must be the culprit behind my high blood sugars. When I removed the old pod, I knew immediately that something was wrong because the smell of insulin was so strong; plus, there was a large, damp spot on the pod’s adhesive, indicating that perhaps my insulin was pooling under my pod instead of entering my body.

It took 5-6 hours after I removed the leaky pod, but I finally did start to come back down to my normal levels, and was totally back on track the next day. It was a frustrating experience to endure, but a stark reminder of something that I’ve known in the back of my mind for years: that when I’m in doubt, I should change my pod.

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.

How to Make Medical Adhesive for CGMs and Pumps Last Longer

Something that all people with diabetes that I know – myself included – struggle with from time to time is the adhesive that keeps our diabetes devices stuck to our bodies.

Real talk? Both the adhesives for my pods and my Dexcom sensors can be lackluster. About half the time, the adhesives that secure them to my body begin to peel around the edges when I’m only partway through the wear time of both devices. And another (much smaller, though far more infuriating) part of the time, the adhesives lose their stickiness entirely, causing the device to fall off my body.

When the adhesive is the reason why a sensor or a pod doesn’t last the full 10 and 7 days, respectively, it’s practically like experiencing a slap in the face because at least a technology error or failure feels more out of my control…the adhesive, though, feels like something that should never be a real issue, and I can’t help but blame myself for not making a pod or sensor more secure when the glue completely fades.

On the bright side, my experience with less-than-sticky pods and sensors forced me to think of ways to get them to last their full lifecycles on my body. Here’s how I make them last as long as possible:

Protective barrier wipes: I use these wipes each time I do a pod change. When my new pod is priming, I wipe whichever site I’m about to place it on with a protective barrier wipe. (I use an alcohol wipe earlier on in my pod change process.) These seem to help with adhesion without adding a ton of stickiness like regular SkinTac wipes tend to do. They literally do what they say they’ll do, which is make a protective barrier for a piece of medical equipment to stick to easily.

Dry my skin: This seems incredibly obvious, but I make sure that new pod and sensor sites are as dry as possible before I apply a device. This is much more of a problem for me in the summertime when weather causes me to sweat more, but I’ve been able to navigate that by wiping my skin with a clean towel and making sure air is circulating well in the room in which I’m applying the pod or sensor so any excess moisture evaporates off my skin.

I may or may not have tried using Scotch tape in the past to get my devices to stick better…(Spoiler alert: It did not work and I do not recommend.)

Specially designed stickers: Both Dexcom and OmniPod produce stickers that customers can request for free. I get them mailed straight to me and I find that they are most useful when a pod or a sensor is hanging precariously off my body. The stickers are shaped exactly to fit around both, so I never have to worry about missing a spot, and they’ve definitely helped me save more than one pod and sensor in the past. I don’t like wearing them unless I have to, though, because sometimes the extra adhesive seems to make the underlying adhesive weaker (not sure how that’s possible, but I’ve always had more luck waiting to add a sticker on top of a loose pod/sensor that’s in its last couple days of wear than adding the sticker on top in the beginning).

The “circle and press” technique: Most people probably already do this, but I actively have to remind myself that when I apply a new pod or sensor, I need to take my finger and circle it around the adhesive firmly three times in order to make sure it’s pressing up against my skin as securely as possible. This method also sort of irons out any wrinkles that might have appeared when the pod or sensor was initially stuck on, so it’s a simple yet effective thing to do…which is absolutely something we could all use more of when it comes to handling diabetes.

PDM System Error: What It Is and What to Do When It Happens

I crack open the slot on the back of my PDM where two AAA batteries are nestled. I smack them out from their slots, insert two fresh ones, and replace the cover. I wait for the system to power back on and am greeted with a high-pitched beeping sound soon after it’s reactivated…

…and become simultaneously annoyed, confused, and a bit panicked when I see a “system error” message displaying on the screen.

I follow the steps that flash on its display, instructing me to reset the date and time. Once I take care of that, my pod immediately deactivates, aggravating me further. I assemble all the supplies I need to activate a new pod, and once I have it on, I receive a message that I won’t be able to use the bolus calculation function on my PDM for 3-4 hours.

The whole incident was majorly inconvenient, but such is life with diabetes…

Anyways, if you’re like me, you’re probably wondering what exactly happened, and why it triggered my pod to fail.

Error messages on diabetes technology are never something I’ll be glad to see, but they do happen.

Fortunately, I can explain it!

I’ve experienced this phenomenon before – it happens when the internal battery within the PDM (not the AAA batteries) has a problem and stops working the way it should. It causes the system to get confused when new AAA batteries are inserted (because the system shuts off and turns back on) and it doesn’t remember the date or time. Because of that, it can’t identify when the current pod was activated, so it immediately triggers it to stop working so new one can be applied.

It’s obnoxious as heck because it’s a total unpredictable phenomenon, but it is what it is. It can be dealt with in a matter of a few hours, and the best part is that Insulet can be contacted so they can be made aware of the issue and overnight a new PDM – which is what they did for me. The day after this PDM problem occurred, I gave them a call, and within 10 minutes I was promised a new PDM that I would receive in about 24 hours.

So when a PDM system error happens again – not that I actually anticipate it to for a long time – I know the right course of action is to keep calm, follow the system’s instructions, and give Insulet a phone call. In other words? Rolls with the punches, because diabetes is good at directing them my way.

“Doesn’t Your Pump Do All the Work for You?”

The answer to the above question is a big, fat, resounding…

NO.

I’ve written blog posts in the past about questions I’m frequently asked about life with diabetes, but shockingly, I neglected to include this one…which is so surprising because it’s probably among the more frustrating questions.

Don’t get me wrong: Diabetes technology has come a loooooong way, particularly in the last couple of decades. There are options when it comes to insulin pumps and pens alike (that is, if the choices are covered by insurance…that’s another story for a different post). There are tubed, tubeless, touchscreen, CGM-integrated, and waterproof pumps out there. There’s even a couple with intelligent software that can kick in and predict low or high blood sugars. And there are smarter insulin pens available that far surpass the ones I used just 7ish years ago…some can track insulin intake and are bluetooth-enabled.

It sounds like our pumps should be equipped to do all the work for us…but the simple truth is that they can’t.

Our diabetes devices are far from perfect.

_Doesn't Your Pump Do All the Work for You__
No…these two pieces of plastic simply CANNOT do all the work for me. They actually rely on me quite heavily.

Failures happen.

Batteries drain.

Error messages pop up.

When it comes to dealing with diabetes, technology certainly helps us, but sometimes things can go so awry with it that it almost makes life even more frustrating.

Certainly, the reward outweighs the risk; after all, I don’t believe that many people would continue to use pumps, CGMs, etc. if they didn’t work for them the vast majority of the time. I know that I wouldn’t.

But there’s too many variables happening independently of these devices doing their jobs that it essentially guarantees imperfection.

Stress, miscalculated carbs, medication dose/timing/interactions, too much/too little sleep, expired insulin, temperature, exercise, menstruation, alcohol consumption, family and social pressures…these are JUST A FEW of the things that are known to impact blood sugar levels. Just a few!!! I can barely keep track of those factors, let alone how they each affect me…and to expect a machine to know how to do that is placing a little too much faith into something comprised of wires and chips.

My point is that I really wish that people living without diabetes didn’t make assumptions that our lives are easy because of these devices. They are easier, most of the time. But there’s that other portion of time in which a lot of spare mental energy is used on maintaining that technology and making sure it functions the way it should, which is far from easy.

The short answer to the question-as-a-title of this blog post is no, I (we) do all the work for my (our) insulin pump(s)…they’re smart and capable, but only with the input of the people handling them.

The Best Time to Do a Pod Change

Whether you’re new to using an insulin pump or a seasoned pro, you might be wondering if there’s a time of day that’s most ideal to do a pod/site change.

And I’m here to tell you…there isn’t a one-size-fits-all answer. (Sorry!)

Like many aspects of life with diabetes, the best time to do a pod change will be different for everyone.

However, I do feel pretty strongly about what works best for me, and I can explain why it does. Maybe that will help you or a T1D in your life decide what makes the most sense for your individual situation!

The best time to do a pod or an insulin pump site change will probably vary for most people with diabetes, just like so many other things.

In my opinion, the best time to change my pod is within the 3-hour window after I’ve eaten dinner. Since I typically eat at about 5:30/6 o’clock, this means that I like to change my pod no later than 9 o’clock at night (but preferably sometime around 8).

Here are the reasons why:

  • I can take my dinnertime bolus using a pod that I know for certain is acting the way it should.
  • That timeframe is early enough for me to verify that my new pod is acting the way it should before I go to bed.
  • Usually, I don’t eat much in the evenings after dinner, so even if my new pod isn’t working right, it’s not too big of a deal because it’s not like I’ll be bolusing for mealtime carbohydrates.
  • When I change my pod at other times of the day, it interrupts other aspects of my daily flow (e.g., my wake-up time or my work schedule).
  • There’s something to be said for ending my day with a fresh pod and incorporating the pod change into my bedtime wind-down routine.

Of course, I’ve had to change my pod at less-than-ideal times (I recently did a 6 A.M. pod change because I was deliberately wearing my pod for the maximum 80 hours and it was not my favorite way to start my day). Pods fail or get knocked off and I’ve learned to roll with the punches by having back-ups at all times.

But since I know my best time for a pod change, it’s really nice when I can stick with it…because any reliable aspect of life with diabetes is one that makes it ever-so-slightly more tolerable.

Throwback to My First Day With the OmniPod

Life is incredibly busy lately; as a result, I don’t have as much time as I’d like to write brand-new blog posts! But I thought this would be a fun throwback to publish today: the post I wrote for ASweetLife.org on January 21, 2015. It’s all about how I got started with my first (and only) insulin pump, the OmniPod. I’ve written so much about it here in the last few years and it recently occurred to me that I’ve never gone into much detail on how my first day with it went. Fortunately, I rediscovered this post, which does a great job at capturing all the emotions I experienced that day. Read on for more…

Today marks a new beginning for me. After seventeen years of taking insulin shots, I’ve made the move to a higher form of technology: the insulin pump! My pump of choice? The OmniPod, which appealed to me mainly because it is tubeless and my mother also uses it.

As the day went on, I experienced an array of emotions. I woke up feeling pumped (ha-ha, diabetic humor) because I realized I would be taking my last shot via insulin pen for the time being at breakfast. It was pretty anti-climatic, but a major moment for me nonetheless.

Some anxiety started settling in around midday. This was partly due to the fact I knew my visit with my diabetes educator would last roughly three hours in duration. I wasn’t exactly thrilled about having to spend a good chunk of my day off at the doctor’s office. I also had a few lingering questions. When would I take my first bolus? When would I be able to eat my next meal? Would it hurt when I inserted a new pod? I was driving myself nuts with my ceaseless stream of questions.

When it came time for me to actually leave for my appointment, I felt as ready as ever. I decided it would be best to just go with the flow and be patient as I listened to everything my diabetes educator needed to say to me.

Turns out there are no cutesy cartoons of insulin pumps out there (go figure)…but this woman looks like she COULD be playing with a new pump (a huge, futuristic one, that is).

Much to my relief, the three hours flew by more rapidly than I thought they would. In that span of time, I learned not only the basics of my pump, but the finer points that I may not have necessarily understood or picked up on my own. And I was reassured when upon inserting my first pod, I learned that it’s painless – my Dexcom causes more of an unpleasant pinch than the OmniPod system.

By the time I left the office, I had three more follow-up appointments scheduled and a fully active pump stuck on my belly. I didn’t give it much more thought until dinnertime, where I tested (more diabetic humor!) its abilities. I was impressed with how simple the entire insulin delivery process was, and I liked that my PDM would beep periodically to inform me of the status of my bolus.

Post-dinner, though, brought some frustration. As I write, I am still higher than I would like to be. It could be due to anything, which makes it especially irritating. Maybe I miscalculated my carb intake, or maybe my basal rate or insulin-to-carb ratio needs tweaking. For now, all I can do is accept the fact that the beginning of this new regimen will bring lots of trial-and-error with it and monitor my blood sugars carefully – it means waking up a couple times during the night, but I know I just have to do it.

I am not looking forward to this start-up period, but I am hopeful for what it will bring and what I can learn from it. I do look forward to sharing my experiences along the way, so stay tuned for my next post about my transition!