A Bit Bumpy

I spent way too long trying to come up with a good title for this blog post.

Let’s be real, here. It’s hard to think of compelling, descriptive titles that will make people want to read a piece of content. This post was particularly challenging for me because of the subject matter: bumps.

Before you jump to any conclusions, I’m not talking about baby bumps or any sort of metaphorical or literal bumps in the road. The bumps that I’m referring to are physical manifestations on my skin of my diabetes that I find unsightly, which is why I had a difficult time figuring out how to talk about them in a blog post.

I don’t understand why the bumps only appear on my thighs, but…c’est la vie.

Let me elaborate on the exact nature of these bumps. They only show up when I remove a pod that had been on my thigh. No other site experiences this blemish, and no other diabetes device (e.g., my CGM) causes a raised bump to appear on my skin’s surface. The bumps themselves are relatively small – they look a little bit like mosquito bites. You can always tell the exact location that the pod’s cannula was in because the skin looks slightly more irritated and raised there, whereas the skin around that site has a pink tinge to it. These bumps don’t hurt me, aren’t typically itchy, and usually fade in a week or so.

In the grand scheme of things, the bumps probably don’t sound like that big of a deal. But I can’t help but feel self-conscious about them because to me, they’re stark reminders of the physical marks that diabetes leaves on my body. I made peace with having to wear two different gadgets (my pod and my CGM) years ago and having those stuck on my being, but these ugly little bumps? I didn’t exactly consent to having those on my body, too.

I suppose I could solve the problem by avoiding using my thighs as sites for my pods, but to me, that’s just giving in to my diabetes and giving up an extra bit of real estate on my body that I need so I can properly rotate my pod and CGM sites. I’m a little too stubborn to just accept that I shouldn’t wear pods on my legs if I want the bumps to stop appearing. That doesn’t mean that I have to be okay with them, though.

Sharing about the bumps in a blog post is me being vulnerable about a component of my diabetes that embarrasses me. I’m hoping that it results in that shame evolving into a sense of acceptance, or maybe even pride, over my bumps. Because even though they’re far from cute, they do add visibility to my diabetes and represent the strength that my body and mind have developed in order to coexist with it on a daily basis.

Maybe writing this post is the launching point for me to think of these bumps not as blemishes, but as diabadass beauty marks, instead.

What I’m Looking Forward to the Most About the Omnipod 5

I experienced many emotions when it was announced, at long last, that the Omnipod 5 received FDA approval. The most prevalent one was joy: I was elated for myself, my mom, my coworker MJ, and all other people with diabetes who have greatly anticipated this day for what felt like ages. The thought that so much of the heavy weight associated with life with diabetes will soon be lifted off our collective shoulders is one that is thrilling beyond words.

Besides joy, I felt anxious (when will we actually have access to this technology?!), hopeful (the wait is bound to be worth it), surprise (I hadn’t expected the FDA approval this early into 2022), and…relief. That last emotion was probably the one I felt most strongly right behind my joy, and that’s because I’m taking solace in knowing that my secret diabetes struggle will be no more with the help of the Omnipod 5. And this leads me to the explanation of what I’m most looking forward to about the Omnipod 5…

I cannot wait to get my hands on the Omnipod 5…but for now, I’ll have to settle for staring at this promo image of it.

…and that is sleep. Yes, sleep. More specifically, sleeping soundly through the night, every night. Because my secret diabetes struggle has gotten in the way of that to new extremes in the last several months.

Long story short (I’ll save the long version for an upcoming blog post), my sleep is disrupted perhaps 3-4 times per week due to a low blood sugar. It’s annoying, sure, but part of the problem is my complacency in the matter. As crazy as it may sound, I’ve grown accustomed to the sound of my Dexcom alarming at any hour of the night and rolling over to grab a low snack from my nightstand drawer.

I think it’s been so easy for me to make peace with because of all the diabetes battles I could pick and choose (for example, if I had to choose waking up for lows or dealing with high blood sugars for hours on end any time of day), it’s the one that seems the most painless compared to every other possible scenario. It’s a weak explanation for this behavior, but it’s the best one I’ve got and I think that some people living with diabetes could probably understand (or even relate to) this rationale.

So that’s why I get a little teary-eyed thinking about how the automated insulin delivery mechanism of the Omnipod 5 could help reintroduce truly restful nights of sleep back into my life.

They are tears of joy, anticipation, and hope over how this new piece of technology may very well help me (and countless other people I love and care about) reclaim so many aspects of life that “normal” people take for granted.

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

This blog post was originally published on Hugging the Cactus on April 1, 2020. I’m sharing it again today because it’s actually one of – if not THE – most popular blog post I’ve ever written. Maybe folks find it helpful as they ponder trying new sites or maybe they’re simply curious to learn what has and has not worked for me. Don’t worry, I spill all the details on everything – read on to get the full scoop!

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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. 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.

Out of Site, Out of Mind

I knew I wanted to write a blog post about how I forgot to change my pod last week, and I knew I wanted to give it some sort of clever title…

…so out of site, out of mind is what I came up with. After all, my pump site was completely out of sight for me, which is one reason why I forgot it.

You’d think that it’d be impossible to forget about the device I have to wear 24/7, but it’s the sort of thing you get used to pretty quickly.

You’d think that after being on the Omnipod for almost 7 years, I’d never forget that I have to change my pod every 3 days. But just like I sometimes forget to reply to a text message or take a load of laundry out of the dryer, it slipped my mind the other night until just before I went to bed.

That’s when I was faced with a choice: Should I change the pod right then and there before I went to sleep, or let it expire overnight and change it first thing in the morning?

There were pros and cons to each. If I changed the pod before bed, then I wouldn’t have to worry about a screaming pod waking me up in the wee hours of the morning (well, I would if it failed, but the chances of that happening were small). But if I waited until the morning, I would ensure that the 30+ units of insulin still left in the pod would get used up as much as possible. It would also mean that I could push back my regular pod change by one whole day, which sounded appealing – until I remembered that it would mean that I’d have to change my pod on a Saturday when I’m double-hosting family, then friends, at my home.

So I sucked it up and changed my pod before going to sleep, knowing that in an hour and a half it would go off to remind me to check my blood sugar (to make sure that the pod was functioning properly), but feeling okay about this because I’d much rather deal with a gentle reminder over an aggressive malfunction alarm.

Now to the whole reason why I decided to share this seemingly insignificant anecdote in the first place: This is just one diabetes-related decision that I had to make on this particular day. I can’t even tell you how many other choices I had to make prior to this concerning which foods I ate, how much insulin I took, when I exercised, when I ate my meals, and so forth.

Diabetes is a disease defined by decisions. Fortunately, this one about when to change my pod was an easier one to make…but unfortunately, there are many others that are much more difficult. And I think all people with diabetes deserve goddamn decision-making trophies because of the funny conundrum of having no choice but to live life by making decisions.

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.

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.

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.

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.

5 Things I Hate About Pod Failures

I’ve had a slew of pod failures – three in the last two weeks.

What gives? I’m not exactly sure yet, but I’m hoping to get to the bottom of it. I sent my most recent failed pod to OmniPod/Insulet for analysis, and my suspicions are telling me that I have a bad batch of pods in my arsenal.

While I wait to hear back, I decided to write a blog post listing the five things I hate the most about pod failures as a form of catharsis…

1 – How suddenly and randomly they occur. Pods don’t give an eff as to whether or not they fail at an inconvenient time. In the middle of a conference call? Fails can happen. Sleeping? Fails can happen. On a date? Fails can happen. Just sitting there minding your own damn business? Yes, still, fails can happen. The unpredictability of pod failures makes them doubly obnoxious and loathsome.

2 – That wretched, unrelenting BEEEEEEEEEEEEEEEEEEEEEEP. Crying babies, barking dogs, ambulance sirens – I’d much prefer any of those other sounds over the high-pitched scream of a failed pod. I get why it’s necessary – how else are you supposed to know that a pod is no longer functioning – but it makes my ears want to bleed. Plus, you’ve got no choice but to silence the pod by sticking a paperclip/toothpick/other equally skinny object into that teensy-weensy crevice in the corner of the device! Let’s be real here, who has a paperclip just…available like that at all times in the event of a pod failure? It’s no wonder I chose to silence my most recent screeching pod by taking a hammer to it (note to anyone else who chooses to use this method: DON’T DO IT INDOORS, go outside and smash it on the pavement or in your garage…and maybe wear something to protect your eyes, just in case).

I smashed this screaming pod with a hammer and let me tell you, it felt great to release my frustration that way!

3 – The perfectly good insulin that gets wasted. When I deal with a pod failure, I can sometimes salvage the remaining insulin left within by inserting the syringe from the brand-new replacement pod into the insulin reservoir and sucking it out (literally the opposite of adding insulin into the reservoir for a routine pod change). But it isn’t always possible to rescue the insulin due to time constraints, amount left, and so forth. So it’s extra painful to just toss the failed pod away knowing there’s insulin left inside it that I just won’t be able to use.

4 – You don’t always find out why it happened in the first place. I am a naturally inquisitive person who is always asking “why”. So when a pod fails, I want to know what went wrong. Unfortunately for me, I don’t always get an answer. OmniPod/Insulet customer service representatives might be able to tell me why based on the reference code I provide them when a pod fails – when that reference code is found in their database, the answer might be that static electricity caused it to fail, or that when the pod was performing its routine and automatic safety checks, the pod itself determined it could no longer be used. But there have been plenty of other times that my reference code didn’t signify anything, leaving me permanently clueless as to what happened to make the pod fail. SO FRUSTRATING!

5 – You have to call customer support in order to get a replacement. As someone who has customer support experience, I dread these sort of calls. It’s just a giant pain in the neck to have to go through everything about your experience with a failed pod, such as how long I was wearing it for, what brand of insulin I use, where the pod was located, the lot, sequence, and reference code numbers…the list of questions go on and on. The silver lining here is that I’ve almost always had a very positive experience when calling OmniPod/Insulet to report a pod failure. My issue is usually documented in 10 minutes or less, and I’ve never had a problem getting a replacement, which shows is indicative of superior customer service.

But…is it so much to ask for the dang thing to simply work the way it’s supposed to 100% of the time?!