Omnipod variability of insulin action

my daughter is 10 and was diagnosed in january. We got the omnipod in June and overall it is great - she loves the convenience and not injecting, However, I am increasingly frustrated with what seems like completely variable insulin action with it!
-there is a trend to much higher sugars on the 3rd day of the pump, though not 100% of the time.
-she usually is low the first 24 hours with a new pod, often I have to cut back her basal rate by 30-40% overnight or she will alarm low (but again, not EVERY time).
-this alone is frustrating since it is not predictable enough to have for instance, separate basal programs for each day of the pump, but I just end up constantly making adjustments, and we have frequent times where she just ends up in the 300-350 range despite higher temp basals and generous bolusing and takes forever to come down. but if I increase her basal then she ends up low after a new pump.
-most recent omnipod seemed fine (a bit low as usual) first 18hours, but then from noon day #2 on she was just 280-320 no matter what we did so I changed her pod early. and first night with it she was low 2x, but now last night she was 300 at 2am!!

Its driving me crazy. Her diet is not hugely variable and at any rate, with appropriate carb boluses I don’t think that what she is eating for dinner at 7pm will be causing the 2-3 AM sugars (whether high or low) to be SO variable.

I don’t know what answer I am looking for, mostly just venting because I feel like there is no way for me to get this managed. When we did MDI it seemed much more predictable, but she hated it and it completely restricted any sort of unplanned snacks and was much harder for a 10 year old. She does not want to switch pumps - she doesn’t want anything showing and so pump with tubing would not be acceptable to her.

I haven’t seen any trend based on the site used - we use her arms (2 sites) and her abdomen (4 different sites there). she is really thin without a lot of sub Q tissue, especially on the abdomen but there is not a trend where the arm is better.

Has anyone else had this happen?

@txliz. Hi liz, welcome to TypeOneNation I hope you find this forum helpful. First of all I think you are doing a great job of being observant and in noting what factors are in play this is very important in dealing with diabetes. Second, even though you have a reasonable grasp of the technology, there is no such thing as stable blood sugar, it doesn’t ever get to a place where predictable or consistency are even useful words.

Variables affecting blood sugar-in “kind of” the order that affect me the most:

Type of carb-glycemic index
Insulin absorption
Everything else

That insulin absorption one, for me can be affected by a new site (for me my sites don’t absorb well until the histamines go away) cannula problems (bending and occlusion) and scar tissue

You are doing the right stuff: treat high blood sugar with insulin (or insulin plus activity). And do the best job you can. A one-off high blood sugar is not the end of the world.

Based on your description I don’t have a single guess as to what’s going on it sounds to me like a multi-variable issue of basal rate, site sensitivity and maybe occlusion/inflammation. She’s too young for scar tissue problems unless you are not rotating sites enough.

In my opinion, you can’t change basal rates every day unless it’s due to massive changes in activity such as “track and field day” over her regular activity levels. A basal change can take 2-3 days before a new pattern emerges.

Maybe a good start is to change the pod at day 2 instead of day 3. It reduces scarring and avoids the day 3 potential occlusion. You may need a new script as you will be going through supplies faster.

Take good notes and talk it over with her doctor and good luck!

@txliz Welcome Liz to the JDRF TypeOneNation Forum! And this is a good place to vent your frustration in dealing with diabetes - and hopefully you will find some comfort and good information here. As @Joe said, you are doing a good job and you appear to have a good grasp of diabetes management; I also ‘second’ all that he wrote.

There are MANY factors. in addition to the basic three of food - activity - insulin, that affect body glucose levels {BGL] and a group of long-time persons with diabetes cataloged more than 100 reasons why our BG fluctuates; has published a poster with the 42 most common causes[ a link to the poster is below. Note that some of the factors have “up arrow”, some “down arrow” and others have both up and down.

CHANGE is the title on one slide of a presentation I’ve used when addressing groups affected by diabetes. The rest of the slide reads: “Change is the one CONSTANT in diabetes”. This certainly has been my more than six decades trying to figure out how to dose insulin - I’m still learning. One reason that you may have had management with MDI was that you were wonderfully pro-active!

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