3
Mar

Bubbles!

I want to ask Medtronic what they recommend when pump-users find laaaaarge air bubbles in their tubing.

Bolusing it out (while disconnected, of course!) might work, but it will count all of that insulin as IOB/Active Insulin, which can severely mess with bolus or correction calculations for the next 4 hours.

Re-priming it isn't as simple as it seems. In order to re-prime you have to let the cartridge rewind, which requires removing the reservoir from the pump.
Problems with this:
1) The little plastic nubbins that lock the reservoir into place tend to break off when the reservoir is removed from the pump. I have not found a way to be gentle enough to keep them attached while removing the reservoir.

2) It counts this re-prime as a set change, which will skew data on how frequently set changes occur.

 

 

This issue was particularly frustrating on Friday, as my workday started with a LOW RESERVOIR alarm on my pump.

I checked my settings, and - grrrrr - I was a day overdue for a set change. I guess the set had just been comfortable enough that I didn't notice I was on day 3 on Thursday. The LOW RES alarm wasn't a problem though, as it triggers the alarm when I've still got 20 units left in my reservoir, and 20 units is more than enough for basal insulin over my workday plus a lunchtime bolus for food.

The story doesn't end there, though!

Not long after the low res alarm, I visited the bathroom and had a chance to actually look at my infusion set (it was sitting in the top of my thigh). I was quite surprised (and more than a little upset) to notice that my tubing was decorated with tiny spots and differently-coloured flecks. Closer inspection revealed that I actually had some pretty huge air bubbles all along the length of my tubing.

I removed my reservoir (breaking one of the two tiny clips in the process) and restarted the set, which allowed me to re-prime my tubing... but by then I was down a few more units of insulin in my pump. By the end of my workday, sitting there with only 4.4 units left in my pump had me a bit on edge. Grrr!

23
Feb

A moment of hesitation

Sometimes these moments of diabetes fatigue hit me out of nowhere.

Last night my pump site was itchy and sore. I'm not due to change it until tonight, so I figured I'd ride it out and just put up with the sore site for a day.

This morning I woke up late, rushed in to work without testing in the morning, and only checked when I got in to the office. I'd been going on my cgm values, which were a little high but nothing too critical.

My BG once I got to work? 18.7.

The most likely culprit is a site that's not absorbing properly any more. I know that to fix it the next thing I should do would be an injection (not a correction delivered through my pump!) and a set change.

I open the "diabetes drawer" at work, pull out my spare reservoir and Mio set... and I pause.

I just don't want to.

I'm actually finding myself contemplating getting the vial of long-acting Levemir that I keep in the fridge at work and switching back to shots for a day or two.

I know that a sore site makes me much more likely to want to take a break from pumping. A sore site is a reminder that I've got a plastic cannula below the skin, making a tiny part of my body itchy and uncomfortable.

For now I've delivered my correction and am waiting on the whole set-change-or-not issue. There is no need to decide right now.

It is uncomfortable, painful, and unfortunate, but it is not currently life-threatening. I can afford to take a minute to try to remind myself why I started pumping in the first place.

21
Feb

Overnight lows

I've been having some issues with overnight lows lately.

 

I've been setting a 70% basal overnight for the last few weeks. Most of me knows that a 70% basal will make me wake up ok; fortunately for me I have a pretty solid network of friends who help me to fee not-so-terrible when I've had some delicious delicious wine.

 

My overnight basal rates have been too high for a while, and the weird thing is that it seems to take having friends over for dinner and drinks to figure out that I need to do something more permanent than a 70% overnight basal.

Bah! I don't want to have to re-jig my overnight insulin rates! Sometimes changes, whether stress levels or natural life stuff, BLOW.

8
Nov

Pet Expo 2014

I took my pooch to the Pet Expo earlier today. Every year a convention centre in my city hosts a giant Pet Expo that showcases pet adoption agencies, pet food stores, etc. This is the second year I've brought my dog, and although he tends to find it pretty overwhelming, we still had good time!

 

Ben and I at the Pet Expo

Ben gives me face kisses while I try to get him to pose

We tried to get a picture on the Milk-Bone chair (they were giving away Milk-Bone tooth-cleaning bone and a printout of your chair picture) for a few minutes, but my Ben was having none of it.  Since he's such a small dog and kept very nearly getting kicked when he was on the floor, he actually spent most of the afternoon sitting in his pet carrier (pictured hanging off of my arm, above).

I started off wearing a sweater, but that place was SO crowded and I started to feel overheated pretty quickly. I stored my sweater in my bag and carried on with touring around the place. After attempting to get a good photo (and monopolizing the Milk-Bone chair) for a couple of minutes, we gave up and started getting ready to continue walking - BUT! There was a young woman hanging out outside the Milk-Bone area. I actually bumped into her on my way in to the chair, so I vaguely remembered her from when I apologized for bumping her.

As I was leaving she tapped me on the shoulder and gestured towards my cgm while she asked if I would mind if she asked what it was. I was a bit surprised (I kind of feel like most people just dismiss "medical stuff" in strangers and don't give it much thought), but I smiled and told her that of course I didn't mind. I explained in a few sentences how it was a continuous glucose monitor that helps me manage my diabetes, and she thanked me for explaining and we both went our separate ways.

 

I don't often see or talk to strangers who have questions about this stuff. People I know - yes, all the time. Friends, family, coworkers, alllll of these folks come up with questions and most of them don't feel shy about asking. It was nice to be able to educate someone today, and also pretty cool that someone felt curious enough to ask. & politely, too!

 

 

 

 

 

6
Oct

Silhouette infusion set

Owwww!

I decided to try out the Silhouette instead of my usual Mio set this morning. Trying a brand-new infusion set in the morning as I'm rushing to head off to work? Baaad idea.

I watched Medtronic's youtube video about how to insert the set twice, then tried it myself. On my first attempt, I think I broke the little button on the insertion device that you push to expose the "teeth" that grab the infusion set. I pushed the button, and the whole pivoting piece sort of twisted. The pins on either side that hold it in had popped out, so it couldn't fit nicely over the infusion set.

I played with it for a few minutes and eventually managed to jam it back in to what I thought was the correct place.

Attempt #2!

I fit the set into the inserter, re-watched this part of the video again just to be sure, and chanted "insert, remove inserter, front tape, remove needle, back tape" (not a very catchy phrase, I admit) in my head as I went through the steps.

It went...okay. I squished some of the tape, so it doesn't look perfect, but overall I thought it went okay. It was not as painful as I thought it would be.

Until I sat down.

The site is in my stomach, fairly high up. I went there for visibility, and also because I was really hoping that an angled infusion set would make stomach sites more comfortable. It seemed a little sore, but mostly okay, until I sat - then OW OW OW OW OW. I'm hoping this irritation calms down a bit, because if not then I'm not sure I can make this set last three days :(.

25
Aug

Rafting and pump supplies

I went whitewater rafting this weekend.  I spoke to my d-team in advance so I could have a solid plan for switching to injections for a day, since my last pump vacation was a bit of a disaster. This time around wasn't perfect,  but it was pretty damn good!

I disconnected from my pump and left it in a cooler in the car (along with my transmitter) after giving a bolus for half of my morning basal insulin.  We decided  to go with half because
     a) rafting is a ton of exercise (possible lows),
     b) I would be in the sun all day (again,  another trigger for lows), and
     c) On my last "pump vacation, " I went super low for a loooong time (so my full dose of basal insulin would probably cause -- you guessed it -- lows!)

I went low somewhere during the safety training. 2 bottles of juice and a banana for me, & then we were off to the boats! The rafting team had my emergency bag in their dry bag; Boyfriend and another close friend both had glucose gel packs in the pockets of their shorts, and I felt as prepared for the day as I could possibly be.

By lunch I was 15.7. Hardly surprising,  since I gobbled down around 90g of carbs to treat the low before we left... At lunch I added together the insulin I'd need for the correction,  the meal bolus, and the "missed basal" bolus, then gave 2/3 of the whole thing, and by the time we finished for the day I was back at 5.6. I think I'd call this a successful(ish) pump-free day. I've obviously got a bit of work to do to fix what happened in the morning, but I stayed safe all day and ended up with a good #, so I'm happy with it!

Of course,  whitewater rafting beat the crap out of both my sensor and infusion set site. The infusion set (big bloody mess) still worked but was extremely sore afterwards,  so it has been changed to a new location. The sensor was also pretty badly squished and abused throughout the day (and gave me a sensor error when I first reconnected it) but seems to be working fairly well again. The excess tape that I had to use to hold it down is making the whole thing feel like a big sticky glob of constantly damp and itchy grossn.ess on my side, but at least it's only 36 hours until I'm due for a new sensor.

3
Aug

CGM: My experience so far

When I started on CGM, things were going fairly well.  I was getting mostly accurate readings, and in general I had few complaints. My sensors felt ok, weren't overly irritating, and all of the alarms it gave me were for good reasons. It woke me up a few times for overnight lows, and overall I was starting to feel pretty cautiously optimistic about integrating cgm into life.

 

Lately though, I've been having some issues with my cgms. On Tuesday night I started getting "LOST SENSOR" alarms. After trying to reconnect to a sensor (one that was only 5 days old), and failing, I called Medtronic to ask what could cause an error like that. The rep told me it was most likely a transmitter battery issue, which to be honest was frustrating to hear. I charged the transmitter before starting my last sensor, so having it die after only 5 days was more than a little bit annoying. I removed the sensor and fully charged the transmitter after being told that Medtronic would replace the sensor that I had to pull out early.

 

My sensor stock was at 2, so luckily I still had enough to start a new one early. After the transmitter was charged, I tried out a new sensor...and then:

 

BLOOD EVERYWHERRRRRRRRRE.

 

SO, SO MUCH BLOOD.

 

I've only been on cgm for about 3 weeks, and in that time I had not experienced any bleeding when I inserted a sensor. None. At all.

 

This time, though? SO much blood.  I followed the cgm instructions and put pressure on the sensor, and it stopped bleeding pretty quickly. I still had the issue of dealing with the blood-soaked tape that goes under the transmitter. The blood pretty much wrecked the stickiness of the tape, so I had to clip off some of it as I couldn't get it to stick to the skin. I called Medtronic again at this point - I know it might have been an overreaction, but as I'd never had any bleeding at all, I was wondering whether all of that blood would affect the sensor performance. The rep told me she couldn't say, and that it couldn't hurt to try it out, but not to expect much from it (I'm paraphrasing. She was much more professional than that). She also told me she'd replace the sensor. That's...um? Thanks? Not really why I called, but still nice I suppose.

 

She was right about the sensor, sort of. It had about 4 days of solid use (reliable numbers, etc) before it started to fail, but when it failed it failed hard. I went to bed with good sugars, and it spent an entire night waking me up with Low Suspend alarms every 90 minutes or so. I eventually turned off the low alarms and tried to get it to shut up, but the Low Suspend alarms just kept coming. By the time I woke up I was 18.6  -- buuut my cgm was showing a nice straight line.

 

It was only off by 12...

It was only off by 12 mmol/l... ( ~216mg/dl)

 

*sigh*... not exactly the number I wanted to wake up to on my birthday!

 

I switched everything yesterday, and this time made sure to separate my cgm and infusion set. I think part of my dissatisfaction with the sites and sensor might have been that the two were very close last time around, and both felt constantly irritated. When I'm always annoyed by a site, I'm just a teensy bit more prone to overreact to things.

 

Since changing both on Saturday I've been happier...ish. My cgm still trends lower while I'm sleeping, and last night (on a freesh cgm) I still got a few false low alarms. I finally googled it today, and found that apparently Medtronic cgms are sensitive to pressure. A few sites I read (mostly diabetes forums and comments from users) said that if you're sleeping on it, the increased pressure on a sensor can cause false readings.

 

Balls!

 

I prefer to put my cgms in my back. They don't bug me there, and I find the sites to be much more comfortable (aka easier to ignore). I just started a new sensor yesterday, so I've got quite a bit of life left in it - but after this one I'm thinking of trying some new areas. I read a few good things about sensors in the top of the thigh, and I've never had issues with infusions sets there. Some users also recommended the arms, so that's another for the "maybe" list.

 

 

25
Jul

New pump

I got a new pump today!

I got a "Motor Error" and followed the prompts. Esc+Act to clear. Remove & re-prime reservoir. Called Medtronic to ask "soooo... why did I get a Motor Error?"

The very kind Medtronic rep had me describe the situation, and decided that my pump had to be replaced.

(Only 2months in & it's already broken? Yikes...)

I have an injection (actual injection! With a syringe!) to cover me for dinner. Around 50 minutes later I had my new pump. Say what you will about Medtronic pumps, but they're damn good about supplying a replacement.

Reset my old pump's settings (uploaded via carelink) to the new pump, linked it to my meter and transmitter, annnnd....it looks like I'm good to go :).

I must say...It's been a heck of a night!

image

At least I've had stable cgm graphs tonight...I know cgm isn't an exact representation of bg levels, but a stable cgm still makes me feel a bit better :).

22
Jul

CGM Start

CGM start day was... interesting. I got up early to do a set change before breakfast, and since it was an important day, naturally my pump kept giving me "NO DELIVERY" alarms. Every time. I don't know what caused it, but something about the set was blocking the tubing. Infusion sets are expensive, so I really wanted to try to make this one work. I tried reattaching the plunger to the reservoir and manually pushing insulin through the set -- no luck there. I swapped out the new reservoir for the old one, as it still had a few units in it -- & this time, manually pushing insulin through the set worked. I reattach the new reservoir, prime the tubing, and this time it all works just fine.

But wait! It gets better!

I got to the hospital and met with my nurse, the Medtronic nurse, and John (someone else who sees the same endo as I do), and we sat down in a conference room to start the training. My nurse showed us, using a "training" sensor and a pillow shaped like an abdomen, how to do the full sensor start.

We got the chance to use our own "training" sensors to do a practice run first, and I'm glad we did. My sensor jammed up in my serter and failed to insert. It turns out the tape got caught and was preventing it from inserting the sensor :(!

They gave me a new practice sensor, and the second time went off without a hitch, so John and I prepared to insert our first *real* sensors. I chose to put mine on my back, still above the belt line but very far from my abdomen. I know it would have been easier to do it where I could easily see what I was doing, but I also know that having something in my stomach for 6 days would drive me crazy.

I picked a spot, inserted my sensor, waited 5 seconds, and removed the serter. Voila! It was in!

Before even removing the needle, I twisted to pull the top of my skirt down a bit so I could see the sensor clearly.. aaaaand in the process, I rip out my infusion set.

& to make things even better?

HUGE BLOODY MESS.
(...ew)

So that was fun - being the person who's bleeding from her butt (the top of my butt....but still) while everyone waits for her to catch up. Awesome.

I took a second to remove the sensor needle and apply the overtape at this point. I also used some Skin Prep around the sensor at that time, as I need it to keep things stuck (showers tend to dislodge infusion sets when I don't use Skin Prep 🙁 ), and the Medtronic nurse told me that if I used the Skin Prep prior to inserting the sensor, the sensor would get gummed up by the Skin Prep and might not work properly. I had no idea!

She said it's not a problem to use it as long as the Skin Prep (or any other product that makes skin sticker) is applied around the sensor after it's already in the skin. It felt extremely awkward to try to wipe under the sensor-tape with a Skin Prep swab, but despite that it still seemed to work ok.

My nurse brought me a spare infusion set, so I just swapped it out for a new one. My reservoir was still working and thankfully didn't give me any more "no delivery" alarms...

Medtronic sensors need about 5 minutes for the sensor to "wet" after they're inserted into the skin, so I spent that time setting up my new infusion set. After that, It was time to attach the transmitter and tape the whole thing down.

Overall, I guess the whole thing went pretty well. A few relatively minor setbacks (a test sensor that jammed, a yanked-out infusion set...) did occur, but honestly if I'm ever going to have a sensor-insertion-experience that's filled with drama and unexpected events, it's prbably best that it happened at a hospital :P.

I've since inserted one new sensor, which went fairly smoothly. I can't say I'm comfortable with the process yet, but hopefully that part will come with time.

9
Jul

CGM Day!

Today is CGM day! I'm on my way in to the hospital for my CGM training with my CDE, the nurse from Medtronic who does pump and CGM trainings, and another patient who sees his endo at the same clinic as I do (they sometimes do pump- and CGM-trainings in pairs).

My list of worries includes (but is SO not limited to), in no particular order:
- It will bleed for ever and I'll have to remove the sensor
- They will want me to insert the sensor on my stomach (seems likely), which will hurt (because stomach sites always hurt)
- It will continue to hurt for the life of the sensor
- I will dislike cgm because my first one started with 6 days of discomfort
- I will screw something up with the insertion
- I'll forget something and look like a tool (but I watched all of the Enlite training videos! I swear I did!)
- When it hurts, I will get all teary. I do not want to cry.

...and that's just the beginning. I know that most of these things are either unlikely (3+ minutes of bleeding) or not as bad as I imagine them to be (6 days of discomfort), but knowing that doesn't change my worry level.

Either way, in a few hours I will be hooked up to my cgm. Wish me luck!

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