May 4, 2005

In which I am my own guinea pig

Small adventure yesterday: I am eating lunch at work. Cheese sammich, V8 juice, apple. I have dutifully counted, tested, administered bolus. I am a good diabetic, yes I am.

Charlotte, without warning, makes her crankiest beeping sound.

Hello, NO DELIVERY. I remember you . This time the bolus has stopped after 3.8 out of 4.9 units.

I disconnect and study the tubing. Hmm. Looks fine. I see no bubbles or kinks or breaks. Is something wrong with Charlotte? To find out, I dangle the tubing over the wastebasket and do a manual prime. Straight away, my favorite liquid (ahem) drips out.

So. Charlotte is working fine. Must be the infusion set. Boo.

Up goes the “please do not disturb” sign. I thank the gods of work, yet again, for granting me an office with a solid door.

Remove reservoir, rewind, fill new reservoir. Knock the damn bubbles to the top, squirt bubbles back into vial, fill again. Insert reservoir. Prime. Ponder abdomen. Load new infusion set into serter thingie. Ponder abdomen again. Swab. Push buttons. Ow. Manual prime to fill cannula.

I’m getting to be a professional bionic.

Okay, up and running again. Now to remove the old set. Ow. I don’t have baby oil with me to loosen the adhesive. Ow. Stupid sticky stuff. I settle for an alcohol swab.

To my surprise, the old cannula looks just fine. I thought it would be bent or kinked or something that would cause the alarm. Apparently not. And there’s no pool of insulin above the site to suggest that the bolus didn’t make it down the cannula, either.

Hmm. A new dilemma faces me, and it’s far less appealing than the uneaten remains of my lunch. Do I redo the interrupted bolus or not?

A no delivery alarm means, in theory, that insulin delivery has (brilliant, I know) been interrupted at some point. The question is when. Charlotte decided that I wasn’t getting insulin at the 3.8 unit mark. But I might have gotten some up to that point, or all of it, or none of it.

I certainly need at least 1.1 units to finish up the bolus—unless I want to subtract food from my plate. Not an option. As for the rest, I have three options:

1. Assume I didn’t get the insulin and redo the bolus. Problem: if I got the bolus, or part of it, I will go low later. Possibly very low.

2. Assume I got the insulin and take only the 1.1 remaining units. Problem: if I didn’t get the bolus, I will go high later. Possibly very high.

3. Assume I got some portion of the bolus, roll dice to determine how much that portion might be, and take the rest. Problem: see #1 and #2 above. Plus I don’t have any dice at the office.

What would you have done? I picked the least life-threatening of these options, #2. One can always correct for a high later on, but a serious low could leave a diabetic beyond the point of caring, ever again, whether her latest A1C is up or down.

My experiment under way, I finished eating and went for a ferocious walk—which can itself cause lows, of course, but in this case I knew that if anything I was short on insulin. (NB: see, I did repeat the miracle, woo hoo!)

Three hours after the alarm, I tested at 120. Phew.

So why did I get the alarm if nothing was actually wrong? Fellow pumpers have suggested that maybe the tubing was squashed in a funny way under my clothes, or maybe it was a battery problem, or maybe Charlotte was trying to tell me that she wants one of those fancy pump pockets that all the girl pumps are raving about. Could be something else altogether.

Hmm, now where did I put my dice?

10 comments:

  1. I think it's the pump troll playing tricks. We set an extended bolus on my son's pump after eating pizza and cake (party). He had something else to eat and he had an hour left on his bolus. My husband swears he set it correctly, but when he went to dose again, the extended bolus had finished. So then we figured he'd be sky high. We checked about a 1/2 hour later, he was in the lower 200's. About an hour after that 150's. 2 hrs after that, 120's. Very weird.

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  2. I've had that happen a few times over the last 16 months, and it never ceases to amaze me. Never ceases to piss me off, either, because I'm ripping out a seemingly functional set from my seemingly non-functional body. I wear the pump tucked into the waistband of my pants or skirt at all times, and the tubing often gets knotted or pinched. I've had those phantom No Delivery whines from my pump, but I'm not always able to isolate the cause. Nice job, though, keeping backup infusion sets at your office. I also keep an emergency kit. Only my supplies are tucked neatly into an old Peppermint Bark tin form Williams & Sonoma. Sort of detracts from the whole "I'm a Good Diabetic with Back Up Supplies!", eh?

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  3. Violet, good to see you posting here again. I've missed yor blog, but certainly can understand the need for quietude.

    With my own pump (MiniMed 508), I notice that there's a delivery pf more than 2 units before I receive a no-delivery alarm. I've decided that some pressure has to build up before the device senses that insulin is not being delivered. There's some uncertainty with this situation, so it's good that it's infrequent.

    When I took shots, I felt uncertain almost every injection over how much insulin would find its way to where it was needed -- another reason why I prefer pumping.

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  4. I called MiniMed when I had my first 'no delivery' about a month ago. The person I spoke with walked me through doing the manual prime etc to make sure the pump was okay as well as check the tubing. The person then said that it was probably scar tissue where my cannula ends. She said that this sometimes happens when you use the same general area often. Just thought I'd share!

    Tekakwitha

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  5. Thank you all for commenting. Shannon, I think that pump troll deserves a name of its own. I will ponder.

    Tekawitha, hi, thanks for visiting! I am such a new pumper that I can't imagine I have scar tissue yet. I've been rotating my sites on a 30-day cycle, and I'm only in my third month of pumping. But I think I should have called Minimed anyway, to see what they'd say. It sounds like you got a pretty good response from them.

    Hi Kerri. I'm sure I'll forget to bring a new backup set to the office--I didn't remember today...Maybe I need my own Peppermint Bark tin?

    Jeff, I appreciate the welcome back. It's good to be here.

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  6. I just have to include my two cents. You know, if you have tested the tubing and pump, and stuff drips out, then you only have to consider replacing the site, you can remove the new tubing and stick the old, working tubing onto the new site once you've stuck it in. This saves insulin and reservoirs. Also, sometimes the troll is just being goofy, and if you try, before replacing everything, the bolus remainder, it might work fine. I'd also go with the assumption that you got the insulin up to the point of the NO DELIVERY - like you said, highs can be dealt with, but a low might not give you time to deal. Anyway, I'm cheap, and don't like to replace parts that don't need replacing. Baby oil? Good tip, thanks.

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  7. Not what I was searching for, but none the less and interesting blog here. Thanks for putting it up. I've enjoyed reading alot of the text here. I got you bookmarked for the future, I'll be back.

    My site is a bit different, some think it's odd. I guess it's a matter how you look at it. I have a diabetes related site. Most of the articles are on diabetes.

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  8. Hello,

    My wife is also a long time diabetic, she was diagnosed at 9 and started using a insulin pump when she was 24... I don't want to scare any one but, We've had nothing but trouble with the minimed 508. Supposedly the doctors said it would help keep the sugar levels more stable. But we notice that the hose and soft needles have problems sometimes... If you hold the insulin pump in your had notice the clear pastic part that protrudes out... Do not let the hose bend right there its cracked on many occasions and insulin will leak also the pump doesnt know so there is no warning... We just started to notice the cracks there recently. She changed it last night and over the corse of sleeping the hose cracked again. The soft needles on the other had sometimes get bent... We dont know what causes this... If you notice extra pain while inserting the needle... take it out and check the soft plastic tip... We've had them bent at a 90 degree angle... I mainly brought all this up casue there are no forums on the internet with people that have similar problems... Are diebetics not reporting the problems? Are the insuance companys not listening? Is minimed not getting reports? I dont know... I just know that my wife has been hospitalized more times while on the pump then manual injections... I would like to leave my contact info incase anyone would like to talk to us, or I would like to hear if you or your readers have had similar problems...



    Jake
    jllamas@morbidlywrong

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  9. oops sorry... jllamas@morbidlywrong.com

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  10. Wow great site. Not what I was searching for but an enlargement said very interesting and informative. I've been on the pump for about 6 years. Still using the 508 and I don't think anyone can get as cheap as me. Usually in your situation I will do as broken said and try it again.

    Now for my dollars worth:
    I have been a "bad" diabetic for quite some time and usually just didn't care as it seemed nothing would work. Recently I started a vailient effort to be good and noticed that changeing your site as recommended (every 3 days) makes a big difference.
    Batteries are the biggest pain to me.
    I have had the problem with the end of the reservoir breaking and wish I had the piece to allow use of less of the reservoir (anyone got one?)
    Since I have no insurance and can't afford the $11 to $15 per site I found out that the newer Quick Sets work with the 508 quick sets as long as you use the same tubing. This at least gives you more options like e-bay to find supplies.
    One more thing. Again since I'm a cash customer I can't stand that Humalog is the ONLY insulin that requires a prescription. First of all why would anyone take insulin that doesn't need it, for FUN!? Second, why in the BLAH do I need to keep getting a prescription? Do they think I'm cured? 'cause if there's a cure let me know!

    Okay, enought venting! Feel free to contact me e-mail or IM tenikiwon@hotmail.com

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