No Delivery

[belyro]

Does anyone else find that, if they have an occlusion, they don't get a "no delivery" message until they try to bolus?

Last night my bloodsugar was perfect all evening, and 6.8 (122) when I went to bed. At 3am I woke up and was 17.5 (315). Since I've been having some troubles with my basals at night lately, I thought it was probably something to do with that....even though that was an awfully high level to end up at. So I bolused 2 units and as soon as it started (or tried to start) giving me my bolus, it gave the no delivery message. So the only reasonable explanation (IMO) is that it occluded a few hours prior to the high reading but that it didn't alarm until I tried to bolus. This has happened in the past too, when I was using the Quicksets, but never with the Sils and never at night. I felt AWFUL!!! I'm on really small basal doses (0.35u/hr overnight), so I think that might be the reason the occlusion didn't register. Still, it's pretty scary to me that if I get an overnight occlusion, I won't know about it until I wake up with really high bloodsugar and probably a lot of ketones - hopefully I wake up before DKA sets in.

It was about an hour before it really started coming down, but I was a sweet 5.8 (104) in the morning, so it did work out. That said, I'm EXHAUSTED today.....nothing like a severe lack of insulin to completely drain a person. :P

Thoughts?

[JediSkipdogg]

The reason is because of the amount of pressure required to set the occlusion alarm off. Here's what the MM manual says....

Occlusion detection
When occlusion is detected, the “no delivery alarm” will occur. The occlusion alarm is triggered by an average of
2.77 units of “missed” insulin. This table shows occlusion detection for 3 different situations when using U100
insulin.

522/722
Rate --- Minimum time --- Typical time --- Maximum time
bolus delivery (1.5 u/minute) --- 92 seconds --- 116 seconds --- 162 seconds
basal delivery (1.0 u/h) --- 2.2 hours --- 3.09 hours --- 4.47 hours
basal delivery (0.05 u/h) --- 37.4 hours --- 59.2 hours --- 87 hours

[belyro]

The reason is because of the amount of pressure required to set the occlusion alarm off. Here's what the MM manual says....

Occlusion detection
When occlusion is detected, the “no delivery alarm” will occur. The occlusion alarm is triggered by an average of
2.77 units of “missed” insulin. This table shows occlusion detection for 3 different situations when using U100
insulin.

522/722
Rate --- Minimum time --- Typical time --- Maximum time
bolus delivery (1.5 u/minute) --- 92 seconds --- 116 seconds --- 162 seconds
basal delivery (1.0 u/h) --- 2.2 hours --- 3.09 hours --- 4.47 hours
basal delivery (0.05 u/h) --- 37.4 hours --- 59.2 hours --- 87 hours


Good grief! So I could miss 6 hours of insulin before it alarms!! Ack!

Well, nighttime DKA has just become a new fear of mine. :(

[JediSkipdogg]

Good grief! So I could miss 6 hours of insulin before it alarms!! Ack!

One main reason it occurs with a bolus though is because of the greater pressure (from a larger amount of insulin) given over a short period.

That's one reason I love the ANimas, you may get an occlusion for missing 2 units of basal insulin, but if during a bolus, you can get it in under 5 seconds. Then you know instantly it didn't go, so you can check all the tubing, see if the site appears infected, and give it a go again (if you are that daring as I find more than 75% of occlusions are not true occlusions) and then if it doesn't work change the site.

[dmorisse]

Hi Beth, It was nice to finally meet you last night. I second Jedi's repy. It does take too long to get the no delivery alarm when your basal's are so low. This is one of times where the CGMS can help a great deal. The sensor will alert you to a high much earlier and you can take action before your BG gets to the point of feeling sick. Hope you are feeling better.
Darlene

[belyro]

That's one reason I love the ANimas, you may get an occlusion for missing 2 units of basal insulin, but if during a bolus, you can get it in under 5 seconds. Then you know instantly it didn't go, so you can check all the tubing, see if the site appears infected, and give it a go again (if you are that daring as I find more than 75% of occlusions are not true occlusions) and then if it doesn't work change the site.

Well yeah...during this bolus I got it immediately. If it was during the day I might have just tried again, but with a high bloodsugar like that in the middle of the night I was NOT feeling daring. I just changed it all....cursing the whole time.

[RLK]

I've had my share of occlusions that didn't alarm until I tried to bolus and it's so frustrating to figure out why it happened. How long had this set been in place? Have you talked to your doc or pump trainer?

Hang in there- you'll get it sorted out!

[belyro]

I've had my share of occlusions that didn't alarm until I tried to bolus and it's so frustrating to figure out why it happened. How long had this set been in place? Have you talked to your doc or pump trainer?

Hang in there- you'll get it sorted out!

I'd had the set in for just over 24 hours.

I've contacted my pump trainer but haven't heard back from her yet.

[Cyborg]

I've never had a single occlusion. I do have some problems with new sets not working well for a awhile sometimes.

Wonder if it is pump related. Perhaps I'll start a poll...

[cheryl]

I had a sil clog on me once....and well there was no warning, I was about 124 for dinner that evening which was odd because I usually at that point getting low everyday, after work.....so I didn't think much of it, ate dinner two hours post meal was over 300 so when I pulled the set insulin was spewing out....hmmm so I put a new set in, I realized I was using a 17mm cannula too, It don't work well with me I use the 13mm all the time but had a 17mm, so far 13mm hadn't done it to me but I had one almost two weeks ago start to get a bit stubborn, took me forever to realize it was the set dumb dumb...cause i would go down, but then I'd go back up....oh well.....but I still have faith in my sils, I just wish it would all work perfectly don't you.....we can never have our cake and eat it too ughh

Cheryl

[mark_in_toronto]

Definitely had this happen....I've only been pumping since March this year, but have had many "sites" go bad/have poor absorption with....

Even recently it happened again and I tossed the insulin thinking it might be faulty.

I heard from a nurse at Minimed, that her daughter pumps, and specifically told me that basal doses don't set off occlusion alarms. Also, I've heard that for low basal rates, if there is air in the tubing at all, you will be getting air doses, not insulin doses.

I'm still trying to figure this out!

[Funnygrl]

I've been having a lot of "no deliveries" with quick-sets. I'm switching to sils.

[cheryl]

I've been having a lot of "no deliveries" with quick-sets. I'm switching to sils.

Are you loosing weight when I started pumping(i make it sound like I am some pro).....quick sets worked fine after 10 pounds of weight loss omg,, kink, no delievery, or bad absorbtion issue's.....sils do well, but don't get lazy, I was starting to keep the bad boys in for four days....and by day three after a while I was starting to elevate, blaming it on everything else but absorbtion......cause it was working at first.....so and last night was a fourth day set on me....bad bad cheryl.....but I forgot...till after the fact that that was day three....oyyyy.....

Cheryl

[belyro]

I've been having a lot of "no deliveries" with quick-sets. I'm switching to sils.

Yup, that's exactly why I switching to Sils. This was my first "no delivery" with a Sil. Generally they work very well for me and are much more comfortable than the Quicksets too.


So I got a response from Minimed to my concern about the nighttime occlusion not setting off an alarm:

"The reason it did not register is as she thought...the pressure is too minimal. She is going to wake with DKA as she will end up vomiting quite frankly and as long as she does exactly as she did along with drinking loads of water she will wake up returning to normal BG. I would however suggest with highs during the night she can use an injection if she is worried and
wants to go back to sleep. The only way to solve it is to use a sensor and she would have been alarmed. This is the reason we ensure no changing sites at night (which she did not ... But just reinforces this critical rule)"

So they say the only way to solve it is to use a sensor. I plan on using sensors from time to time to figure out trends, etc, but since I'll be paying for them out of pocket, I absolutely cannot afford to be on them 100% of the time. So I guess I just have to live with the risk of going into DKA in the middle of the night. I'm pretty unimpressed with that. :mad: Here's hoping either (a) my insurance company starts to cover sensors, or (b) no more sets go bad on me at night. *crosses fingers*

(I hate leaving diabetes/health issues up to chance. That shouldn't have to happen.)

[cheryl]

Hey Beth two things, how long was the sil in again when you had the bad set, and was it a 13mm or a 17mm.....I was wonderining about that.....

I have come to find out that and I am just being honest, something is always out to get us, when it knows we are the weakest, yours is in the middle of the night, mine is omg it might happen when I eat....

I am so sorry, I have my issue's too....I so know how you feel.....I guess we have to except that nothing is full proof....nothing.....

Cheryl

[belyro]

Hey Beth two things, how long was the sil in again when you had the bad set, and was it a 13mm or a 17mm.....I was wonderining about that.....


I had it in for just over 24 hours and it was a 13mm.

[Funnygrl]

Lol Cheryl, thanks for asking, my I'm sure being too skinny is NOT my problem :)