[Cielo]

It’s a week now that Adam has been on the pump and he’s encountered three situations where he’s had his sugars skyrocket out of the blue.

1. Day 2 – He would bolus but his body would seemingly not absorb the insulin, resulting in high readings.

2. Day 5 – There was an air bubble in the tubing causing Adam to not get the proper dosages of insulin b/c his insulin would shoot up out of nowhere.

3. Day 5/Day 6 – Adam changed his site on the morning of Day 5. He ate lunch and everything went well. He then ate dinner and his sugars shot up to the 300s. He took three corrections during that night b/c he couldn’t get his sugars down. In the morning of Day 6, his sugars were really low. After a late breakfast he changed his site b/c it’d been really sore since the night before (Day 5) and was uncomfortable. Note that the site before was perfect, no pain, no discomfort. With the painful site, boluses were felt with searing and burning sensations. When he pulled the cannula out, it was bloody. We think that he wasn’t receiving insulin with this painful site resulting in his highest BG reading in about 5-6 years (it was 400).

Adam is a very careful and cautious diabetic so these readings are freaking us out. We understand that it takes awhile to get used to the pump and make the changes in order to get ones sugars just where they need to be. But we’ve SEEN these great readings and we’ve SEEN that his sugars have been stabilized. It’s these problems that pop up out of nowhere that are causing these crazy readings. If these problems are just a part of being on the pump, maybe the pump isn’t for Adam. He is starting to really worry and these readings are scary….he’s thinking maybe he should get back on MDI. He feels that he had better control then…he wasn’t able to control his DP but he never had the really high readings.

So please, any advice would be appreciated….To pump or not to pump???

[ricardo]

Originally Posted by Cielo

It’s a week now that Adam has been on the pump and he’s encountered three situations where he’s had his sugars skyrocket out of the blue.

1. Day 2 – He would bolus but his body would seemingly not absorb the insulin, resulting in high readings.

2. Day 5 – There was an air bubble in the tubing causing Adam to not get the proper dosages of insulin b/c his insulin would shoot up out of nowhere.

3. Day 5/Day 6 – Adam changed his site on the morning of Day 5. He ate lunch and everything went well. He then ate dinner and his sugars shot up to the 300s. He took three corrections during that night b/c he couldn’t get his sugars down. In the morning of Day 6, his sugars were really low. After a late breakfast he changed his site b/c it’d been really sore since the night before (Day 5) and was uncomfortable. Note that the site before was perfect, no pain, no discomfort. With the painful site, boluses were felt with searing and burning sensations. When he pulled the cannula out, it was bloody. We think that he wasn’t receiving insulin with this painful site resulting in his highest BG reading in about 5-6 years (it was 400).

Adam is a very careful and cautious diabetic so these readings are freaking us out. We understand that it takes awhile to get used to the pump and make the changes in order to get ones sugars just where they need to be. But we’ve SEEN these great readings and we’ve SEEN that his sugars have been stabilized. It’s these problems that pop up out of nowhere that are causing these crazy readings. If these problems are just a part of being on the pump, maybe the pump isn’t for Adam. He is starting to really worry and these readings are scary….he’s thinking maybe he should get back on MDI. He feels that he had better control then…he wasn’t able to control his DP but he never had the really high readings.

So please, any advice would be appreciated….To pump or not to pump???

Number one: get ahold of his endo and explain what's going on.

Number two: You probably didn't get him a MiniMed pump, right? The other pumps will cause burning during bolusing due to too-fast infusion rates.

Don't be so quick to give up on pumping. Explain all your concerns ASAP to Adam's doc. Something you guys are doing is going awry; find out what it is and FIX it; don't just GIVE UP.

You should be taught how to properly purge the line and reservoir so that air bubbles are of no consequence. It's not all that difficult, once you are shown how.

I'm not gonna try to diagnosis what's wrong...

[duck]

There is a learning curve, yes. And some people do not do well on a pump, let's get that out on the table now. But from what I read about Adam here, he is not typical of those who do not do well on a pump.

Now, is Adam really thin? I'm not, so I can pick nice, comfy insertion sites at will since I can "pinch and inch" in a lot of places. And I was just thinking today that for whatever reason, I am much more comfortable with certain sites than I was when I first starting pumping...I don't know if I am just better at inserting (but how do you get better?) or if my nerves are dead (I very much doubt that), but that's my observation.

When I started pumping, I seemed to kink my insertion sets a lot--That would lead to highs. I also seemed to have air bubbles get caught a lot in the quick disconnect, and that would lead to highs. I've learned to eyeball the entire length of my tubing to make sure there are no air bubbles.

Don't give up yet. Have your "backup" insulin ready at all times in case the pump seems to be not working correctly, but I am a firm believer that the pump is the best treatment method out there for Type 1's.

[Cielo]

Yea, we're not ready to give up yet....we want to be on the pump until Adam is comfortable with it and has given it a REAL try. And I know that it's only been a week so we have to learn as we go. But Duck, your post reminded me of something else...the cannula when it was pulled out was bent at the tip...does that make a difference?

[duck]

Originally Posted by Cielo

Yea, we're not ready to give up yet....we want to be on the pump until Adam is comfortable with it and has given it a REAL try. And I know that it's only been a week so we have to learn as we go. But Duck, your post reminded me of something else...the cannula when it was pulled out was bent at the tip...does that make a difference?

Yup. That's kinda what I meant by (I don't know if) I am better at inserting now...Initially, I was bending, kinking insertion sets at least twice a month. I seem to recall initially it was not a problem, but after a day sugars would rise slowly, etc. Also, initially, I often would remove a "bad" set, examine it and notice *something* lodged into the canula--I don't get that as much anymore.

What kind of "inserter" do you use with the Animas?

[Dewey]

Originally Posted by Cielo

Yea, we're not ready to give up yet....we want to be on the pump until Adam is comfortable with it and has given it a REAL try. And I know that it's only been a week so we have to learn as we go. But Duck, your post reminded me of something else...the cannula when it was pulled out was bent at the tip...does that make a difference?

Hi Cielo, and sorry to hear Adam's having some trouble. The bent tip of the cannula is just as Duck had described (kinked). It will result in high readings and such, and unfortunately, No pumps are able to detect that kind of problem (whereas they can detect occlusions in the line and such). Another possibility might be to ask Adam's endo about trying the untethered regimen. If he's had success on Lantus before, and can do a 75% Lantus/25% pump ratio, his body won't be solely dependent on the basal insulin that he currently receives from the pump. The down side is that if the pump's not working properly, he may not know it until he goes to bolus for a meal, etc. This is something I'm going to ask my endo about trying, as I want to fine tune sugars as much as possible, and can only do so well with the pump alone. I sure hope things get better, and please hang in there. As Duck said, there is a learning curve. If Adam hasn't already, perhaps trying the slower delivery might help. Some users have had that issue with the Animas (I know I have), whereas with the Deltec, delivery settings can be changed from a time frame of over one to five minutes worth. Sure hope this helps and hope Adam gets adjusted soon.

[am1977]

Ultimately, the decision to pump or not, is really a personal decision. I've had more than my share of frustrations with pumping (even chosen to take an extended break from the pump) , but I have chosen to stick with it...and I'm relatively happy with that decision.

I think there is definitely a period of adjustment...one needs to find the right basal rate, the right CHO to insulin ratio, the right infusion set, etc. However, once you figure this out...the pump can be an excellent tool in managing diabetes. It allows us diabetics more flexibility and freedom than shots do and that's something I really value. As far as the pump, it definitely isn't a cure-all. I think I had thought that orginally and when I saw that I still had highs and lows...I was very disappointed. The truth is Adam will most likely still see those issues and, unlike shots, trying to find the problem isn't so straightforward. Those bouncing blood sugar readings can result from anything from carb counting errors to problems with infusion sets/sites. You need to be a bit of a detective sometimes to get to the bottom of things. That's another thing that can be frustrating. Not to mention, that there is a fair amount of work involved with pumping. Many pumpers have increased the amount of blood sugar tests they do a day. Also, there's planning involved with managing pump supplies, rotating infusion sites, etc, etc, etc. I would even venture to say that it's more involved than injections.

Like others suggested, the best thing to do would be to continue working with Adam's doctor and diabetes team. You will figure things out . If he does decide to return to injections, that's ok too. You have to do what works for you.

Good luck

[Belinda]

as the others have mentioned it takes some time and getting use to. I kink my cannulas on occasion. I have also gone to bed with a 112 and woke up with a 350 where "somehow" their was an occlusion, but since I was asleep I don't get up to check......in the daytime I check more frequently and can catch when this happens....doesn't happen much but it still happens.

Just don't give up!!!!

[Cielo]

Originally Posted by Dewey

If Adam hasn't already, perhaps trying the slower delivery might help. Some users have had that issue with the Animas (I know I have), whereas with the Deltec, delivery settings can be changed from a time frame of over one to five minutes worth. Sure hope this helps and hope Adam gets adjusted soon.

Dewey, He changed his setting to deliver his insulin slow after reading one of your posts. That helps most of the time. It was really just that one bad site that caused the burning. Thanks for the support and ideas....we'll keep on trucking.

[jeggeman31]

Just wondering what pump does he have ?

[Cielo]

Animas 1250, he uses the Comfort infusion set b/c he's pretty lean, not much fat anywhere.

[jeggeman31]

Originally Posted by Cielo

Animas 1250, he uses the Comfort infusion set b/c he's pretty lean, not much fat anywhere.

Thanks Cielo. I was just wondering, as I go to the ENDO today to talk to him about the pump.

[Cielo]

That's awesome, congratulations! The Animas 1250 is really an awesome pump and the support team behind it is great. They're really supportive and they are always there. Very quick response time. I hope it works out for you!!!!

[Amanda_Jo22]

Cielo,

Congrats on the new pump. I remember when I first started pumping...it was very frusterating! It took me a good month, maybe even two, to really feel completely comfortable. Sorry about the frusterations...it WILL get easier!

A bent cannula is definatly the reason why he couldn't absorb the insulin. You might want to try the insets. You can get the cannula in a smaller size. The nice thing about the insets is the inserter. It makes the insertion much much easier. I use to have several bent cannulas when I used the quick set but I've never had a bent cannula with the inset. You're pump should have come with a sample...you could at least give it a whirl and see how it goes.

Best of luck to you and Adam! I know this time can be really frusterating. Hang in there!

[dixiepixie64]

Cielo, I don't have much to add other than what everyone else has already said...there is a learning curve with pumping. For me, it was about 3-4 weeks before I got my basals and the infusion sites right. You two hang in there and stay in communication with your medical team. I firmly believe it is worth the extra effort and aggravation at the beginning because once you get the hang of it, the results are worth it! Better control and so much more convenient to name a few.