Tag Archives: infusion set

Device failures.

I’ve nearly had enough.

The past few weeks have been full of diabetes device failures, and I’m actually asking myself how much more I can take.

Dexcom sensor failures are frustrating me more than I can express here. Since January, roughly one out of every two sensors fail without working more than a day, or ever working at all. I mean, how long do you put up with that kind of unreliability before you chuck it into a box and give up?

And believe me, I’m doing the insertions exactly the way I’m supposed to. Every time I do an insertion, I’m still going back to the online tutorial to make sure I’m not missing anything. The failed CGM sensors have definitely become my biggest diabetes nightmare.

I’ve even stopped contacting Dexcom support about it. The calls are all the same: the support person goes through their script so they can cover everything they need to cover… I get that. Usually, after about half an hour on the phone, they agree to send me a new sensor. But… how much is the sensor, and what is my time worth? In addition, I’ve had to replace a transmitter and a receiver too. In a little over five months. It’s quickly becoming not worth it.

But my pump issues are still there too. I have an Animas Vibe pump where a 200 unit limit to my reservoir isn’t really an issue. But it’s not really 200 units. Because once the pump says the reservoir is at 0 units, the pump stops… even though there are usually around 20 units left in the reservoir. So, something that could last 3 ½ days (for me) winds up lasting barely 3 days, if I don’t have other issues. Why do I have to waste 20 units of insulin every few days?

Which I almost always do, because my Medtronic infusion sets can’t seem to go more than 2 to 2 ½ days before they just don’t want to work as well anymore. At that point, I still seem to get insulin, but instead of hovering between 80 mg/dL and 120 mg/dL, I suddenly go up to 220 to 320. So I have to bolus huge amounts of insulin to try to bring my glucose level down. When I change out the set my BGs go immediately down to a reasonable level again. Why can’t an infusion set be made well enough to last the FDA-mandated three day limit? Or greater?

These are all issues that I did not experience in the five years I was managing diabetes through my previous pump and no CGM. Let me put it another way: my A1c is climbing, due only to medical device failures. This leaves me asking even more questions. Like:

Why can’t device makers make something that is simple, and not as susceptible to breakdowns?

I understand the all-consuming need to develop the next special product with all the bells and whistles, but… why can’t there be a simple option that I can use? My previous pump seemed to do everything I needed it to do. Why can’t I just choose a new version of that?

I actually like my Dexcom when it works… why can’t it work more often, with fewer breakdowns of the individual parts?

I hate to pick on individual companies. But the truth is, if these were cars, I would probably choose not to drive as opposed to breaking down on the side of the road every few days.

Granted, there still aren’t many (in a trending sense) people who are managing their diabetes through pumps and CGMs. But I don’t think that should be a reason for me to settle for inferior products. It certainly isn’t a reason for me to continue to pay for said products without noting where they are coming up short.

And without saying that maybe some device companies need to go back and make their current products as reliable as they can before devoting resources toward the Next Big Thing.

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It happens to all of us.

If you’re a pumper, chances are you’ve seen something like this before:

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The story: I changed my set on Friday night, about 2 hours before bed. When I woke up in the morning, my #BGNow was 174 mg/dL. Higher than I would like, but I can deal with 174. I had a smaller-than-normal breakfast, and a fair amount of both coffee and water throughout the morning.

When I checked just before lunch, I was at 286 mg/dL. I was meeting a friend for lunch, and I just dealt with it… sometimes, new infusion sets just don’t seem to take right away. I had a very small lunch, enjoyed my time with my friend, and headed home.

Just before dinner, my BG test resulted in a 266 mg/dL. Okay, I’m getting some insulin, but something is clearly wrong at this point. What to do? Do an injection and wait it out some more? Or make the decision to change my set and start over?

I opted for changing my set, but not changing my tubing. If it was a bad cannula (pictured here) or a bad site, the tubing wouldn’t matter. If it was bad tubing, then a site change wouldn’t change anything, if you know what I mean. I’m the kind of guy who likes to know the cause of something, so I didn’t change the tubing, knowing I could do it later if I had to. As you can see in the photo, there was no need to because somehow the cannula got kinked. Which almost never happens to me, which is probably why I waited almost a day to change out the set.

After making the change, I did a correction bolus and ate a nearly carb-less meal. When I checked almost three hours later, I was at 84 mg/dL. Problem solved.

Just another annoying, stupid thing. Freakin’ diabetes.
 
 
 

The inevitable downslope.

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This is why changing infusion sites in the evening worries me a little.

I changed sites last night around 8:30… Great. I was primed and ready for the #DSMA Twitter chat. About halfway through the chat, The Great Spousal Unit brought me a small bowl of strawberry ice cream with fresh strawberries on top. There were more strawberries than ice cream, but when they’re fresh, I don’t mind at all. Now, where was I? Oh yes… the infusion site change.

So often after site changes, I’ll have a… What do you call it? A phenomenon? An anomaly? An unexplainable variance in The Force? It seems as though the site isn’t working at all for a while, which is why I got a high alarm around 11:30 while I was fast asleep. I’ve been through this kind of thing before, so I knew better than to do a correction bolus at that time. And my BG just kept on climbing, up into the neighborhood of 250 mg/dL at around midnight.

From that point on, however, I started dropping. Again, this is without a correction bolus. Certainly, the ice cream and strawberries had lost a lot of their oomph by then. But I just kept getting lower and lower until I was awakened by a low alarm at around 5:00 a.m. No big deal, because that’s when I get up for work (if I don’t go to the gym first). But I just don’t understand why, at least half the time I change sites, all of the insulin I’m pumping seems to be worthless until all of a sudden it’s not worthless anymore. And then it makes up for it with a vengeance over the next few hours. I’ve seen others write about this, so I know I’m not a weird statistic. But I don’t have a scientific explanation for it yet.

Just to be sure it was the new site and not the dessert that caused my glucose to skyrocket last night, I may have to try the ice cream and strawberries again this evening. You know, just to be sure.
 
 
 

Site Change Musings, Part 2.

Time for part 2 of our discussion about infusion sites. Lots of super comments after yesterday’s post. Let’s see if we can answer a few more questions today.

If I have trouble with a site, how long do I wait to change it? That depends. Didn’t expect this to be a simple answer, did you? Mostly, how long I wait is in inverse proportion to where my blood glucose readings are. If my BG is hovering in the 200-250 mg/dL range for a while, I’ll try to do my best to get that number down. Drinking lots of water, avoiding almost all carbs, exercising, etc. If I’m still not coming down roughly 18-24 hours later, I’m moving on to a new site. But if I’m stuck in the 300+ range, I’m waiting only about 8 hours tops. I should also mention here that this kind of thing doesn’t happen very often to me, so I don’t have a lot of experience. And I hope I don’t get a lot of experience with this, if you know what I mean.

Do I have a favorite site? Yes… that’s definitely my leg. Never hurts going in. It always feels like it’s out of the way (except I sometimes forget it’s there when I take my pants off… #TMI). In fact, I’ve been known to time my site changes or switch around the order temporarily just so I can have it in my leg for long bike rides. Always seem to get a smooth delivery of insulin, maybe because there’s less fat there. If I had enough space, I think I would have it in my leg all the time. By the way, before finding the Diabetes Online Community, I had never even heard of using any space other than my midsection or my butt. Thanks DOC. My second-favorite site? On either side. It just feels comfy, though it’s much more likely that I’ll rip the thing out from there than from anywhere else.

And a final bonus question… thanks Jen for making me think of it: Will I do a site change anywhere? Only at home? Okay, two questions. I’ve only done site changes at home or in a hotel room (once without an inserter). Never at work. Never on a day trip somewhere. At work I’m just worried about getting a gusher when pulling out the old cannula. Which I suppose I could handle by waiting to pull the cannula until I get home. So maybe I’ll try that in the future. Otherwise, I don’t know. Can’t think of a reason not to do a change somewhere, other than for sanitary reasons. I think my hang-up (and it’s really my hang-up) is the whole my comfort with doing the change versus someone’s discomfort watching me do the change thing. I don’t really have a problem, but I don’t want someone else to feel weird about it. In the greater sense though, I think it would be helpful for people to see things like this that we have to do all the time, so they can be reminded that diabetes is real and it’s not a simple thing to live with.

Once again, feel free to post your answers, or any additional questions, by leaving a comment below. It’s been a great discussion so far.
 
 
 

Site Change Musings.

Okay, that title is a little whimsical for such a mundane subject. But I did an infusion set change last night, and it brought up a lot of questions for me:

How often do you change your sites? Where do you place your sites? Do you have a specific trouble spot? If you have trouble with a site, how long do you wait to change it? Do you have a favorite site?

Let me take those one at a time. First, How often do I change my sites? The answer is that I (usually) change them when my reservoir goes dry. How long it is between site changes is then determined by a number of factors: how much insulin was in my reservoir to begin with; how my diet has been since the change, and how that affects my glucose; and how much I exercise between changes. Sometimes that means a site will last four days. Sometimes it will last six. My all-time record is seven days. But let me tell you, a site gets mighty sore after seven days. I try to keep it at four to five days.

An additional question: Why four or five days instead of the suggested three from manufacturers and the FDA? The answer is simple: As I’ve said before, I’m consciously concerned about real estate. How much usable real estate my body has, and how long I’ll be doing this pump thing, and whether I might run out of good infusion sites are all things I think about every time a new site goes in, and I take a look at the previous site. I don’t know if going an extra day or two is really helping to preserve future infusion sites, or if it isn’t. But my gut feeling is that it’s helping. I plan on being around for a lot more years, and I don’t want to have problems when I’m 80 because I ran out of decent places to insert a cannula.

Where do I place my sites? I generally rotate them between six places: My right side, my right leg, my stomach to the right of my navel somewhere, my stomach to the left of my navel, my left leg, and my left side. In that order. That means at four days per site I’m using a given area every 24 days. At five days per site I’m using an area every 30 days. I haven’t tried using my arm yet… I don’t know what I’d do with the tubing, or if I’d have enough. And I haven’t tried the back of my midsection or my bum. Mostly because I can’t see around there, which I realize is a completely ludicrous argument. But there you have it.

Do I have a specific trouble spot? That seems to be my belly. Especially lately. I don’t know why. But I’ve had some stubborn highs the last few times when it’s been in there. Even though I move it around a lot between high, low, a little to the left, a little to the right, etc. It just doesn’t seem to be working great there right now. Maybe it’s the extra baggage I’m carrying around right now.

Since this is getting a little long, let’s stop right here for now. I’ll pick up answering questions about infusion sites later in the week. Until then, feel free to post your answers, or any additional questions, by leaving a comment below.
 
 
 

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