We have been using the Animas Ping with Inset 90 infusion sets for over 4 years.
I have always periodically noticed about a half inch of air at the end of the tubing - at the part where the "fork" that clips into the site is. I notice this as the pump (it's my daughters pump) is laying on the counter as she's taking a shower. I prime it out when I see it, and can see insulin fill the vacant space. But then if I hold the tubing straight up in the air, I can see insulin sinking back down into the pump.
Animas helped me out with the suggestion that we should make sure we are not putting cold insulin in the pump, as the physical properties of a liquid cause it to shrink at temperature. We started doing that and I have still occasionally noticed the air space.
Other suggestions were to make absolutely sure the lure lock is tight - did that. And also to make sure we were priming the cartridge up and down several times before filling with insulin. We do that, too.
They asked me to send the cartridge to them so they can see it which I will be doing. It doesn't look cracked or bad or anything to me.
Anyone notice this? I also wonder if when the pump delivers a dose or basal, if this 'dead space' fills in. Am I being paranoid? Sometimes when we give a correction, it does nothing to budge the BG. I chalked it up to diabetes sucks, a random occurance, but maybe it's because we are infusing air.
We live in a cold climate, so I wonder if the insulin is just really sensitive to temperature changes, but you'd think it would equilibrate out over the 3 days you have the pump site on.
The plastic cartridge seems sturdy, I can't imagine it expands/contracts with temperature? But maybe? Even if it was these cartridges, I can't imagine other cartridges are any different/better. Anybody have comments?
We use incets and our insulin is always cold and we don’t ever experience this, I do know though that on ours the tubing looks like it has no insulin at the end because it bends there and gets a kind of white appearance. There is insulin in it though. Do you have unexplained highs? That’s bad because I know one small bubble or gap in the tubing can be like hours of no insulin here and cause major highs. Sorry I can’t help!
I know the white part from the bend you are talking about, and it's not that. It's definately an air space. We do have unexplained highs occassionally, nothing super dangerous, i.e. no ketones or anything. I can't say I always check the tubing every time there's an unexplainable high. I would if BG were say >400 for no explainable reason...but a random number of 280 or so, I usually just correct.
We've been experiencing bubbles too which I think is the cause of some highs. I prime the bubbles out when I see them as I've tried all the rest too. I haven't seen 1/2 inch air but small bubbles but my son's on such small doses (8units total per day) that I think it affects him when there's a little bubble. We use the inset 30. I have been checking out for bubbles lots now and I'll hold the pump on end and tap it near the cap to send out any bubbles that accumulate at the luer lock area then prime. I was maybe going to switch to vial insulin as we use penfills right now and I've heard that could help.
Even checking for bubbles when there's highs doesn't always tell anything as it could be in the cannula and you can't see those. We love the pump but it definitely comes with different troublshooting issues than the needles!
Yes when I was using Inset IIs (90 degree all in one sets) with my Vibe but only after disconnecting for shower, it was like the insulin was sucked back a little and there was this air space at the end next to the clip like you describe. I then went on to try different sets, including from other co.s, and continued to have this problem with some sets but not others. My conclusion was that the set co. should provide a clip for the loose end so that it stays sealed and under the same pressure so no air can get sucked in, but they don’t! Or won’t (when I suggested it to Animas and Roche). I now use Roche steel sets with my Vibe and do not have this problem as I guess the connector construction is different with these and stops air being sucked in.
Wow. Upon reading your post I went to check my tubing (also on Anamis Ping and use the QuickSet) I disconnected and there was a 1/8 inch bubble seen. I unhooked and let it fall from my hand in order to get pump out of pocket, looked again and a full inch of air was in the end. I primed, hooked, unhooked carefully: no problem. I hooked, unhooked like I normally do when in a hurry for a shower, etc. and: again, air.
My thoughts are: when she unhooks to take a shower that’s when the bubble occurs, but I noticed —> it wasn’t a result of air being sucked in but a drop being let out as I felt it hit the back of my other hand during the jiggling of the tubing just after unhooking and letting it fall.
So, I agree with Ingrid above: It is the type of infusion set tubing. Twice more I experimented and used the “Fill Canula” and advanced it .50 which fixed the problem without letting my pump think I had more insulin in me than I did.
This would certainly resolve problems when disconecting and losing a bit of insulin out of the tubing connection, but not any other problems if there is another reason for your bubbles on the end. Have you noticed bubbles near the end at any time BEFORE she disconects?
Hope this is helpful to anyone. Sure helped me note that I should check for that air gap every time I reconnect.
Interesting! Thank you. I don't notice the air there when it's connected to her...but it's also hard to see when it's next to her body. This makes sense what you said, about the drop coming out. Perhaps we should just make a habit of checking before reconnecting like you suggest.
I have never had this problem with the Inset 90. A couple of things I do that might help make a difference...
I do a manual prime before I insert the cartridge into the pump. I do this because I am from the old school when you had to do this - and I have never had air bubbles. Occasional champagne size bubbles - but not often. I still do a small amount via the pump process - so I am actually doing most of the priming away from the pump and then a tiny prime through the pump.
I also make sure I do a .50 fill of the cannula every time I reconnect. I also have been known to do a prime if I suspect any air bubbles.
Ha famous last words, I had to disconnect a few times today (cannula change, battery change and on the phone to Animas Tech about a battery change prob) and EACH time saw it suck back air into the loose tubing…about 1-1.5 cm!! So my steel sets don’t stop it happening. I think it was the angled sets from Roche which were the only ones where it didn’t happen and that was because there was a plastic cap to put over the loose end when disconnected. Roche told me they provide it only for these sets as the needle is visible, actually sticks out, so it’s a hygiene thing.
Ah well, I’m about to get another replacement Vibe (for the prob with the kaput internal battery) so we’ll see if the ‘air in tubing when disconnected’ issue is present with the new one.
I do remember a couple of years’ ago a lady on the Insulin Pumpers UK list saying how she mentioned the air in tubing on disconnection issue to Animas when she was phoning about something else, and they said it shouldn’t be happening and replaced her pump (she left the list so I’m not sure whether her new pump did or didn’t solve the problem)…she told them she had assumed it was normal that everyone primes that air gap out every time just before they reconnect, but no, not according to Animas. Hmmmm…maybe some pumps do this and some don’t?
I still wish there were cap covers for the loose ends of all the different infusion sets as this would protect the ends and help stop this problem occurring.
I fill the cannula - that is not priming while connecting. Sometimes doing a prime while disconnected will push the air bubble out. It is a trick I have learned after pumping 15 years.
We USED to use the inset 30...and they came with caps for the tubing part. I can't recall if I was having this air problem back then with those sets. The 90's don't come with covers. I wonder why? They do come with a cover/cap for the part of the pump site that's connected to your body, but I never use them. I wonder if I should! Is that cap just a sanitary thing or does it actually have a function? When I look at it I can't see how it would function either way. (Except when we were at the beach and sand kept getting in those holes that the tubing clips in to. If we didn't have the cover on, sand would get stuck in them and you couldn't hook your pump back on. We'd have to change the entire site.)
I had no idea what those caps were in each box for about a year of pumping! Thought they were kind of pretty little replicas of the loose end connection but it honestly never occurred to me to clip them onto the site end when disconnected. So I never used them in the shower. I was told by the rep that they were mostly for the reason you give - to stop sand getting in at the beach, and that the other end would be in a protective bag with the whole pump. It would seem easy and cheap to produce little caps for the other end too for the straight sets?? (I did suggest this to both Animas & Roche reps…the overall impression I got was that they hadn’t heard about the air sucking back problem and weren’t taking it seriously. Maybe it does only happen to just a few of us? Or maybe a lot of people just don’t notice it? Or maybe, like the lady I mentioned above, people always prime a little before reconnecting and assume that’s what everyone does and never normally mention it?). Hmmm… ?
Hello,
I have also found that, upon disconnection, there is air in the 1/8-3/4" at the connection between the tubing and the site-connection-clip.
At other times when I disconnect, I find that there is a large drop of insulin at the tip of the steel-tube bit in the connector.
Curious, I played around with the tubing, reservoir/cartridge (with both an Animas and a Medtronic pump), infusion set. No success in determining the cause of the air, and I assumed the large drop of insulin was as a result of disconnecting mid-basal-dose.
But wait!
Try this:
while connected, hold the pump level with the infusion site
disconnect the tubing, keeping the pump and site-connection-clip level with each other
keeping this level configuration, bring the pump and clip up to eye level
watching the tubing next to the clip, move the pump down so that it is below the level of the clip
watching the tubing next to the clip, move the pump up so that it is above the level of the clip
Go ahead and try this a few times, moving the pump up or down the full length of the tubing. Also try moving it just part of the length of the tubing. This consistently causes what looks the same as the gap/drop I have seen at the end of the tubing upon disconnection.
The fun part (?) is that I tried this once while the pump was connected to a just-discovered “vampire infusion site” - more blood got pulled into the cannula when I lowered the pump and went away (got flushed out of?) the cannula when I raised the pump. I probably should NOT have tried this while the pump was attached, and do not recommend that anyone else tries it while attached either)
I hope this long reply has been interesting. I don’t know if this has any impact on insulin dosing - it could be that the siphoning in and out (i.e. when I take the pump out of my pocket to bolus or move the article of clothing it’s attached to) ends up as neutral since the pump usually ends up in the same place as it started.
