Frequent Pump Occlusions

Hello all!

I’m writing this with a lotttttttttttt of built up frustration and a blood sugar of 329. I currently have the Medtronic 670G (which I’ve hated since I got it) and for the past 2 years now I’ve experienced FREQUENT pump site occlusions. Lately, it seems every single time I rotate infusion sites, I get a “insulin flow blocked” message and I have to go through the painful process of inserting a new cannula again and again.

Mind you, I had a baby in 2018 and at first, I thought the occlusions were only happening when I inserted the site on my abdomen where there were stretch marks. They never happened on my back sides. Then I thought, maybe they’re happening because I gained weight and I need a new cannula size. But I didn’t need a new cannula size when I was pregnant? Anyway I’ve lost about 30 lbs in the last 6 months and now the occlusions are happening even more and everywhere, including my back. So it can’t be the weight either. Idk about the stretch marks but I avoid them.

Could the occlusions be due to overuse of the sites?

I’ve brought my A1C down by 0.6 points in the last 6 months and it’s soooo infuriating that the only times I have extreme episodes of hyperglycemia are when I’m having pump trouble! It is also now 1 am where I live and I can’t sleep because I’m monitoring my sugar. I’ve changed my cannula 3 TIMES, 3 DIFFERENT SITES, and given a correction ONE unit at a time to avoid getting that occlusion message. It lets some insulin through and then sometimes it says it’s blocked again! My sugar has been high for 4 hours now. This pump only tells me that insulin is not being delivered when I try to bolus or HOURS later if I rely on undelivered basals. I can’t keep giving myself boluses to ensure that the insulin is going in. This is ridiculous and dangerous.

Please excuse the angry tone. It’s not you lovely people I’m upset with (I love this community). But this pump… UGH it’s hell. I’m flustered and desperate and don’t know what to do anymore.

How about:

  1. Eliminate pump from daily use and switch to MDIs using Humalog/Novolog and Lantus/Tresiba (I also use Regular, for a total of three insulins)
  2. Figure how much 1 unit of Humalog/Novolog insulin will lower your BG a) in the morning (due to the Dawn Phenomenon) and b) during the day.
  3. Figure out how much 1g CHO will increase your BG.
  4. Switch to a high protein, very low CHO diet as protein meals will help avoid very high BG spikes and will allow you to flatten daily BG profiles.
  5. Use CGM and BG meter 6 to 10 times a day, preferably Contour NextOne to understand BG trends and the actual BG levels.
  6. Purchase Dr. Bernstein’s Diabetes Solution book for ~$26 and READ it with a highlighter 2-3 times and use it as a reference book going forward. This book should never sit on a shelf collecting dust.
  7. Develop the discipline to adhere to Dr. Bernstein’s protocol, which will take ~4 weeks to overcome excruciating hunger for the missing CHOs in your diet.
  8. Fall in love with diabetes as this mental approach will make it easier on you when you encounter higher than expected BGs. (in my case, anything higher than 95mg/dL is High and I treat it accordingly)
  9. Make diabetes your BFF.

Never Pumper
(T1 for 42 years with consistent 90-day A1c between 4.9 and 5.3% for the last five years)

If you get some steel infusion sets you will be able to determine if it’s a problem with your sites or the pump.
I am having an issue with mine I think it’s a pressure sensor issue. But my issue just started 4 days ago and it has never happened in 6 months before.
It is very irritating to have this happening I know.
You can ask your pump trainer to give you samples of all the different kinds of sets maybe one kind will work better for you.
Otherwise it might pinpoint where the issue is.

Hello Alex!

Thank you for your suggestions.
First, I want to ask what the acronym MDI stands for haha. I only know it as metered dose inhalers. From what you’re saying though, it sounds like it’s the same regimen I was on before I started using insulin pumps. I used to take Humalog a minimum of 3x/day to address meals, more if I snack, and Lantus once in the morning. I didn’t like manual injections several times a day so it was hard for me to adhere to that routine. Switching to pumps has significantly improved my A1C over the years.

I was given the Freestyle Libre here in Japan 2 years ago and I LOVE IT. I’m able to simply scan my arm and check my sugar every 5 min if I wanted. I used to use the Medtronic 670G’s Guardian sensor and it required WAY too much maintenance for technology that’s supposed to make tracking your BG levels easier. That’s saying the least. With the Libre, I’m able to adjust my own basal rate and insulin to carb ratios according to my trends. My settings right now are pretty solid. I’m currently sitting at a 5.7 A1C.

I love weightlifting and I’m currently in a fat loss phase so I’m eating very specific macronutrients all day (high protein, moderate carbs, low fat) to help me feel and perform my best. I eat no more than 157 grams of carbs per day split between 3 meals and maybe a few snacks. It’s already drastically improved my BG levels by eliminating fluctuations. So unfortunately I don’t think going low carb would fit my lifestyle as it doesn’t give me optimal physical/mental functionality.

It’s amazing to hear that you’ve kept your A1C within that range for so long and without the use of a pump. I’m glad to know you have a routine that works for your lifestyle. Thank you for sharing.

Hi Timothy!

If I may ask, what model is the pump you’re currently using?

That’s a great suggestion! I might just have to do that. I’m actually a military spouse and we’re currently stationed in Japan so my resources are quite limited here compared to home. But I’ll make an appointment with my PCP anyway to see what they’re able to help me with.

I’m really happy with my CGM and it’s in no way connected to my pump. I’ve heard great things about the Dexcom? Hopefully I can give it a try.

Thank you for responding!

I am currently on a tandem x2 and dexcom integrated

I had Medtronic with Medtronic guardian cgm before.
They were not integrated and it was on but my new system is so much better.

I used the sets that you put in in a sharp angle almost parallel to my skin to prevent butting up against muscle. I am pretty lean and it seems to work better.
I also use the shorter 13 mm cannula for the Same reason.
Medtronic calls them silhouette. They are exactly the same as the tandem except the tubing is different.
You put them in manually so you can see them go in, you can feel before your hit a vein and you can more easily check to see that it is still in correctly.

Wow thank you! You’ve been incredibly helpful, I really appreciate it. I’ll definitely be asking my doctor to look into the Dexcom then and even the Tandem since I don’t know if I’m going to be able to keep my Libre once we move again.