I'm going to try this again. Tried to post a discussion yesterday in another forum and it didn't work. This is a little different. I switched from a Medtronic Insulin to a Tandem t:Slim about 8 months ago and over the past few months I have experienced nothing but occlusions. After endless sessions with tech support and trying all of their infusion sets, which their local rep only offers me three that are available, I still get only occlusion alarms. They keep telling me it's NOT their pump, so it must be me. I just have too much scar tissue or I am doing something wrong even though I have spent hours with their tech support who basically won't even help me anymore because they just tell me the same things over and over which I do and it doesn't work. SO, what am I supposed to do?? I've been a type 1 for 30 years now. I've been pumping for 18 years. So, is there just no hope for me? Are they telling me that I just have too much scar tissue for my body to receive any outside sources of insulin??? Huh?? Is there anyone on the boards who have switched from pumping for a long period of time and gone back to MDI, or mixture of Novolog or Humulog and Lantus? I have never used Lantus btw. Before I started pumping 17 years ago, I used NPH. Oh and I also do not use Apidra with my insulin pump, I use Novolog, so it is NOT a Apidra issue.
Wow! Novolog is a very stable insulin. I think I have had 1 occlusion since I've been on it in my pump.
I had an appointment with a CDe and for my backup plan - in case of pump failure - she said I should do a similar basal shot to what my daily basal total is on the pump. SO - I would take 9 or 10 units of the Lantus. I recently was in a car accident and my infusion set was knocked out and I did not have a back up set. I gave myself 12 units of Lantus and it was just a bit too much. So - I guess the safe way to do it is to take as close as possible a shot of Lantus that equals your daily basal - and then tweak it slowly as you go.
I would bet Medtronic would do a trade on your pump to have you back as a customer. Seems like Tandem should be making sure you are a happy customer though. Do you have a rep there you can contact? Your Endo office probably has a contact you can call. I find a rep does not want to lose your business - so they will go the extra mile to make sure you are happy.
Insulin pump occlusions and poor infusion site absorption are two different things. Since you've been pumping a long time, perhaps you have some scar tissue that impedes consistent absorption.
I went through a period three years ago when I struggled with infusion site absorption problems. I experimented with various infusion sets and tried using some fresh sites. I had been using my abdomen for over 20 years. I found that changing infusion sets combined with trying fresh sites solved my problem. It started using the love handle areas on both sides.
Have you ever tried the metal cannula infusion sets? They are fine gaged and not very deep. The advantage of them is that you'll never suffer from a bent cannula episode. There are TuD members here that really like them for their dependability. One downside, however, is that it's recommended to change them every two days.
Can't help you with the switch back to MDI. I've been on the pump continuously since 1987.
Try to identify some new sites to use. I've been using my lower back recently and that's working well. I now realize that I can connect the infusion set to the site connector just by feel.
Good luck!
I was on a pump for three years before changing back to MDI. I think Jen has described repetitive problems with infusion set failures. Maybe you two can trouble shoot it together...Jen
Susan, yes, I was surprised this was happening with Novolog as well. I really, really miss my Medtronic pump. I think all of the 16 years on my Medtronic, I had two separate occasions with occlusion alarms and they were troubleshooted and fixed without any further issues. I am regretting changing to Tandem now just for the new bells and whistles when I was having no problems with the Medtronic. Not very wise of me. Yes, I have a Tandem rep and no I am not real happy with her. Don't want to write a book here, but I have several issues with her. My endo is a little new in her practice and she just sort of shrugged her shoulders when I asked her for help. :(
Have you tried other areas where you may not have scar tissue? I have been pumping for 19 years and D for 31. I can no longer use my abdomen because of all the scar tissue. It requires some creativity, but it's a job requirement.
I have never used any other pump except Minimed/Medtronic. The biggest reason for this is their stellar customer service.
I'm sorry you're having such struggles right now. My 0.02 would be try other areas for your infusions.
Good Luck.
Sarah
Thanks for the reply Terry. Yes, I realize the issued with scar tissue can cause occlusions. I have always rotated my sites all over, changing every 3 to 4 days. I use abdomen, but I don't use that as much anymore because I'm on a Dexcom and try to save that area for the cgm. But I use my love handles, thighs, upper back, just about everywhere that I can reach. The only place I do not use yet is my upper arms because I just don't want to get tangled up in all of the tubing. I guess that may be my next go to though. I know I used to inject there a lot so.
I am using steel cannulas right now and am pretty happy with them. My skin isn't really happy with them but I'm adjusting. However I do get occlusion alarms with them as well. Just about every day. I am finding the alarms I get, can be cleared and I usually don't have to change my set. After doing this, my blood sugars seem to be okay for the most part. This is what leads me to believe, this IS a pump issue. Something that just about NEVER happened on my Medtronic.
Right now I'm just trying to decide what I should do. I wish I could find a really good, knowledgeable CDE to talk to about all of this, and if I should, or if I even could try and send my t:slim back and get ANY $$ back at all and go back to Medtronic (I called mine "Elvis"), or just go back to insulin pens of Lantus and Novolog mixing. I'm thinking/wondering if the injections along with my Dexcom would be cheaper over the long haul or be about the same. But my husband told me I shouldn't even be thinking in those terms but we are thinking of retiring in the next 8 to 10 years and I'm afraid with me on all of these devices, we may never even get to do that until we drop dead.
Thanks so much for your feedback and replies. I hate making these monumental decisions. After making such a horrible decision last year in changing from my Medtronic, I'm afraid of making yet another bad one.
Thanks Sarah. Yes, I do think a lot of issues are probably scar tissue related and yes I am rotating my sites all over the place or at least where I can reach and where there is areas of fatty tissue to put an infusion set. I've also lost over 65 pounds over the past year and a half which is great, right?? But that also has led to changing my size of cannulas. But it's trickier now too because depending on where I put a set, ie. my upper legs, I need shorter cannulas, my love handles, maybe a slightly longer one. SIGH. I'm willing to work at it, don't get me wrong, I'm used to it. It's just taking about 98% of my time right now in my life and I do have a lot of other things that need my time!! :)
I think Medtronic would give you a trade in on your TSlim - and you would not have to pay them much or anything. It could be scar tissue - but since you were using the Medtronic with no issues it is worth trying.
This is not the first time I have heard about occlusions with the T-slim....I was thinking of changing from my Animas Ping to a T-Slim - but that is looking more and more grim every day. I will either go with Medtronic or Animas - as I have pumped with both company's products and both are good.
I have had problems with site failures and absorption problems due to allergic reactions to the cannulas. This was mostly solved for me by switching from plastic to metal sets, and changing the metal sets every 24 hours (or sooner if it’s getting sore or itchy, which are my symptoms that my body is reacting). At one time I was getting a lot of occlusions with metal sets, but switching from Humalog to Apidra fixed the problem.
What type of infusion set were you using? I used to have constant occlusions when I was using the 90-degree QuickSet, but once I changed to the 30-degree insertion set (Silhouette), problem solved. I don't have a lot of body fat, so I was hitting muscle a lot with the QS, and the Silhouette lets me go in at a fairly shallow angle...usually 15-20 degrees works well for me. I still get an occlusion or two once every year or so, but it has worked really well for me.
I switched from a Medtronic Insulin to a Tandem t:Slim about 8 months ago and over the past few months I have experienced nothing but occlusions.
First thought.
When you switched did you have to get rid of your Medtronic pump? Did it die on you? Or become otherwise unusable? Because if you can still use it then why not do that? It's not like any Medtronic pump supplies order you might place will be refused unless you can prove your pump is still under warranty, right?
Granted, if the Medtronic pump dies on you then you're in a pickle. But you could switch back to the t:Slim for whatever it's worth. Or MDI, of course.
You'd need your endo's support in this, naturally. But if your endo writes the scripts then I don't see why your insurance wouldn't pay for the supplies which ever pump they are for. I just wouldn't recommend purchasing ahead much in case the old pump actually does fail.
Second thought.
Is there any type of a usage pattern to the occlusions? At what point do they show up after you start a new infusion site?
A long time ago (7 years?) I recall someone saying that whenever she started a new infusion site she always timed it so she would be giving a (relatively) large bolus right after inserting. Her thinking was that the large bolus helped blast (?) the site open a bit.
Probably nonsense. But if your occlusions occur while you are only pumping basal after you start a new site maybe something to at least try just to prove it doesn't really help?
-iJohn
I can see you're faced with a tough decision. Since you get occlusion alarms that are not confirmed by unexplained rising blood glucose, that points to a pump malfunction. Maybe it's just your serial number. Perhaps you could lean on Tandem to replace your pump with a new serial number. Your pump is under warranty, isn't it? Have you read about other t:slim users having this problem?
The biggest problem I would have with switching to MDI is remembering if I took my dose or not. When you're taking 5-10 shots a day, that would just become a blur to me. There's no question in my mind that a well-executed MDI program can produce just as good results as a pump. One of the things MDI has a hard time covering, however, is a pronounced dawn phenomena.
If I were you I would lobby for a replacement t:slim pump. Good luck with whatever path you take!
This sounds super frustrating. The t:slim does seem to have a very sensitive occlusion alarm. I have noticed that if I'm sitting down and/or clenching my abs while giving a bolus, I'm more likely to get an occlusion alarm, relaxing the midriff where the infusion set sits seems to help.
I have “wall to wall” scar tissue from having three big babies. I almost gave up on the pump because of kinking cannulas. I switched to Metronic Sure-T cannulas and that has solved the problem. They are metal but comfortable and they can’t kink.
If this helps at all, Lantus and Levemir (another long-acting insulin) are terrific. I've had T1 for 3 years now, and have been on MDI the whole time. I have no interest in trying a pump; my A1Cs are quite good as it is, and I don't mind the tiny pokes from slim syringes I can barely feel (and I'm thin). I have a CGM, which helps a lot. More long-acting insulins should be on the market over the next couple of years, from what I understand, so if the pump just doesn't work out, don't despair.
The newer long acting insulins are fantastic! I had to use them recently when I was in a car accident and my infusion set was pulled out. The hospital got me a vial of Lantus - and I loved it. Denver - do you exercise? I am curious as to how it works with activity. I was not on it very long. The last time I was doing MDI was on NPH and Humalog....so - a long time ago.
Lantus works well. I can tell you from personal experience that I almost got killed by occlusions in the pumps that I used, and I have even had a "unsecured" wireless pump that is known as being hackable with wireless technology pump n' dump 25 units at random leading to a seizure that the doctors said should have made me a "vegetable" in their own words. That was the end of the pump for me. I still wake up with a high of about 200 some mornings, but I am much better this way, and happier. Wish you the best.
I am SO glad to read this!!! Overall I have loved pumping but I just do not think it’s working forgot me any longer. Its not the needles or the equipment, it’s just not working and it’s just a load of wasted time, expensive supplies and equipment and money down the toilet. What I DO need is my CGM and wouldn’t ya know it, now that’s causing me fits!!! I only have time and energy for one. I can live with injections, I’ve done it before and this stupid tslim is only making my a1cs horrible. I’m going to use your feed back when I see my endo in a couple of weeks and see what she thinks. Thank you all for offering your advice abd feedback. It all has helped me weigh the pros abd cons abd I appreciate it so SO much!
Honestly I have been having repeated problems with the Dexcom too. I thought I had it all sorted out about a week ago since the 505 update. Then I come to find out that my Dexcom was WAAAY off last night, and I almost had a seizure. It's lucky that I tested on my big tester, because I have SEVERE hypo unawareness. Dexcom is good about replacing faulty sensors and everything but there's something that gets me. I have been using the device for about a year, and they used to say that the transmitters only have to be replaced 1 time per year (approximately). I was on the phone with their tech support yesterday, and now they are saying that the transmitter will only last for 6 months at a time!!! My medical insurance doesn't cover anything related to the Dexcom at this point. I guess they basically expect me to pay a minimum of $3600 dollars/year to be able to use their device. I don't have that kind of money to throw around, and the tech support is basically treating me like trailer trash because I'm not rich enough for the product that they sell.
That's a-ok with me. I have decided that I am going to go back to the dreaded low carb program. The reason I say dreaded is because it is not fun to not eat carbs, but at the same time the control I get of my diabetes is unparalleled. Less carbs = less insulin = much less lows/highs. If I can keep the willpower to stay off of carbs, then I will not have to use a Dexcom or anything like it. The stress that all of these inferior gadgets creates is just not worth it to me at this point.
I recommend reading a book by Dr. Bernstein called "The Diabetes Solution". It takes a ton of willpower to stay on that program, but that is the only time that I did not have a seizure for longer than a year (besides since I have had the Dexcom). I just got too close last night for my comfort, and that is why I am switching back to the old program.
Sometimes I feel like these companies that make all of these fancy devices are like piranhas in a pool, and they want to eat every penny that a person can produce. Another great metaphor for the corporate greed would be to watch the movie called "In Time" from 2011. Look the movie up on the Internet Movie Database, and give it a rent if you can. That is unfortunately why I believe that we will keep hearing about a "cure" for the next 100 years, yet nobody will actually do it-unless they can take money from you on a repeated basis. Capitalism at its finest... Sorry for the cynicism, I have been T1D for 31 out of 34 years... I hope I am wrong or will be proven wrong about what I said, but I don't think that I am.