Thanks, I think I have done this but I will try again. The problem is the air bubble is really big so If I syringe it back into the penfill it will put air in there and maybe degrade the insulin. Also for some reason air seems to get caught in the end of my syringes also near the needle area( they are larger syringes and needles that come with my pump cartridges) and I have to shoot that out because is won’t all go to the plunger.
@Jen I’m using penfills for my novopenjunior. I leave them at room temp for 20 minutes before filling a cartridge and then they go into my novopen and my purse to carry with me. I’m changing the cartridge every 3 days now so they get used pretty quickly. I’m still on old penfills and haven’t used even one of the larger viles I have- I wonder if that will change the air bubble situation though. I think it’s maybe something to do with the syringe.
as i have mentioned before, i will be seeing my CDE in 2 weeks. i have an entire list of questions for her and i am not leaving her office until all my questions are fully answered and i understand exactly what she has explained to me.
I think I have figured out at least when the air bubbles were happening: I used a vial of novolog this time instead of one of my penfills and had NO airbubbles. It has something to do with the penfill obviously. I’m still wondering why my trainer and others had no clue and didn’t seem concerned that I was getting huge air bubbles-???
I’m just wondering how long I can leave the vial sitting out on the counter- I will still carry a penfill with me most likely and not the vial. I change the cartridge every 3-4 days now with around 80 units in it each time. The vial has so much more insulin… I think it will be used up though before there is any issue of bad insulin.
Sorry to make this a zombie thread (back from the dead), but this is a topic near and dear to my heart. For some background, I’ve been in tech for almost 40 years. Mainframe computer programming, ham radio (I build 'em), electronics of all sorts… I love this tech stuff. I very much love my pump.
To Karen’s point: manuals are almost never designed to teach. They are there to remind one how to get the pump to do X. It’s up to me to work out when I want the pump to do X. It’s not easy to work backward from the manual to find the general principle of ‘Which of these pump functions do I want for this situation?’
The thing is, the general principles of diabetes management are different between MDI and a pump, because the available solution set is different. So even though I was doing a pretty good job with MDI, I was able to adopt a different mindset when I started on the pump.
To Daisy’s point, I probably knew every feature my pump offered before I ever strapped it to my belt (I’m a tech nut, after all), but I can tell you that even now, 4 years on, I don’t have a foolproof (yeah, me-proof!) set of general principles to guide me as to which of those features I want to use for every situation I find myself in.
I agree that it’s one thing to know what many of the options you can use for your pump are but it’s another thing to know what to do with them. A recurring theme of many D posts I’ve seen is the sort of lament that what works one time may not work the same way next time. I’ve gone so far as to weigh different pieces of bread from the same loaf and then used quick ratios to get the carb count more precise than the “15G/ slice” on the label but a sandwich still has an element of adventure. “Sugar Surfing” had some interesting biology tips sprinkled into the text and explained that part of the deal is that we are always changing and should anticipate changes rather than search, quite possibly fruitlessly, for consistency. Maybe that’s more my take on it than the book, as Dr. Ponder is very positive in his approach.
What Ponder made me realize is that there is not a “magic formula.” Thinking that there is a perfect insulin dose puts you in aconstent quest for the unatainable. Monitor, respond, repeat. I think the blanket admonition about insulin stacking serves many poorly.
I do agree that people just diagnosed with type 1 should do MDI until they get the feel for how dangerous insulin can be and how to use it correctly for all the things that will come up day to day. If you don’t understand how insulin works the pump isn’t going to make it easier. I started pumping after 20 years of injections so I had a very good understanding of how insulin works. Main reasons for going on a pump were to fine tune blood sugars for future baby and worked in a restaurant and my insulin was always peaking at the wrong time. Don’t get me wrong, love my pump but so glad I already knew what my carb ratio was, sensitivity levels etc. And once again I’ll say pumping isn’t for everyone.
Sally you bring up a point that I think is quite important–that if you don’t understand how to inject insulin properly, then pumping isnt the answer. I cringe every time I see a brand new diabetic going on the pump. I think that’s ridiculous. It’s like running before you learn to walk. Fundamentals are important.
I have been pumping for about 9 years. My first pump was an Animas and my current one is a Medtronic. I, too, can’t say that I use my pump to it’s full potential. In the beginning, I start with good intentions to learn every feature and be on top of uploading the data to analyze/make my own changes. It’s hard to not get ‘lazy’ with it when things are going relatively well.
I have to fundamentally disagree, because the fundamentals are different.
1 - Most people find their TDD goes down when they move to a pump. Part of this is because there is a better ability to fine-tune your basal, but also you can fine-tune your bolus and ISF. So, MDI is not a direct correlation to pumping.
2 - Associated with #1 is the fact that you are using only one type of insulin. So to a large degree, you learn how that insulin works in your body. MDI means you have to learn how two insulins work, each with their own active periods, AND the long acting is unlikely to last for 24 hours, meaning a split dose with another wrinkle in the active period. Again, MDI is not a direct analogy to pumping.
3 - For me, once I understood the basic premise behind pumping. I had to marvel at why pumping isn’t the standard of care and MDI the exception when pumping doesn’t match well with the patient.
IOW, one insulin, one infusion set every 2-3 days, basal delivery to mimic a sugar-normal’s background insulin, bolus delivery to match with glucose generated from meals (also mimicking a sugar-normal). Versus two insulins, 5 or more insulin shots, syringes and/or pens with needles??
While all that’s true, I think MDI is a more forgiving introduction to the skills you need before moving to a pump. It’s a lot simpler in term of all the bits and pieces you have to familiarize yourself with and carry around. I found it a lot less demanding of my time and concentration precisely because the control is much finer with a pump. Coming to MDI after far too long on R/NPH I found it a revelation–just the concept of basal versus bolus was news to me, and even though Lantus is a much poorer analog for what a natural pancreas does, it gets you in the right ballpark without overwhelming you with all the myriad options pumps provide for fine-tuning everything. I’m sure there are people who take to that right away–if you have a techie mindset and like screwing around with data and gadgets it’s all kind of fun actually, but that’s not everyone. Even though there are more shots involved, the technology with MDI is much simpler and easier to grasp when you’re just learning how this disease works.
Well maybe I just have a techie mind then, but technically I’m not so sure
I went from 1 shot/day of NPH (aka, “Not Particularly Helpful”), to MDI with the cursed NPH as the long acting, then to the pump. Yes, basal-bolus was a revelation, but pumping for me was nearly as life-changing as getting diabetes in the first place.
My control went from “20+ years of guesstimating” on NPH, to wild gyrations on MDI and two times waking up in the E/R due to severe hypos, to way better control and zero E/R visits (so far!) on the pump.
In some ways, my experience with MDI was quite scary, even though I was spending some time in range vs. virtually no time in range on 1x NPH. Pumping was like coming safely into a harbor after a long storm.
I’m content to agree to disagree with your disagreement with my point about “learning to walk before you run”. Learning all about a pump can be a daunting task for many, so to introduce all that is involved in pumping, to a brand new diabetic, is, IMHO, folly. I know you don’t agree. that’s fine. let’s please move on as we aren’t going to see eye to eye and I’m not much for back and forth and back and forth. I say my peace once or twice and I’m done!
It may be that that explains some of the difference in our perspectives. For me the whole essence of MDI was switching to Lantus, which behaves much more like a basal to begin with, and getting off of NPH, which has a rise, peak and fall effect, hence Eat Now Or Die as I called it (though Not Particularly Helpful is good too). That may be why I experienced MDI as The Great Liberation, and the pump more just a refinement of that.
Actually, something I learned about fat, it slows down your metabolism, the carbs in the pizza alone (the bread part) works different because of the cheese. I have to dual wave bolus for about 3+ hours, so because of this it appears more insulin is needed. Which technically is. If you were to regular bolus, your blood sugar will skyrocket in 2 or more hours. Just trivia I learned a long time ago
glad to hear that you found some form of managable option w/ the pump. it really was life-saving for me when i began (and still) using it, and it continues to be.
I highly recommend getting a book on pumping insulin. You will learn a lot. The concepts are pretty much transferable between pumps. It will teach you how to verify basal rates by skipping meals and all kinds of other things. I would never turn control of my pump settings blindly over to someone at my drs office. You’ll be much happier really understanding what’s going on. Also, this is a mix of art and science. The fact that we can control basal down to 0.025 increments doesn’t mean that are bodies can be controlled to the that level. Thre are so many outside factors like eating a bunch of carbs the day prior and your liver is now slowly releasing more glucose than normal for the next 24-36 hours, exercise, sleep, etc. Analogy, if your house thermostat could be set in 0.1 increments, the heating unit would not be able to maintain that level of accuracy. It would constantly be going on and off trying to match that level of accuracy.
Learning all about a pump can be a daunting task for many, so to introduce all that is involved in pumping, to a brand new diabetic, is, IMHO, folly. I know you don’t agree. that’s fine. let’s please move on as we aren’t going to see eye to eye and I’m not much for back and forth and back and forth. I say my peace once or twice and I’m done!