I'm glad I'm not the only one this happened to! lol- But not glad we have to deal with it.. I already thought of that- that I should just use more liquid and then be able to waste more of it to get rid of the air bubble. You're right, more is better for sure too to be safe, but then again less insulin would mean less insulin to overdose you if something terrible went wrong. Wow, do those occlusions happen frequently for you? That is certainly not something I want to deal with at all much less on a regular basis, waking up at 280, horrible :-(
yes, think I did something like that but it just didn't work without pushing out tons of fluid and even then there still seems to be some air at the top not sure...
Well, there are many issues to consider for sure but I already put tons of time into mdi- up all night controlling dp and watching for lows etc. However maybe if I do like and feel safe on the pump it will be much better in the end for me and will be a great tool to help my unpredictable bg patterns. I'm still worried about that because I never know for sure what will happen overnight, when I will start to rise, whether I will drop a lot also and then rise. The past two days I have been spiking up a lot earlier than usual, so I don't know how you can decide your pump profiles or whatever you use for that before possible going to sleep earlier and letting the pump do its job. One thing that will be markedly different is the delivery of basal insulin which is much more similar to our natural insulin. A tiny dose each hour, which can be changed, compared to a large bolus of long acting that can't be changed once it's given.
One thing that seems to be improving, cross my fingers, is I'm not having pain today and last night in the new inset, I hope that continues.On the injection issue, keep in mind if you were injecting intravenously, it could be lethal to inject an air bubble, so for purposes other than loading a pump, proper syringe technique is pretty key. Using a syringe without air bubbles or wasting a lot of the fluid being delivered is eminently doable--even heroin addicts manage it!--but it's really something your nurse/educator/rep should help you learn how to do properly. Or just practice with water. On the spectrum of pump tasks, this one's not too hard, so with a little practice I suspect you won't have any trouble.
Meee,
I completely agree with niccolo, but I would go even further, I am not a diabetes educator or an endo, just a patient, but after reading some of your comments I would strongly discourage you from start using ANY pump right now. The pump therapy can be very dangerous if you don't have some concepts very clear, and it's quite obvious you don't have them at this moment. A forum like this one can be great with concrete issues, but I think you need to go from the scratch again with your training before trying to solve each one of the issues you will have.
Don't get me wrong, I'm not saying you don't give it a try (I've been in pump for five years and I'm very happy), but not until you are sure you know exactly how it works, the risks, the benefits, etc. Otherwise you will never feel safe or comfortable, but which it's worst, you won't probably ever be.
I'm sorry if this sounds rude, but I'm really just trying to help you here because you will be endangering yourself instead of enjoying the advantages of a pump.
Being that said, I guess that we all have our concerns when we are moving from MDI to a pump, and of course at the beginning it can be hard, but most of the times it's a no-return way and most of the people do better with a pump therapy, so definitely I think it's worth the effort to see if it fits your needs.
Just my two cents.
Agreed. Unless you feel completely comfortable after your next appointment, do not start insulin in a pump! Instead, maybe do another few days of saline, and have another appointment after that. There's no harm in delaying a pump start by a week or two. And there's a lot of potential harm in screwing up the operation of the pump, and even if no physical harm, then at least significant stress.
And again, I really think there's no shame if you ultimately decide you gave it an honest shot but the pump's not for you. But I suspect within a week or two you'll feel much more comfortable with all these things.
Since this is a pump I won't be injecting intravenously obviously(I'm aware of that issue with intravenous injections), so that won't be an issue. Having an air bubble in the line could cause lack of insulin supply but since I've managed to do it twice now and get rid of the air that was there, I think I'm doing ok so far. I haven't noticed any bubbles in the tubing. Mimikins says this has happened to her, so obviously other people have this issue too apparently and have resolved it. I will try practicing it a few times with water and see what happens. Are you saying you've never had an air bubble when doing this with saline/water or insulin? I find that hard to believe since I used to syringe the insulin out from my pens into a cartridge into my novopen junior and I frequently had air bubbles but tiny ones that I got out by shaking or whatever.
I think I have the basic safety concepts pretty clear now in regards to filling the cartridge and attaching the inset, the main one being never have the inset attached when you fill the tubing. Otherwise according to what the tandem rep said the other thing I was concerned about( the tubing becoming damaged etc. or the luer lock being removed while attached) is not a dangerous event, although I will be avoiding it anyway just in case and there is no reason to detach it purposely unless you are changing the set and removed the inset. As to the air bubbles when filling the cartridge I will definitely ask to be retrained on that and take your other thoughts into consideration.
Everyone has to learn the how to and I'm sure we all have our issues at first, but some more training definitely can't hurt. Unfortunately we will never be 100% safe on any type of insulin delivery and pumps are more dangerous imo overall, however the tandem seems safer due to the way it delivers insulin. My endo said mdi is also bad though and has seen many overdoses and mistakes with mdi.
I will definitely think about this, I may ask to try another week of saline first and train some more with my cde as well as the tandem rep, however at some point you have to go ahead with insulin to see if it will be for you. Trying it on saline for weeks while you still do mdi really gives you no idea whether it's for you or not other than the mechanical issue etc. I really feel horrible a lot of the time on mdi and since my life depends on insulin, I can't go off it ever, I think I have to try something else- the pump being the only something else we can do, to see if it will help me. I'm not going to give up just yet but of course I wouldn't feel any shame if I end up not doing it.
I disagree. Seeing if it's for you isn't about seeing whether you can safely run a pump or not. It's seeing whether, assuming you can safely run a pump, it makes sense for you. I think it would be irresponsible to start insulin if you don't feel confident in these basic pump management issues. I'm sorry if that sounds harsh, and I'm spending so much time responding because I want to be helpful. The pump, if misused, really does provide a lot of opportunities to mess things up, as you're observing, and especially in terms of hypos, that's potentially very serious. Agreed you can screw up with MDI, but the pump complicates everything (in good and bad ways). Don't get me wrong, I want it to work for you, I just want you to be comfortable operating it before you start, however long it takes to get comfortable.
@niccolo, yes true, I was talking about a significantly longer period, not more training until you feel you have everything down, eventually you do have to try it or not and my insurance won't pay for months of training I'm sure. How long did you train before starting on insulin and how long have you been on this pump/the pump?
I tried to go straight on insulin, they insisted on a week of saline, and they were right. I'm extremely comfortable with the stuff with which you're struggling--I'm a former EMT, I love medical tech, I'm super curious and engaged with these issues--and even for me, there was a bit of a learning curve on the pump. I've only been pumping insulin for five weeks, so feel free to take anything I write with a grain of salt, tons of folks on here with far more experience than me.
Re your time window, the one major issue from my perspective is when you have to actually return the pump if you decide not to keep it. But the pump company wants you to keep it, so I suspect that if you tell them you need to be authorized more time before making your decision, they'll offer that. In fact, I did that because my doctor wasn't able to get me in for an appointment, and I was supposed to be doing international travel during which I didn't want to start, but which ended up getting canceled, and honestly, it was a non-issue to get more time from Tandem.
Ok- well, I'm much more cautious than you then! lol- because They wanted me on this in two days I think and I said no way. The tandem rep I spoke with when getting the ball rolling said this anyway, I said I want a week on saline first. I think she meant two days of training though which is what I'm getting- 2 3 hour periods although we were only there 2 hours I think and I was tired by that point anyway, my bg was high and I was having trouble absorbing more info at that point. I'm guessing since you're a former emt you have plenty more experience than me with all of these things. I have to tell you though, no reflection on you, that one of the emt's who came to care for my father tried to tell him he was only hyperventilating when he was in arrythmia with a very fast heart beat, not good!
I'm a slow learner but once I get things I get them very well for the most part. I know I sound a bit confused in my questions here but I actually think I understand the basic things now after you're explanations and the calls to tandem. Another week of saline may be a good idea and I was planning to ask about insulin dilution before I go on it anyway.
Yes that is an issue about returns- when I called about the occlusion she said there is leeway in that and I only started training last Tuesday. She took my name and my trainer's name so I assume there is a note of this somewhere but I wonder if I should call tomorrow and get more time authorized? I'm not sure if my convo will count for that.
It's not an issue money wise since there was no copay but maybe only if I decide on a new pump and getting that covered. I can always keep it if I decide not to use it all and use it later too, some people here have more than one pump I think, but I'm not sure how long I would have to wait to get an omnipod if I do decide to pump, maybe a few years? I hope it's not that long. My endo said that even if I get a pump I don't have to use it and can use it later or whatever. Some people also do a combo of pump and injections/long acting too.
Many EMTs are scarily incompetent, having been one makes me much less confident in the care that may be delivered when one calls an ambulance. Parademics are far better, with much more training and a real selection of drugs to deliver, and obviously it varies, there are some fantastic EMTs out there, too, of course.
I think most insurances will cover a new pump every four years.
Unfortunately that is true, we can only hope they don't kill us, lol. I have seen so many fatal/near fatal errors and so on in these settings etc., including with myself so I hope never to go into a hospital again except for a test. There are plenty of good people in the field too of course. I think I will call tomorrow and ask about all of this. Thanks!