So here’s the deal:
I’m applying for a job which requires me to work with an MRI several hours a day, during which I cannot wear the pump due to the high magnetic fields in the room. I do not want to disclaim the job because of this, because it’s a great opportunity (it’s in diabetes research btw), but how can I manage a 2-4 hour pump break each day? Does any of you have experience with giving little boli or other techniques to avoid the upcoming high?
Yes, I do this on a fairly regular basis. what I do is I reconnect every hour and bolus my basal amount. I also check more often and try not to eat anything (unless I’m going low). Usually this works out well for me.
Hi Vera. It sounds like MyBustedPancreas has a really good solution. You might carry a pre-filled syringe or two for emergencies.
Using the bolus feature to manually enter an amount equal to the basal rate every hour works for me. Long term, you may have to go to a long acting (i.e. Lantus) insulin and Humalog bolus. Try the basal/bolus first.
Thanks for your answers so far. I don’t know how the work is organized yet and whether I will be able to reconnect each hour, but I don’t see any better option.
I hope I can persuade my future boss, because she’s really worried about the safety issues. I am not willing to let go of this job because of D. Not this one. I want it because it’s about D research, for heavens sake; the irony of fate would just be to cruel.
Interesting dilema. The “book” will tell you to reconnect every hour or 2 and bolus for your missed basal. I am not sure if Germany is like the US in that they need to make “reasonable” accomidations for your disability/health. If so, then this should be a reasonable accomidation and work for you.
If for some reason you would not have access to your pump during the time off of it you may want to try a humalog pen as someone suggested. And if the time period is longer (4 to 6 hours maybe) you may want to consider using the “old school” regular insulin (novulin R). R’s activity peaks around 3 hours and ends around 6 may fit the necessary time frame better than humalog. Not using your pump for boluses may make you insulin on board numbers inaccurate and may make you have to really do some math and remember stuff.
I have no doubt that if you get the job you can figure out a system that works given some chance to experiment.
Don’t mention it, see if you get hired and THEN ask for accomidation. It’s illegal to discriminate against someone for health needs!
Under law, they have to provide you with reasonable accomodations (under the ADA). I would recommend getting hired first and then, once you’re securely hired, bring it up as an issue. That way, you can secure the job first. Worst case scenario, if it is absolutely impossible to work around, they will have to offer you something similar (I think that’s how it works). And you’re right, the irony would be hilarious.
Also, have you checked with the pump manufacturer about what is a “safe distance” to be away from the MRI machine? I’m just curious because when I got my most recent pump, the trainer made it sound like I just couldn’t be inside an MRI machine with my pump on. what about people just walking by an MRI facility/room? Does that pose an issue?
I have always given myself my basal added up for the four hours (Novolog tends to stay in me for 4 hours so you would change based on how long you get action from it or whatever rapid you are using). So if my basal is 1 unit an hour I will give 4 units total and if I need correction or food add that all in to one big basal/bolus shot. Of course up to the first 45 minutes to 1.5 hours it won’t be quite enough followed by 1 hour (the peak of the insulin) where it is a bit too much followed by an hour or so where it is not quite enough again (the tail of the action). Despite the weird action profile I have always found this keeps my blood sugars reasonably stable without having to worry about getting back to my pump every hour (what happens if you can’t?!?!?). Of course I would highly suggest you play with it at home before you need to do it at work.
I think for the most part just walking by the room is ok. It may depend on the pump. I had an Animas rep tell me he travel’s a lot and always sends his pump through the x-ray machine so he dosen’t have to hassle with security. He was saying the electronics for the Animas pump are encased in lead which reduces the risk of these types of things. Obviously the risk is still there and of course there is a difference between MRI’s and x-rays. The other thing is, if his pump breaks he has an endless suply at his fingertips so screwing one up was less of an issue for him. I have had others tell me they forgot about the pump and did get an MRI with it on and it was ok but who knows. When I got an MRI they were pretty close to patting me down before I went in so I don’t see how you could just “forget”.
I would like to propose a more unusual approach. Combine pumping and normal basal insulin therapy. This is how it works:
a) you reduce the basal profile of the pump to the lowest flow rate possible to prevent site clogging
b) you use a good basal insulin like levemir twice a day - every 12 hours - as a compensation for the missing pump profile
c) you then fine tune the pump to add a little basal in the morning if you use the pump to fight dawn phenomen
This way you will have good numbers and you can disconnect the pump at any time of the day without being in massive trouble. The only problem is that you can not reduce your basal profile for physical activity anymore. Unusual activity will then need additional carbs. This is how I would try to solve the problem.
I see this done in kids that are prone to DKA as a kind of back up plan as any little infusion set failure will put them in DKA quick. Seems to keep most of them out of trouble. They usually give only 1/2 of the total basal needs so they can decrease for exercise. Maybe a combo of this plus any of the above other suggestions would be grreat for control and still allow flexibility for exercise.
This is indeed an interesting and unusual approach. I ususally reduce my basal rate to 50% for 2 hours before exercise, so if basal insulin and pump basal rate are at a 50:50 ratio, it might even work with reducing the pump basal rate to 0% before exercise.
Thanks for all your answers!
The MRI has a 3 Tesla magnetic field, and Medtronic tech support says that the pump can resist field up to 0.06 Tesla. So no way to bring a pump into the room when the MRI is running. The motor could go wild and uncontrolled pump insulin into my body (yes, there have been cases like that).
Unfortunately, my future boss already knows about my pump - I told about my diabetes right from the start because it’s my major motivation as well as a qualification for the job, and when she asked whether I pump I didn’t even think about lying, nor would I have wanted to lie if I had. I don’t really know what the German law is in such cases… Anyway, she will not be available for the next two weeks, but says she will come back to me after that. I really hope it works out…
My programmed stuff continued to work the other day about 4 ft away from the MRI going on and off, in the room. I think the pump mfg might have data for you, and I think you will learn more about this particular MRI once in the job. It will be individual to the machine. The rest of the comments are great advice.
If you’re concerned about the close proximity to the MRI I’m wondering if a case or pouch could be made from a company like this http://www.marshield.com/ ??
Am I the only one who finds it odd that someone with diabetes would have a problem getting a job doing diabetes research? Would this be an oxymoron?
Sounds like the person who would be your boss needs to be told about this site and then they should come in and do a little research.
MRIs, once “turned on”, are always on. The magnet is forever on (and the cryogenic portion of the machine keeps the magnet cool, which is the noise you are hearing when you walk into the room w/ the magnet). The pulses are applied to align the hydrogen atoms and the coils (the things that they wrap close to your body) pick up that signal and translate that into the image. But that’s beside the point 
My point is that the magnet is always on. Once you go inside the 5 gauss line (which is typically just inside the threshold of the door for most 1.5 T machines, but can reach further w/ a 3T machine), it is imperative that you not have anything metal on. It would destroy an insulin pump if you got too close. The only time a magnet is ever not producing a magnetic field is in the case of an emergency when you “hit the red button” to quench it (remove the cryogenic properties of the machine). This could crack the magnet, so that’s only like a $2 million dollar press of a button lol. But again that’s beside the point. I wanted to work in MRI but picked pumping over MDI so I worked in a cardiac cath lab instead.
The console can be close b/c of the shielding that is used to disrupt the magnetic field on the window, in the walls, etc (but should also be close for safety reasons b/c the tech needs to have direct line of sight w/ the patient).
To our knowledge there is no harmful side effect to MR exposure (unlike ionizing radiation). It is similar to ultrasound/sonography…there is no harmful side effect that we know about at this point, except at really high Tesla field strength, like 5-8T, which are not used in a diagnostic setting and are very rare. Once you get above 3, you can get light headedness–among other things–when entering the room quickly, etc, b/c the magnet is of course trying to align all of your hydrogen atoms throughout your body, brain, etc
Regarding the OP, I am not sure how to handle the situation w/ pumping and mini bolusing. I ultimately chose another field of radiology for my line of work b/c of this fact. I had considered trying to get a copper wire mesh case made, but that would have been big/bulky/not practical, and would still have allowed a small amount of magnetic waves to get in b/c it would have had to have an outlet for the tubing, etc. I just didn’t think it was a feasible idea. I considered leaving my scrubs untucked and only wearing my infusion sets in my stomach too so that I could disconnect in the case of an emergency, but trying to remember to disconnect every time a scan was done before walking back in the room was just too much of a safety risk for me…
I hope that some of the others might have some ideas for you w/ how to mini-bolus effectively, but if you take the job I would not recommend having the pump on your person/attached at any point when you’re going to be in and out of the scan room frequently.