New pumper needing advice!

Hi everyone! I started on my Accu-Chek Spirit Combo pump about 3 weeks ago and am having a rollercoaster of a time. I have been as high as 21.0 through boluses not being added up properly and sensitivity changing (and my ever-changing dawn phenomenon!!!) and sometimes down to 3 in the middle of the night. Just as I thought I had straightened my basal rate out, something makes them screw up... I guess I'm just feeling a bit down about it. I fought hard for 9 months to get the funding from the NHS for this pump and I suppose I feel bad for not getting on with it as well as I should. I just feel ready to pack it in.
I am also experiencing a very bruised and sore feeling ALL the time around my cannula - I am currently using Rapid-D 6mm steel cannulas as I thought that the flexi ones would be too mcuh hassle at this early stage. When i take it out, there is not bruising, but when it is inserted it feels very tender and sometimes sore to the touch... I am wondering if this is just me????? I have moved my sites all around my absomen and there is not insulin absoroption problem or occlusion. I hope there are others out there like me. I am going to try the 8mm ones to see if it makes a difference.
I was wondering if it may be to do with the fact that my tummy is a little pudgy and when i sit at my desk all day the cannula is sort of squished by the little roll of fat on my tummy?? Is this plauisble? I'm thinking about trying my bum as a new site!!!
I am just looking for a little reassurance that I am not a big screw up and that things should get at least a bit easier!!!! And also any advice to straighten things out.

Yikes, that sounds like a frustrating situation! I agree with your notion of trying a bit longer needle! I use 13 mm angled ones, I put them in sort of like an injection, pull out the steel needle and hardly ever have any problems with absorption or sites. I read from one of my FB friend (Ginger Vieira who's a member here and also author, activist, etc.) a suggestion she'd had to increase your basal rate initially, to combat the trauma of the site slowing absorption there until it heals up a bit. For me, it often just takes a couple of hours for things to calm down but a bit more insulin does the job in that situation.

Re making adjustments, I usually use the pump software (I have a CGM now too, so I have perhaps additional data but the theory is the same...) to see how things are running. If an area shows highs after meals, I adjust that particular meal ratio to give more insulin. If it's lows, I do the opposite. If it's before meal issues, I adjust the basal rate.

My other recommendation would be to read "Think Like a Pancreas" and/ or "Pumping Insulin" as I found these to be the most helpful guides to managing your pump yourself. They contain instructions for setting rates, determining ratios and everything else you need to do. They aren't too pricey and they are really handy to have around.

Couple of thoughts:

Have you done basal testing? I don't do it much anymore, but when you first begin pumping, it might really help you get those basals worked out better. You can have many different rates for different time of the day, so if you need more in the morning, bring it u., Remember that when you program a basal, it will lower your glucose readings over a four hour period, not immediately. So if you readings are starting to rise at 7 am, you might raise the basal beginning at 5 to start and see how that helps.

Are you confident that your carb to insulin ratio is correct? That can also change at different time of day.

Finding the right insertion spot, as well as the correct cannula can take some trial and error. Contact the pump folks and explain your problem. They talk to hundreds of pumpers everyday and might have some good ideas. I know mini med sent me a bunch of different types to try.

Are you brusing around the cannula or just feeling bruised? If you are bruising, I would call the pump helpline or your pump coach, if you have one. Maybe you are not inserting it quite right. This could also affect insulin delivery, so I would check on that.

I am also a little "pudgy." I try to place the cannula at least and inch// inch and a half below my waist. That way it does not get disturbed as much by clothing.

Moving to a pump is a huge lifestyle change. For me, it has been a godsend, but you need to perserver. Talk to people (coach, doctor, pump helpline, etc) as well as here on TU. There may be a real simple solution. Hang in there. I am confident you will be glad you did.

I like all the suggestions made already, especially testing your basal rates. Gary Scheiner's Think Like A Pancreas has step by step instructions on how to do that.

As you are beginning to appreciate, managing blood glucose manually means considering many different factors including insulin amount (insulin: carb ratio, basal rates), insulin timing, the quality and quantity of food, exercise intensity and duration, stress and several other factors.

When you try to figure out which factor is playing a role and therefore which one to adjust, It can be confusing and daunting. The solution to this mess of factors floating around in your head? Keep a detailed log. Write everything down, at least for a week or two. It is a powerful tool that will make your efforts much more effective.

Good luck with your pump. It is a sophisticated tool that, once mastered, can pay big dividends in better control and ultimately free you up to pay attention to the rest of your life!

I second the log advice. By detailed, read DETAILED: all glucose reading, what time, basal rates, what you ate and the amount of insulin you took and what time, stress levels, activity levels, illness, everything. I like to do mine in Excel.

The logs will create a picture and you will recognize what is going on in a better fashion. Plus, it is easier to really see and believe patterns when they are on paper.

You might be having trouble with the metal infusion set.. could be sensitivity to nickel... could be the movement.. Flexi ARENT more hassles, they actually (if inserted correctly).. much more comfortable than metal sets.. The angled flex set is a little tricky to insert but the 90o set *Ultraflex or Flexlink*.. are EASY... upper bum works as a site but you dont want a metal set... this may completely be a set issue.. Get some samples and have someone show you how to insert a Ultraflex or similar set... No your not screwing up.. Your set is not a good fit for you!.....

Also as someone else here suggested, I tend to do a 120% temp basal or similar for 3 hours after a set change.. you might need to do something like that, and also some people need a little bit extra insulin on insert.. (more than the suggested prime).. but its a trial and error thing... but trying a temporary basal after a site change and giving a bit of insulin up front during cannula fill..can smooth out a bit of a rocky start, if your basals are good
Might need to talk to your doctor/consultant/endo/etc about it

1. Three weeks is NOT long enough to decide that pumping isn't working. You have to give it time. It took me about 3 months to get basal rates straightened out to the point where I wasn't seeing extreme highs and lows. I'll admit that during those initial three months, I didn't feel so good. But once my basal rates were (more or less) figured out and I had a firm idea of when I needed temp basals, I felt tons better AND had phenomenal BGs for the first time in years.

2. If you haven't already, read "Pumping Insulin." It's a great book wtih some really good info. It will explain how to do basal testing, which is what it sounds like you need to do.

3. Call the manufacturer and see if you can get different infusion sets to try. I have a minimed pump, and when I was having issues with one kind of infusion set, they sent me out samples of other ones to try. I personally found steel canulas uncomfortable.

4. Experiment with sites and rotate! I use my thighs and side-butt a lot. I use my stomach sometimes too, but always find that a little more uncomfortable.

Try using an 8-mm vertical teflon infusion set. The stomach is the best area for good absorption. Since you are getting random readings of 21.0 and 3.0 it's probably nothing to do with your pump settings. It's most likely depth related or possibly an allergic reaction to the metal needle. I switched back from steel to teflon sets and I definitely prefer them. I use one of the Medtronic "steam catapults" to insert them and I never experience crimped cannulas.

Hi everyone,
Thanks for all your help. I have tried 8mm metal needles but am still getting a lot of leaking and bleeding and bruising. I have booked an urgent appointment with my pump nurse today, as she thinks my body may be rejecting/allergic to the metal needles - she is going to teach me how to use the 90 degree flexlinks so fingers crossed.
I am hoping that once the site areas settle down, I can do some basal rate monitoring and double check all my ratios. I have been carb counting for years but am not sure if my ratios have changed since starting on the pump. We shall see. Thank you for all your kind words and support :)

I'm Rob Muller with Roche Diabetes Care. I'm so sorry for the trouble you're having. Please know that you can reach out to customer care in the UK at 0800 731 22 91 if you ever have a question or issue like this. Their holiday hours are posted here.
There are also other good resources available there, and you are in very good hands here, too.
Please let me know if there is anything I can do to help you, and keep us posted as to how you're getting on.
Once again, sorry for the issues, and I hope you have a very happy Christmas.

Will be interested in hearing the results of your meeting. I definitely recommend flex canulas to everyone that I get on a pump. Start with a 6mm and if it works, it is less intrusive which means less pain. Not for everyone, but seems to work for most of my friends, and I've been using that size since I first started with a Pump in Jan '00.

I had the most smooth transition ever to a pump, two days later I felt 15 yrs younger and my wife commented exactly the same. However I've been forced on Novolog by my insurer six months ago and have passed out so many times, I've lost count. Never passed out in 25 yrs of Type 1, it's my body's inability to process the Novolog. So two of my docs have pushed the insurer to get me back on Lilly's Humalog. Everyone's different, and the insurer (my wife's employer actually) needs to take that into account. So I know how you are feeling right now. But realize that the pump will make it easier for you, once you get the basal rate figured out. Start with lower rates, as it is better to have high sugars and work them down with small increases in rates over two weeks or so, than go low. I went on the pump due to having Dawn Phenomenon as something new in '99. Understanding which basal at what time is best for you does take a little time. Stick with it!!!

Also I use Tegaderm over the infusion site and under the infusion set because I'm allergic to just about any adhesive. I find them much superior to IV3000.

I am sorry to hear about your problems. I have problems you describe when I used Accu-check Rapid-D to my Medtronic pump. When I got the hose and needles from Medtronic it all changed and went great. I couldn´t imaging that it could be such difference but i was. Perhaps you can change to another mark or something? Perhaps Medtronic needle etc can fit your Accu-check pump? It seams crazy...but? Good luck from Sweden :)

YOU ARE NOT ALONE!!! I have been diabetic for 20yrs and been on the pump for almost 3 yrs...I have problems pop up all the time! For example...since the 1st of the month I have experienced 10 low bs...I havent had this kind of trouble in a long time! Our bodies change and therefore adjustments have to be made...the one thing that gets easier (for me) is how I react to these gets frustrating for sure (i took my pump off the other day and threw it on the couch) but I no longer react in fear...I know that it going to take some attention but I will figure it out (with the help of others) and make the adjustments and carry on.
20 years later I still get frustrated, angry and scared...but we get through it!!


Give it some time ... Having a pump is a blessing but it takes time and patience to be
in the know of it ! ----

These are some good tutorials on how to hide the pump depending on what you are wearing ! I hope they work out for you !
dresses with pockets :
skirts and dresses:
with jeans:
exercise clothes

Hope everything workds out well !

Hi I’ve been diabetic for 30 years and been pumping for 5. The pump definitely changed my life in so many positive ways. I’ve still got the old Accucheck Spirit that I started with and am looking forward to getting a new pump with all the modern features next year. I’ve always used the flexlink cannulas and find them very comfortable. I know that the Animas Inset II sets also fit the Accucheck.
I know tha your original post was months ago so I’m hoping that things have settled down and you are doing much better.

Hi, beckarini, you have probably moved on a little now, but I am reading your post with great interest as I have now been on the Combo pump for around 6 weeks. (36yrs T1D). I too had some ups and downs, but did start on flex link 6mm. I now watch them at 2 days and change early if there are any problems, but I have less problems now.
PS I read all the books, pumping insulin (latest edition from US ie from not, has european units and is cheaper as well) and think like a pancreas before getting the pump and these do help loads.
I have had a couple of bruised sites and one bleeding site, so wonder whether you found any techniques that helped. One was a problem when near a natural crease when I leaned forward, and that one pinged off one day...! I felt a sharp feeling of the cannula tip scratching me which at least warned me.
Good luck, and I hope things have improved.