New spirit user - 3 weeks and counting. ;)

I was diagnosed in 2000, presumably Type 2 but found out earlier this year I’m 1.5. I’ve used insulin most of the time for the last 10 years so I’m not new to insulin but am new to a pump.

I got an Accu-Chek Spirit pump three weeks ago yesterday. I have to say I absolutely love it but am having some issues and perhaps y’all will have suggestions.

The first two weeks went swimmingly with no glitches other than the normal trying to find the right settings and such. Starting Monday of this week, though, my BG was too high most of the time. Not horribly, dangerously high but much higher than I like or was at before this point, especially my FBG and if I wake up high, it’s a battle most of the day.

I changed everything on time, never late. But I noticed bubbles in the infusion tubing, disconnected, primed the set and carried on. The next day I noticed the same thing and performed the same fix. The day after that I noticed a bubble in the cartridge that had no been there before. I changed everything out again, a couple days early, and the next morning I was high again. I can’t figure out just where these bubbles are coming from when they are not there when I first change things and whether or not they really do make a difference in delivery. Some say yes, some say no.

Today I talked to the educator and she suggested I try extended bolus. I don’t eat a diet high in carbs most days. I’m a low to moderate carb gal and she suspects the culprits are really the protein and fat in my diet and not necessarily the functioning of the pump itself. She said it the extended doesn’t help quickly we’ll try multi wave next.

Well, I messed up the extended bolus at lunch today but got in from work a bit ago, set the pump for another extended bolus for dinner and we’ll see how it does.

Anyway, input on the bubble issue is appreciated as is input on extended bolus in general. I really do see the advantages of a pump and want to be successful with this but need some guidance. :slight_smile:



  • Are you filling the cartridge with cold insulin?
  • Are you checking the luer lock to make sure it is finger tight?

If your FBG is high, I would try testing @ 3AM and playing w/increasing your basal using a tempy basal rate. You might even want to do some hourly testing overnight, just to see what happening and when. This assumes that everything else is normal (yeah right!)

Thanks, Mike!

I let the insulin sit out 30 minutes or so, which is a bit longer than the educator had me do the first time. I can’t tell by the feel of the bottle whether it’s ‘room temperature’ or not so I figure 30 minutes is probably safe. How long does it generally take for it to be at room temperature? I make sure to not over tighten the luer lock so I think that’s okay.

I wake up several times during the night and generally test when I do. I’m usually between 125 and 145 which I think is is too high but I have a history of hypos in the wee hours so the educator is being conservative with the basal rate during those hours. We did increase the basal rate a little during the hours of 3 to 7 AM but that was right before all this other stuff started so I don’t know if the lack of improvement is due to the basal still not being right or the other issue.

My FBG this morning was 132. Yesterday it was 175 so I’m grateful for this morning’s reading. :slight_smile: I’m off this weekend so I think I’ll try the hourly testing tonight and see what that shows.



I would think 30 minutes is more than adequate. FWIW, I rarely wait that long. Prior to filling the cartridge, do you operate the plunger? IOW, I pull the plunger down and rotate it a bit clockwise, then push it back up, then pull it down again before attaching the cartridge to the vial.

Once the cartridge starts to fill with insulin, I am fairly aggressive at getting the bubbles out (ouch, my fingers hurt!). When I am having a lot of bubbles, I sometimes remove the plunger with the cartridge all or mostly filled and the vial still attached and let the whole thing sit for about 5 minutes (I balance it all in the corner of my bathroom countertop). This lets all the little teeny bubbles that are suspended in the insulin make their way to the top of the cartridge.

When priming the tubing, I always strike the pump with the heel of my hand to get the bubbles up and out. I may end up doing two priming cycles (or at least part of two).

If I have a cartridge that STILL has bubbles (grrr!), or seems to develop some after a day or so. I sometimes will work on wearing the pump differently so the bubbles move to the bottom of the cartridge.

Finally, I sometimes see a bubble that forms in the luer lock/adapter area. It will typically get “stuck” there because of gravity, and I just ignore it.

132 is not bad for a FBG. A little high, yes, but keep tracking. If that is the lowest you end up, I would then tweak the 3A - 7A basal up just a bit, depending on your insulin sensitivity. It definitely sounds like your educator has a good understanding.

BTW, welcome to pumping!


I do push the plunger in, turn it, pull it out some and do that again as that’s what the educator showed me. The problem is I don’t see any bubbles in the prepared cartridge or in the tubing. I look very closely, even use a magnifying glass, and I simply don’t see any so I carry on. And it seems to be the next day or the day after that that I notice bubbles. I’ll try letting the cartridge with vial attached rest for a few minutes and see if that helps. I generally prime the infusion set twice, sometimes part of the second cycle, before the drop of insulin comes out the end.

I’ll try your suggestions when I change it all next time and hopefully they will help. Thanks. :slight_smile:


also while priming, set the pump upright on the flat end, not flat on its back

I have the same issue. I also let the cartridge sit with the vial attached for a while, I don't keep my insulin cold. I even fill the cartridge a day before needed and I still get air the day after change the set. I'd like to know also what to do to fix it!