No occlusion alarm

I don’t know if I’m posting this where I need to but I’m annoyed. My cannula keeps getting kinked I called tslim because my pump isn’t alarming that it has an occlusion. They have a new reason everytime. My problem is I understand when it’s pushing my basal thru maybe it’s not feeling it but when my sugar is 500 and I take a correction of over 6 units why isn’t it feeling it then. That’s alot to push thru with no alarm. They said it could be coming out before the site but I don’t smell insulin anywhere and insulin smells. I’m fed up and feel like I’m done. They sent me a few of the steel cannulas but I dont know what I think of them I found it uncomfortable. I’ve been T1D for 17 years I have scar tissue which is a part of my problem. But why is no alarm going off I went into dka 2 times and this has happened 5 times in the last 3 months

Hi Allie,
Sorry you are having this trouble. The reason the alarm is not going off is that insulin is still getting through so the “occlusion” is not recognized by the pump even though the set is kinked. I don’t feel my bolus so I can’t comment on why you don’t feel 6 units. Is there any pooling at the site?

What are the other reasons the support calls give you? If you have experienced DKA twice since pumping, it may be that pumping is not a good option for you. Basal not being delivered is dangerous as you have learned. Pumping is not for everyone. I hope you find a solution.

I feel you on this one. I was with Medtronic for about 24 years and never really had any issues. I switched to Tandem two years ago. It was time for a change and I really do like the pump but like you was having more problems with infusions sets. I also thought it was pump related and during my calls to Tandem (very helpful) the discussion of infusion sets came up. Way back when, there was only metal and when Teflon came out, I was so thrilled as I didn’t notice them at all. But that being said, I noticed a lot of issues with Teflon since switching to Tandem. But unlike yourself, I would get occuslion alarms. I know some people also have problems if they have a very low basal rate. I’m hoping that has been part of their troubleshooting with you. I did meet with the Tandem trainer and we tried many different infusion sets. I think most problems with pumps is not pump related but infusion set related. It does take a lot of trying different sets to find the right one.
I currently am using a 6mm metal infusion set but I also have Teflon of both 6 and 9 mm when I use them in different parts of my body. Can’t use metal in leg due to lack of fat but can in buttocks, hips and abdomen as I have more fat than I’d like there. Keep playing with infusion sets and order different types and sizes so you have choices. You can get samples from pump companies, and infusion companies. Samples are usually not a problem because they want you to buy them. Good luck and as you know, when it doubt, pull it out, take a shot and start over, again. Sorry!

I’ve been pumping for many years and have witnessed a whole range of insulin non-delivery issues. When you say that your cannula keeps getting kinked, does that mean you’ve pulled out a poorly or non-performing site and actually seen a kink in the cannula? If so, has the kink been fully folded over or just partially kinked and letting some portion of insulin pass?

What infusion set do you use? What is the material of the cannula and how deep does it penetrate? Is it an angled set? Do you manually insert it or does it have an spring-loaded inserter? I think the spring-loaded inserters probably have a higher success rate than manual insertions. I’ve read about some people not inserting with a crisp-enough action and induce kinked cannulas.

Where do you insert your infusion sites? Do you rotate sites? Have you tried any new sites? How many days do you let a good set/site remain?

A few years ago when I ran into a whole host of absorption problems, I found that switching to a different infusion set and using a brand new area of my body solved the problem. Up until that time I had exclusively used my abdomen. I had been struggling with this issue for months and months.

I don’t mean to bombard you with questions but it may help you to think about all these issues as you try to find your way to more dependable insulin delivery.

I move my sites around really good. They have all been used alot and everytime I find a new good area it gets used up in time. When I take out those sites the cannula is all the way kinked. I am going to start with the steel ones tho the first one i tried was uncomfortable but I think it had to do with the fact that I had it in a spot on my leg that wasn’t ideal.

I tried getting some different samples but tslim said they don’t do that. I need to find out who my local person is so I can try some different stuff. I just hate that I don’t get an occlusion alarm it makes me feel like my pump has an issue.

So sorry to hear you couldn’t get samples from Tandem. Maybe I just had a great trainer because that was who I got 3 different kinds. You can probably call the different infusions companies and they would probably send a few because like I said they want our business!
The only other issue I have heard of with delivery problems, is those who have very, very low basal rates. Some pumps handle it quite well and some don’t. Not sure which ones are better if you are indeed on a very, very low basal rate. But I know there are plenty out here, who would have that kind of detail. But I find that most times, it’s not the pump, it’s the infusion set. Infusion sets are the biggest reason for delivery problems. Good luck and as always when in doubt take a shot. If after the first major bolus to try and bring down a stubborn high doesn’t work and I start getting into that feeling like crap state, I just take a shot and pull the set. The joys of diabetes! Good luck with trying to find the right infusion set!

You might want to call your endo’s office and see if they have some infusion set samples. Pharma sales people often give samples to doctors for them to pass on to patients.

Yeah the cannula is totally kinked. It goes straight in and is spring loaded. I rotate very good but alot of areas are no longer be used. My legs are done, my hips are done. What areas do you use that seem to help? Im trying to answer all your questions I keep my site in 3 days.

Maybe you could use some one-on-one help to recheck that your insertion technique is good. Do you have access to a certified diabetes educator (CDE) through your doctor’s office? This is the kind of thing CDEs do. I’m surprised that the automatic inserter leaves you with a kinked cannula. Knowing that, I would suspect a bad lot of infusion sets. Although I think the Tandem customer service people would be well aware if that was happening.

If all else fails, you could return to try MDI, multiple daily injections. I tried the long acting basal insulin, Tresiba, this year and found it reliable and flexible. I used Apidra for my meal and correction boluses. I found the insulin pens to be easy and convenient to use. Perhaps this could help you and there is no penalty for trying. In fact, doctors can often give you insulin samples to try.

So, I would seek the help of a CDE to check your infusion set insertion technique. Then, if you’re really committed to pump therapy, I’d try some other infusion sets. Finally, you may find that MDI works well for you. Many people choose MDI over pump therapy for a variety of reasons.

Good luck! Don’t stop trying various changes to your current set-up. I’ve gone through this a few times and while I didn’t like the frustration and uncertainty, it definitely felt better when I discovered a new method that actually dependably worked.

I’m not surprised. I have always used angled infusion sets. When I was originally trained (on a Medtronic pump), we were trained to insert manually because we were told the “sil-serter” was more inclined to kink the cannula. When I switched to an Animas pump, I tried the Inset 30 angled sets, which come with a built-in inserter and found that they kinked more often than not, so I went back to the “Comforts” which are identical to the ;Silhouettes and are inserted manually.

I used Inset-30s with the built-in inserter for several years. I stopped using that set since I was having a lot of hyperglycemia from what I thought were failed infusion sites. Perhaps I was also trouble by kinked cannulas and didn’t detect it.