Occlusions


#1

I started the 670G March 12 after 7 years of pumping on my Animas Ping. I ended up replacing my first pump 8 days later as I had 3 episodes where it appeared the pump failed to deliver basal insulin overnight. The first instance was 12 hours after a site change; the second was 24 hours after a site change and the third was the day after a site change. I also had one episode where it looked like the pump had stopped delivering basal but I bolused and was able to bring down the highs just as ketones started to appear. That was about 6 hours after a site change.

I am just one week into my second pump and today after a site change very clearly I wasn’t receiving basal insulin as 90minutes later my blood glucose went high and I had ketones. I changed out the site and it appeared fine - no kinks, no problems that were obvious - yet it seems there was some sort of full or partial occlusion. Because I do not take large amounts of insulin - 18 to 20 units per day of both basal and bolus insulin - it is unlikely there was enough pressure build up to cause the pump to alarm an occlusion (I have heard it is about 7 units). I am now wondering if the 4 other episodes I have had since March 12 were also partial or full occlusions. In 7 years of my Animas I never had a single occlusion or appearance of what could be an occlusion without a kinked or bent cannula so am concerned that this might be a serious problem with this pump. I am running in manual mode only and using my Dexcom for monitoring level directions. I never had ketones with my other pump except when I was sick and now in 3 weeks I have had 6 episodes of serious ketones. This is very concerning. I use the Mio injectors and use the same sites I have rotated through for years so that the same site does not get used more than once every 6 weeks (arms, legs, hips, buttocks). The site that just occluded was a brand new one I have never even used before. So, any suggestions about how to avoid occlusions, if they are common with the 670 G or the Mio set? Thanks! (It is enough to consider going back on MDI - 5 times near to hospitalization in 3 weeks is 5 times too many)!


#2

avoid occulsions by avoiding the use of cannula sets. Metal sets will rarely occlude. I get about 1 every 2 years with metal sets. I used to get several a month and sometimes 2 in one week, using cannula sets. And there you have it.


#3

Thanks, the cannulas are not bent, though - they are perfectly straight. Were all of your occlusions from bent cannulas or were some with straight cannulas that appeared undamaged?


#4

Its neither here nor there, if they are bent or not. The fact remains that cannula sets are prone to occlusion–more so for some folks than others. Rather than debate the fine points, I suggest you call tech support for FREE SAMPLES and see for yourself! And ignore people who say they hurt. LOL! I can’t feel Sure-T’s AT ALL, neither can my wife and both of us used to use and be bothered by the feel of cannula sets that we both used for too long–about a decade.


#5

Thanks Dave, I intend to do that. I was just trying to get some clarification that it is indeed occlusions even if I cannot see the ‘how’ and ‘why’ of it (ie. bent cannula). It just reaffirms your statement if you too experienced occlusions when the cannula was straight. Thanks for the advice, though, I appreciate it and will be following up with the Sure-T sets. Any advice about using those, other than to ‘use them’ :-D?


#6

Sure-T’s are super-simple to install. There is no priming other than to prime the line and set. ie, you won’t be removing an introducer needle, so once you prime the line and set, you make sure to finish the prime function on the pump BEFORE installation. Remove the needle guard first, then the two paper pieces covering the adhesive. Place the set where u want it and just TAP it into place with a finger. Next, remove the adhesive covering from the set connector and place it so that it will act as a “strain relief”. ie, if the pump falls towards the floor, the set will remain in place!


#7

Thanks! That reference guide is useful. You say just ‘tap’. Can you also push it in much like a thumbtack? You don’t put the adhesive section down before the needle goes in, but it will place itself as the needle is inserted to secure the needle location? (Just double checking).


#8

I wouldn’t push it in slowly! You want it to go in smartly–a tap provides the speed needed to make it go in effortlessly. I hold it by the tubing (u don’t want to touch the adhesive or it loses its effectiveness). The needle goes in and then the adhesive will immediately go against the skin. It can be done blindfolded–like if you need to place it where you can’t see it. HINT: don’t follow the medtronic instruction of pinching the skin when using this particular set. The mfgr doesn’t ALWAYS know what’s best. :slight_smile:


#9

Thanks - those are exactly the types of useful hints I was hoping you might have for me:-)!


#10

And then there was the time I forgot to remove the needle guard :kissing_closed_eyes:

I did wonder why the site hurt so much, but ignored it until the site went bad 36 hrs later.

There’s a mistake I’ll never make a 2nd time :stuck_out_tongue_closed_eyes:


#11

Steel insets are better. But I still had two near dka in the last few months due to various things. Pump inset, absorption, dehydration, heat, insulin degrading etc.


#12

meee, is that while using the steel insets? Was it an occlusion or the combination of the factors that you mentioned?

I have got two Sure T inserts from my trainer and will start with one tomorrow when I change out this site. Keeping my fingers crossed that all goes well.


#13

I’ve tried the steel sets and found my sites would almost always become tender to the touch after 36-48 hours. I remember reading that the steel sets are recommended to be changed every 48 hours though I certainly believe that some people can comfortably get 72 hours from their steel sets.

I’d like to make a point about occlusions. Often times, when people observe an unexplained rising blood sugar, they conclude that the infusion set has become occluded or blocked. A kinked cannula is often found upon removal and replacement.

Other times, an unexplained rising blood sugar, can mean the infusion site suffers from degraded insulin absorption. The site may be scarred from over-use or the person may even become systemically insulin resistant. These conditions can often be interpreted as an occlusion, when in fact they are not.

I’ve been using an angled plastic cannula for about 2.5 years now and I only see unexplained blood glucose rises 3-4 times/year. When that happens, I closely examine the cannula when I remove. In almost every case, I see a slightly bent cannula tip. I attribute this to the cannula tip rubbing up against muscle tissue and then bending.

The steel infusion sets do eliminate this from happening but pain at or before 48 hours makes me wonder if the steel sets, in my case, are damaging the tissue and make healing longer and possibly causing scar tissue.


#14

I can’t fathom why steel sets bother you, Terry. They are so much thinner than cannulas. I have the opposite problem to you–cannula sets irritate the devil out of me with soreness, redness,swelling, and of course what I’ve mentioned often which is frequent occlusions. Funny how not every person has the same experience with some products. A long time ago I found the actual outer diameters of each type of set and I think I’m correct in saying that the steel sets are roughly HALF the diameter of a cannula. (I had posted those diameters in online discussions but it was so long ago there is no way for me to unearth them) So unless someone is allergic to the stainless needle, I wouldn’t think it would bother them as much as a cannula.


#15

I don’t find this unusual. That’s why it’s never safe to generalize one’s personal truth to a collection of people. There is almost always a spectrum of experience due to the fact that we all have variations in our physiology and metabolism. This is why the “your diabetes may vary (YDMV)” mantra is embraced by most people who interact online.

To be fair, we often share the experience of others with diabetes and that’s what makes sharing our stories important to us. But we cannot expect our personal truth to confidently extend to a wider group of people.


#16

I agree with you totally.


#17

Sometimes people hide behind the YDMV claim when they simply do not want to adopt a suggested tactic for some other reason they don’t want to examine. This is the dark side of YDMV.


#18

Hadn’t seen YDMV before–just YMMV. :slight_smile: Ever find out what “REL” is?


#19

We will see what happens - I am meeting with my trainer to get the Sure T sets and to insert one in about an hour:-). I have never had any problem with the thin metal wire in my CGM sensor and have not had any problems with the cannulas at the site - my sites when I remove them are invariably smooth and uninflamed. Interestingly, the site that set me off on this particular tangent was in a new spot on my arm I had never used before - closer to the elbow - because my 23" tubing wouldn’t reach that far and the 32" does without a problem so that was why I was trying it. In my particular case, occlusion makes much more sense than absorption issues or insulin degradation. In all cases there was not even the slightest bend, kink, or deviation of any sort apparent in the cannula. I am even wondering if it is a manufacturing defect in the Mios I have been using - they have all been from the same box - and something in between where the insulin enters the inset from the tubing fork and when it flows through into the body through the cannula gets blocked. The cannulas all had drops of insulin so they were not ‘dry’ and completely blocked, but partial occlusions would make sense if there was some incomplete passageway in these Mios.


#20

Remember, don’t pinch. Do it the way I mentioned earlier!