Occlusions


#41

Thanks Meee. I had one of those problems today when the needle worked its way about halfway out. I tried to push it back but it didn’t want to go and I couldn’t get it to go elsewhere, so I used the needle and small tubing from another pack and chose a place where there wouldn’t be so much motion. I was able to get a bit of iv3000 over top of it by cutting the ones I got in half and using it over top of the needle. So far so good. I have more iv3000 coming and will try longer length needles. These ones are 6 mm so my trainer is sending me some 8s. I will get this eventually!


#42

good on getting the proper IV3000, but I think u made a mistake on getting longer needles…a longer needle should never be necessary in order to retain a Sure-T, if it’s installed correctly, and covered with IV3000. I don’t care what body type.

The main reason for someone to use the long needle is if absorption isn’t great, when using the shorter one. Period.

I already lost confidence in your trainer, due to several things you have told us and for her to suggest u need 8mm needles to prevent sets falling out makes me lose more. :slight_smile: Does she work for Medtronic?


#43

FWIW, I use short straight in steel sets and find them super comfortable but I do get occlusions with my steel sets. I had more trouble with the teflon. I also get more occlusions in hot conditions and different insulins tend to occlude more than others. Not sure if it is the reaction in the sets or my body chemistry.


#44

Dave, she is sending me samples of 8 mm to try. She didn’t say I should use them but when I asked her if she had a sample I could try she said she would send me several. I have several of the 6 mm here. I am trying to determine what works best for me. Yes, she does work for Medtronic.

What size needle do you use? 6mm?


#45

ali8, how often do you get occlusions with the steel sets? What length sets do you use? This is totally alien to me - in 7 years with my Animas Ping I did not get a single occlusion that was not directly attributable to a bent cannula, so I do find this disturbing. The only thing that has changed is the pump and pump accessories.


#46

Well, I have had T1 for almost 50 years. Using a pump for many years. Medtronic and now Tandem. I hated the teflon sets. I love the short steel sets. But for me it is I suspect my bodies reaction to insulin that causes the few occlusions. And really it is not a big deal, you might jump up to 200 but quickly get it under control when you change sets. It does not happen that often I just wanted to say that it is not unique to teflon sets, but I found it much worse with the teflon.


#47

I use the shortest set. I am thin and do not use large amounts of insulin. Typically the total basal bolus amount is under 30 units a day. I am low carb.


#48

I currently use Fiasp insulin, have used Apidra, my favorite, and all the others:)


#49

That is much like me. I am thin and my total basal bolus is 19 to 20 Units a day. I am also low carb. Do you like Fiasp? I understand Apidra actually has a higher occlusion rate than Humalog and Novalog. I use Novalog right now. You have never had a problem with the shortest sets (6 mm) staying put?


#50

26 years here. Ah, I wish it were not such a big deal for me. The times it has happened to me since switching over I have gone from my average of around 120 up to nearly 250 in an hour and develop ketones. It continues to rise as it takes insulin a good 20 minutes to begin to work so I end up close to 300 before the insulin starts to work! I never developed ketones with my Ping except when I was sick :-(. That is what scares me - how quickly that happens. I am glad to hear that it does not happen often with the steel sets - I was able to catch the problem today and get it addressed within 2 hours although it took another 3 hours before blood glucose levels came down safely. I have always been very brittle.


#51

I found Apidra worked the fastest and ended the quickest so i was not dealing with overlaps of insulin when I was snacking:). But when I switched from Medtronic to Tandem Apidra worked great until our weather heated up and then it was a disaster not working after 24 to 36 hours. I had asked repeatedly about Apidra in Tandem pumps and was told no issue, and I did not have any issues until we got into warmer weather. I am going to try Apidra again in case it was just a freaky occurrence, but I switched to Fiasp as it has a preservative in it which keeps it a bit more stable. I think Novolg is great, I just like the quicker action time of Apidra and Fiasp. I found Novolog very smooth and did not clog my sets.


#52

It does take time to address, I use a CGMS so get alerted to issues. But i sometimes get up to that 300 before the correction helps. FWIW if you want a quick correction I would switch to Apidra or Fiasp.And you give yourself a shot in a good spot:). There are ways to more quickly deal with highs. Talk to your Endo team about all this. I have been dealing with this stuff for so long I tend to just accept that I will have highs and lows and I just relax and work with them But I am working with pretty tight ranges:)).


#53

Thanks for the advice. I will talk with my endocrinologist about having Apidra or Fiasp on hand for injections, and see if that will give me the edge to get on top of the highs quickly then let the pump catch up with the rest. I am extremely grateful for my CGM as well because I can see the trending highs and when there is nothing to explain it ( carbs, stress, etc.) I know I need to check something with the pump. That is how I found out that the steel set today had started to come out.


#54

I have been using the Sure t sets for over a year now (6mm). I think I decided to finally try them because they didn’t need an insertion device and were a lot less expensive than the Mio ones. I didn’t know about the “tapping it in” method and will try that. I have never had an occlusion with them. I found i only needed to tape one in place when I put it into my leg or arm. I ended up with extra overtapes from the Medtronic Enlite Sensors and find them perfect for securing the set. Now and then I hit a “bad” spot on insertion (it hurts after it’s in there, and my blood sugar goes up as well); I’ve learned to just move the needle to a new spot (within reach of the connector so that doesn’t get moved) and reinsert it and tape it to secure it.

Christine


#55

I’m on my fifth pump now. I’ve only had occlusions once until my current pump, which is a Tandem t:Flex, which holds 480 units of insulin. But those occlusions weren’t the problem. Mid-year 2018, I switched to FIASP from Novolog. After doing so, I was getting occlusion alarms all the time, but only in the last half of the cartridge. My conclusion, agreed upon by my endo, was that something about FIASP was dissolving part of the tubing or cannula which then plugged up the plumbing. I changed to only filling the cartridge with 330 units of FIASP at a time and changing the thing more often. Completely solved the problem! But of course, I’ve now negated the advantage of having the t:Flex pump. But Tandem has made that OBE now, since they discontinued it last June. So now I’m waiting impatiently until my warranty is up this October to get a t:Slim X2 with integrated DexCom.

I have had problems with kinked cannulas (I use the Animas Inset infusion set), but only about once every two years. I don’t like the metal infusion sets, only because of psychological reasons - even though I’m a diabetic, I am highly needle-phobic. Having a metal needle in my all the time gives me the willies. I’ll live with a kink now and then to avoid that.


#56

I use MMT-866 which is 32" 6mm


#57

I am getting beyond frustrated now. Tonight, once again, inexplicably and for no identifiable reason, my bg again began to rise long after the carbs and protein from my meal have been dealt with, and I bolus and it still goes up and I do an increased temp basal and it continues to rise and I end up with ketones! So, even though the site looks good, I pull it. I test the needle to see if there is an occlusion but insulin drips through cleanly. So, I place another Sure T(I am using the 8 mm this time), bolus and set up a temp basal and my blood glucose starts to respond quickly and goes down. I got 12 hours out of the first Sure T and 32 hours out of this one. At this rate I will be going through them every day to day and a half! They appear to be doing the exact same thing that was happening with the Mios. So, it doesn’t look like the issue is the infusion sites. That leaves two other possibilities:

a) there is something that it is going on with my body that is objecting with an infusion set in for more than 1 to 1 1/2 days! This has happened with 2 separate vials, different locations, different insets, different tubing lengths - the only thing that is consistent is that sometime around 20 to 36 hours more or less insulin stops working through that site. I have used sites I have used before and sites I have not ever used and it doesn’t seem to make a difference. It all started when I switched pumps but I don’t know why that should be a trigger. All the removed sites, btw, look fine - both the insets and my body - no inflammation, no swelling, no indication of anything amiss.
b) I have noticed that the tubing material used for the Animas pumps is different than the tubing material used for the Medtronic . The Animas tubing is stiffer to the touch, thinner and has a clear/bluish cast to it. The Medtronic tubing is softer, a little thicker and has a whiteness to it.

This problem started when I started using a Medtronic pump and supplies. I wonder if there is something about the tubing interaction with the insulin going through it that is setting up a reaction in my body.

Anyone else have any suggestions?


#58

I don’t think that happened to me often, maybe once when I pulled it on something etc. now I cover them but that causes more irritation and pain. I have terrible trouble sometimes with dex and pump sites. Had a super painful ps on my back 2 weeks ago. Not covered. I had to remove it. I use 90 degree 6mm, the longer one would be too long for me. The angled one can be better for absorption maybe.


#59

Sorry to hear this. Could it be the insulin? Maybe you are reacting to the steel cannula. Is it stainless steel? I use the tandem stainless steel ones now, was on contact detach before. Or maybe it is the pump? If I am high for too long etc or spike alot I usually do inj and a new site etc.


#60

I had opened a new vial of insulin when I started on the first Medtronic pump I had. I was using the Mio infusion sets. That pump was replaced after 8 days when I kept getting unexplained high bg levels with ketones every 2nd day. With the new pump I had several 1 1/2 day changes and then went a full 50 hours without a problem followed by another 3 hour problem site. I changed to the Sure Ts. The first one lasted 12 hours. The second one which I just changed lasted 32 hours. It seems to be the same dynamic whether I am using the Teflon cannula or the stainless steel needle. I opened a new vial of insulin on Monday. Each time I change out, my blood glucose starts to respond like it should and comes back down. Something is causing a problem from 20 to 36 hours that is common to both insets. The things in common are the pump - which has been changed; the tubing - which is different than what I used for 7 years without a problem, and my body which has only started having this problem when I started on the Medtronic pump. :frowning: