Occlusions


#61

Did you have some bleeding at the site when you took out the set after 12 hours? I’ve found that sometimes I have a bad site and don’t feel any pain and it looks fine, but when I decide to try changing it, there is some bleeding at the insertion site, and if I choose a new site not too far from where it was so I don’t have to peel off the connector piece as well, reinsert the sure t and tape it well, my bg improves. I also discovered that I have the most success when I change sets every two days. So much seems to depend on body type, how many years you’ve been using the areas even when you rotate sites regularly.
But, talk to Medtronic tech support. I have always found them helpful and they have replaced sets for me when I had problems. They ask a ton of questions and will want product lot numbers and as many details as you can give them, so block out some time to make the call.

Wish you good luck. I’ve been diabetic since age ten, over the 50 year mark, on pumps since 1992. Still walkin’ the tightrope…

Christine


#62

Kathryn,
Did you have some bleeding at the site when you took out the set after 12 hours? I’ve found that sometimes I have a bad site and don’t feel any pain and it looks fine, but when I decide to try changing it, there is some bleeding at the insertion site, and if I choose a new site not too far from where it was so I don’t have to peel off the connector piece as well, reinsert the sure t and tape it well, my bg improves. I also discovered that I have the most success when I change sets every two days. So much seems to depend on body type, how many years you’ve been using the areas even when you rotate sites regularly.
But, talk to Medtronic tech support. I have always found them helpful and they have replaced sets for me when I had problems. They ask a ton of questions and will want product lot numbers and as many details as you can give them, so block out some time to make the call.
Wish you good luck. I’ve been diabetic since age ten, over the 50 year mark, on pumps since 1992. Still walkin’ the tightrope…

Christine


#63

Multiple pumps and different sets and you are still having ketones. Doesn’t sound like hardware issues now, but that’s just my opinion


#64

Kathryn - I think somewhere above I read you’re on a low carb diet? Perhaps the ketones you’re mentioning are a result more of your diet than of BG rising to 200-300?

Depending on whether you’re checking ketones with urine strips or a serum (blood) Ketone meter, what level of ketones are you testing? 0-3.0 mmol/L. Over 10.0mmol/L?


#65

@Kathryn41, I’m curious what your typical total daily dose of insulin is. What’s the approximate division between basal and bolus? My hypothesis is that your site failure is a function of total accumulated insulin delivered to a specific infusion site. You could test this by temporarily substituting pump boluses with syringe-delivered injections and see what effect, if any, it has on site longevity.

Associated with my guess are some references in the medical literature that infusion sites can become resistant to insulin over time when the immune system attempts to seal off the infusion site as it sees the cannula as an invader to be fought.

Have you experimented with using a site that you’ve never used before?


#66

Hi there. I have hadD for 50 years; LOVE my 670G pump. I am 50 and I understand how frustrating this is. Keep working at it. Talk to Medtronic and get something done. THIS IS NOT OK!


#67

Medtronic can’t make a silk purse out of a sow’s ear. I spent untold hours with Medtronic reps at my home, and on the phone over the course of about a year, dealing with Enlites. (and prior to that, a month of failures with Sof Sensors) Not everything that Medtronic has made lately (the last decade or so) has panned out all that well. the 670, in particular is a very polarizing product. Don’t count on Medtronic to magically fix her issues, is what I’m saying. Besides which, the model of pump is unlikely to be the source of Kathryn’s issue with absorption.


#68

Given that this all started when you switched to the Medtronic pump, it’s hard to argue it’s anything other than a hardware issue (pump + infusion set) as opposed to something changing with the insulin or your body. You used multiple infusion sets, infusion set designs and infusion sites. You changed the insulin bottle.

Do you still have your Animas pump? If you could switch back for a few days you could confirm this is and then ask Medtronics for the next tier higher in their support organization. Maybe it’s differences in pump design compared to Animas?

When I changed from Animas to T:Slim X2 I had to adjust my basals and bolues. I think it’s because of the T:Slim’s slower delivery speed.


#69

You seem to criticize everyone. Do you not have ANYTHING better to do? I have asked tou NOT to EVER respond to me again. Why fo you keep doing it?


#70

Thanks Christine,
No bleeding. The site - all of the sites - look absolutely fine. No swelling, no redness, no pain, nada. I tried to move it over to reinsert it and on that attempt there was bleeding so I just used a new inset instead. I developed a rotation schedule when I first started pumping so that I basically do not even use the same body area for 6 weeks. I had to modify it slightly when I started using the CGM 2 years ago but still there should be no scarring or build up under the skin. I have no lumps, no areas that give any indications that they are not sound. With the Medtronic, I have 32" tubing also available to am now using some absolutely new sites that I can reach lower down on the thighs and upper arms. Even those sites go off.

I have an appointment with my endocrinologist on Tuesday and I am going to ask him also to do some additional blood work to check and see if there are adrenal gland issues at work. I have never had blood pressure concerns but since starting this pump my blood pressure has also become elevated and my cardiologist today has ordered a thallium stress test for next Tuesday and started me on Valsartan as he is concerned about the blood pressure and the intermittent higher glucose levels. It may be related to an immune system reaction to the new pump and a component/accessory, or it may just be a coincidence and there is another health issue arising at the same time. I am in my early 60s so other health concerns are a consideration too.


#71

Jim, occasionally I would get the very low ketones when I had a meal that was predominantly protein and fat and yes, I recognize those. These have been above 15 going into 40 on the rest strips and I am definitely feeling the body sensations associated with high ketones. I am seeing my endocrinologist on Tuesday and will also be asking about him prescribing a ketone meter and strips as the strips are pricey.


#72

Thanks Terry4. My typical total daily dose of insulin is between 18 to 20 Units with between 65 to 75 % as basal and the 35 to 25% as bolus depending on the carbs I eat that day. I bolus for protein if I don’t have a comparable amount of carbs for a meal and I find the fat tends to delay the digestion so use a extended dual to cover protein and fat digestion.

On one of the occasions when the site when off early and before I changed out the site I was blousing with a syringe every 3 hours - when the CGM started to show a rise again - and just could not get it down until I changed out the site. Then it came down.

Yes, the immune system could be attempting to seal off the infusion site and that means something in the site or in the insulin being infused is triggering a reaction that did not happen when I was on the Animas. That was why I was wondering if there is a component in the tubing that is affecting the insulin and that my body is reacting to that. The tubing is definitely made of a different material than the tubing used in my Animas pump.

Yes, I have used 3 different sites that have never been used before and if anything, the site went off earlier than for sites I have used before :-(.


#73

Hi paytone,

I had to return my Animas pump in the exchange for the Medtronic pump. I do have an older, out of warranty Ping that I had planned to use as a back up and I think after I see the endocrinologist next Tuesday if nothing else changes, I will propose switching back to the Ping and see what happens. I also sent back the majority of my supplies in the exchange programme but should have enough left to do about a month on the Ping. It is certainly a reasonable next step.

I have changed the delivery speed on this one as well - I had it on standard when the first two problems happened and switched to quick which appear more aligned to how the Ping infused insulin but it didn’t seem to make a difference. I have switched back to the Regular rate since I have now started with the Sure T needle set and will see if that makes a difference too.

I have had to increase my basal amounts, yes and I am using a lot of temp basal amounts. When I first use a new inset then I tend to go low and use a temp reduced basal rate for an hour and keep re-doing as long as it is needed. Then as the site goes on up until it fails I am using an increased temp basal rate. That indicates to me that there is a building resistance at the site and again, is it because of my body’s immune system randomly deciding it doesn’t like infused insulin anymore - or is it reacting to a component of the Medtronic system or with the system delivery?

Big Sigh! :frowning:


#74

Are u in manual mode or auto mode? If u are in auto, that might explain the issues.


#75

Manual. I am using my Dexcom CGM instead and did not plan to go into Automode.


#76

:grinning:. I have no idea then. Good luck, I hope you get it figured out!


#77

I agree with @Paytone. I would switch now. I could care less what the Endo thinks or says.

Switch over to the Animas for two weeks. See what happens.

Whether the problem persists or goes away - either outcome gives you valuable information.


#78

Thanks @Tim35. You took the words right out of my mouth!


#79

I use medical paper tape to to cover it, and also to cover the attached loop of tubing.


#80

So . . an update. I had less Ping supplies than I realized so while waiting for some cartridges to arrive I went ahead and tried the 8 mm Sure-T I had received from my trainer on a Regular rather than Quick delivery rate. That was 72 hours ago. I changed it out tonight at 69 hours of trouble free use! I also changed my reservoir separately 30 hours ago just changing the long tubing and continuing the short tubing and needle set, and that transition also went smoothly. My blood glucose rates have been stable and in range, with short expected post-prandial highs that responded to bolused insulin and small corrections as I work out the correct dual bolus timing. I changed out earlier tonight with another 8 mm Sure-T and it has continued uninterrupted with good bg readings! So, keeping my fingers crossed that this is the solution that will work. I will be contacting Medtronic tomorrow to switch out my Mios for Sure-Ts. If I make it through the night without a problem, I will feel even more confident that this is the approach I need.