Has anyone ever used their insulin pump above 10,000’ or 3048meters from sea level? Any problems?
The tandem insulin pump has written limitations for altitude usage. I will be very close to and most of the time above this level on mountains soon. I wanted to know your experience and feedback. Thanks.
Took the cog railway to the top of Pike’s Peak (14k+) a week and a half ago with Tandem Tslim. Was above 10k for a few hours. No issues with the pump.
Also, around 8k in the Rockies for a few days. No issues.
I have. I have a T:slim X2 and live on the Western Slope of Colorado in a “low spot” of about 7,500 ft, but I have to go up to get anywhere. I have to cross the Dallas Divide just to get groceries and I’m up around 12-13,000 ft in Telluride pretty often to ski, hike, or bike. I think the highest I’ve had it is taking the Pike’s Peak train up to about 14,100 ft.
I get altitude alarms every once in a while. Maybe 2 or 3 times a year? All that means is that the air pressure inside the cartridge (the insulin is inside a plastic bag and not touching that air) is too different than the air pressure outside the cartridge and the pump doesn’t like it. This seems to have more to do with his quickly I change attitude, rather than the actual attitude itself. And that alarm has a real quick fix. I just pop the cartridge out for a second so it can breathe and the pressures equalize, then snap it back in. I’m back in business in just a few seconds.
Pumps just aren’t tested for altitudes greater than 10,000 ft, but in my opinion it’s perfectly fine. The 10,000 ft is just because commercial flights are usually pressurized to 7-8,000 ft, and that gives a little extra wiggle room. Fluids don’t expand with reduced pressure like gases do, and there are other mitigating safety features to make sure expanding gases can’t push extra insulin out. Though, I might sing a different tune here if I was REALLY sensitive to insulin and using Medtronic, the upcoming Mobi, or any other pump with that syringe-style piston, because the reservoir isn’t separated from the tubing so they’re susceptible to leaking but testing shows the amount is infinitesimal. There shouldn’t be any air in there to expand, anyway. I intend to use Mobi when it’s available and I have zero fears because I know the laws of physics are on my side. Omnipod and T:slim physically can’t “leak” because of their unique pump mechanisms. I don’t know anything about iLet’s pump mechanism.
Thanks a lot for the detailed information. I will be visiting from 02/01 to 02/08 Telluride Mountain village for skiing 
So every time I am at 14,000’ and skiing downhill, will I be hearing alarms? I hope it wont distract me. Then I need to remove the cartridge without selecting any menu options on the pump and slide it back in? I was considering the Mobi also as soon as it is available. I hope Mobi won’t have any leaking risk as you described it.
Thanks
Did you receive any alerts or alarms when you were above 10,000’?
No. I received no alerts of any kind and had no problems or stoppages above 14k.
I really wouldn’t worry. The alerts Robyn describes are a possibility it’s worth knowing how to handle not a certainty.
thanks. I hope I don’t receive any alerts also 
I’m grateful for the information that you and Robyn provided. It’s very valuable for me.since having my pump never been at such high altitude 
I went to Cedar Breaks National Monument (elevation 10k ft) with my Tandem tslim and had issues. Altitude alarm almost immediately upon arriving. Did what others suggested above and removed cartridge for a minute and put it back in. A few minutes later started having random occlusion alarms despite not having changed my cartridge or infusion site within the past day. Tried removing and replacing the cartridge again to no avail. Ended up switching out the entire cartridge and infusion set and it was okay from there, but the whole thing was odd and annoying. I have since switched to Omnipod and wasn’t given any specific instructions or warnings about high altitude on that system, but I haven’t had a chance to try it at high elevations yet.
Hmm interesting. Maybe if cartridge and infusion is changed above 10k feet it won’t give any alerts since it’s lower pressure there? 
I’ll keep that in mind also. Thanks
I look out my windows at Pikes Peak, some 12 miles due south of my home. My elevation is 8,400’ and I go to higher elevations frequently. I do take care in filling my cartridge to get as much air out as I can possibly do.
When filling a cartridge, I suck as much air out prior to filling it with insulin. After the initial removing of air, I do several partial fills and suck the insulin out and see quite a bit of micro bubbles come out with the insulin. I cycle the partial filling and sucking it back out until I don’t see much in the way of micro bubbles any more. Then I fill the syringe with the full fill amount, again taking care to not allow any bubbles to enter the cartridge. When filling the infusion kit, I rap the pump on a block of rubber and watch to see if any air bubbles show up in the tubbing. I rarely see any bubbles appear in the tubbing.
YMMV
John
Are you thinking that micro bubbles are associated with higher elevations or would you follow this procedure anywhere?
My thinking is that any air inside the cartridge could make it sensitive to elevation change. As I’m often dropping to 6,000’ in Colorado Springs and up to 9,200’ in Divide, there is plenty of pressure change, usually makes my ears pop.
I used to only evacuate my cartridge once before putting any insulin in. Later on, when putting the full amount into the cartridge and then filling the infusion tubing, I noticed some good sized bubbles showing up. I started hitting the cartridge on my table pad and working more bubbles out. I then experimented with flushing the remaining air out of the cartridges by putting in about 1ml and pulling it back out, several times. This process seems to leave between .1 and .2ml inside the cartridge even when pulling a full vacuum on it. Now when filling the infusion tubbing, I never see any bubbles in the tubbing where I was used to seeing quite a few.
This process seems to eliminate any bubbles that I used to see in the tubbing during the life of a cartridge. So, I believe this ends any variation in my insulin dosage due to elevation change.
Again, YMMV
John
Sorry, I should have added that I am now using this procedure any time I fill a cartridge, sea level to the stars. -j
It may be similar like even the smallest air volume at sea level where I’m now, becomes much larger volume at high altitude. I think it was the “Henry’s law” same as in decompression sickness when you scuba dive and resurface. The majority of air consists of nitrogen and how it dissolves and expands in our blood . I guess vacuumed prefilled insulin cartridges could’ve solved this kind of issues 
I’m at approx 9500 feet at Mountain village telluride in my room. And during the last three days have been all day skiing up to 11,000 feet, never had any tandem x2 alert or issue. However my body changed a lot, my calorie burn is between 3500-3800 daily since cold weather and all time activities. So my BG is not that stable lately. But still good enough. Dropped from 99%TIR to 97% 
