Pumping... what the *bleep* is happening?

I’ve been on my Accuchek Spirit pump for slightly over a month now. My first three weeks were wonderful totally awesome sugars no swings or highs or anything…the last 2 weeks have been absolute hell.
It started last week just a normal day and I noticed I was running slightly high…150’s when I’m usually 100-120ish, like every good pumper, I checked my cartridge for air bubbles, I checked my insulin expiration date, I checked my tubing for air bubbles…nothing…but…my infusion set was loose…and slid right off (I use the accuchek ultraflex), no big deal; I changed it to another sight, everything was ok sorta, I was still running a little high. The next day I’m running really high close to the 200’s I go through my check up routine, cartridge, tubing, my infusion set was itchy… I took a closer look it was kinda damp, smelled like insulin and again slid right off and boy was it irritated.
Changed the set out again and called Disetronic, they asked about where I had my sets and how I was rotating them (the W system on my upper stomach since the lower has scar tissue from injections) and what cannula length I was using (8mm). They thought that I should try using my buttocks in the mean time and that I probably needed the longer cannula length (10mm), that my body was probably pushing out the insulin and sent me some of the new sets to see if that solves the problem. I got the new sets yesterday (after having to give myself shots all morning cause the sugar was just not coming down with the pump) and used one on the opposite side of the buttocks like they suggested… post meal dinner was ok, and then by morning after breakfast my sugars were in the 200’s again. It’s like I haven’t been bolusing at all. They say after two high readings swap out the site and set again… when I went to remove the old set that one too slid right off, like there was no adhesive at all. I put the new set on my stomach before I do another correction bolus, but I just don’t understand what is going on.
As I said before the first 3 weeks everything was perfect, no all the sudden nothing works. I use IV prep and make sure the skin is dry before using the link assist to insert my set, I am really careful with carb counting and portion sizing and use reference software on my pda to double check, all my correction factors, insulin sensitivity, basal rates, carb ratios have been tested over and over again and have always worked before: they even work with injections that I’ve had to do since the issues with the infusion sets.
Has anyone had anything bizarre like this happen when starting the pump or issues with infusion sites like this? Any help or advice?

Hello, Meg! I also use the Accu-chek Spirit, and I love it. Whenever weird things like this happen to me, I start over again with everything new - new bottle of insulin, new cartridge, new box of infusion sets and a site where I haven’t been in a long time. I have had Disetronic pumps for 19 years, and I started with Minimed infusion sets, and I still use them - the quick release with the 9mm cannula. I also use the IV3000 to tape them downso I can’t accidentally pull it out if I get caught on a door handle or something.

My first few weeks with the Spirit I loved it too, but now I want to throw it against the wall I’m so frustrated.
I’ve been thinking about when I change everything, and went over it with Disetronic, incidentally when I change sets (they’re all different boxes cause I’m still working on samples) it usually corresponds with new cartridge tubing etc, only thing that hasn’t changed is the vial of insulin until I switched sets, sites, tubing and cartridge today, the insulin there is from a new vial, I guess we’ll see how the rest of today goes.
Another question does Disetronic supply minimed sets? I only ask because that is the only provider my insurance is approving at the time. Also are they manual insertion or do they come with a device? Are they Teflon cannulas or steel needles?

Thanks again!

I get all my supplies from Sterling medical - they are also online here Sterling was able to work with me even when I had a really crappy insurance, so I’ve stayed with them.
I use the MM315s, which are teflon 9mm cannulas, and just started using the serter. All their sets and seters can be viewed on videos on Minimeds website here
I’m sorry to hear about all your troubles! I doubt the problem is bad insulin. That would not cause it to fall off. What kind of tapes have you tried?

I haven’t tried using any tape because it seems that the sets are coming up because the insulin is being pushed back up, at least that is what the CDE said, also I am allergic to most band aids/ first aid tapes.

Are you pmsing?? Week before my period my bgs go through the roof and I have to change all my setting, basals and boluses.

Medtronics has a product called IV Prep that leaves the infusion site sterile and sticky for better adhesion. Its just like an alcohol swab.

Thanks for the ideas guys, I am currently using IV prep, and no unfortunately I’m not pmsing…I think I’ve been through all the easy solutions lol

They call it “tunneling” when your body reacts around the cannula to create extra space between the outside wall of the cannula and your skin. Perhaps this is what’s happening? I pulled out my copy of Pumping Insulin and it suggests using slanted sets as they are less likely to have this happen. Accucheck has a couple of these called “Tender” or “Tender Mini” if you’re worried about purchasing from other companies. Also, I don’t think that Accucheck has a proprietary connection like Minimed - you can use (even if you can’t get insurance coverage for) pretty much any infusion set, I’m guessing.
I would also see if a stronger adhesive might help. If you aren’t reacting to the IV Preps, you might try SkinPrep. It’s the same company and same ingredients in the package as IVPreps, but it has 70% adhesive instead of 5%. Much stickier :slight_smile:

oh, I just remembered Meg, there was a discussion not too long ago titled “Sticking advice”. The link should be here - but if not or you can’t find it, tell me (I’m new to imbedding the links). Hope today is a good day for you!

The “tunneling” thing seems to describe what is happening with the shorter 8mm cannula’s. My question about this is does it only happen with the flexible ones or if I tried the Rapid D’s (steel needle) would it not occur? Also is it more prone to happen at certain sites than others? I’m slightly nervous about the Tender’s first they’re scary (I’m a big wuss when it comes to needles that’s why I went with the Ultraflex and linkassist to start) I was told by my CDE that they were really only for people that were very thin or children, and I certainly are not either.
Yesterday I switched a new 10mm set back to my abdomen, as on my buttocks I didn’t seem to get much absorption at all, and it was much better I came back down to target numbers except for my morning sugars (which is another story all together), it also hasn’t come loose or pushed insulin back up.
So my new question is it seems that the only sites that seem to work are my stomach, at least with the pump, I want to try my thigh but I seem to remember that with injections I didn’t have good absorption there either, how has using the thigh worked for you guys?

BTW, I just ordered my copy of Pumping Insulin…why oh why they just don’t include a copy with your pump I’ll never know…

I am not thing by any means, but I do not have enough fat on my thighs for the 90 degree infusion sets. I use the silhouttes on my thighs and I get great absorption there. In fact I have gotten to the point where that is the only place I like to use. I am on a MM 722 with CGMS.
And Pumping Insulin is a great book and I agree it should come with the pump when you order it.

Tunneling is supposed to happen more frequently with Teflon (flexible) cannulas rather than the steel needles - that being said, those look pretty icky to me (enough needles as it is, thankyouverymuch!). The slanted infusion sets can be used by anyone - the primary difference is that you can use them in places where you don’t have as much cushion. I tend to use the slanted sets more on my hips and thighs where I have heavier muscle, and the straight-in sets on my tummy where there’s more padding. I use the 9mm sets - the 6mm ones seemed like they might cause the tunneling issue or at least wouldn’t go deep enough to get the insulin to the subcutaneous tissue where it’s supposed to be.
I’ll admit, I was nervous about using the slanted sets as they are a bit scary at first. The trick is to be willing to test the site you’re going to use by poking at it with a needle a little bit first, just like you would if you were doing a regular injection. If you’re worried about the insertion, there are a couple kinds that come with an inserter. The Silhouettes (Medtronic) and the Inset 30s (Unomedical - can buy through Animas) both have inserters that are pretty good.
I stuck with tummy sites for the first 18 months or so with only occasional attempts at sites other places. Absorption-wise, tummy sites are just okay; thigh sites seem to work as well or better.
And yes, they should include Pumping Insulin with your pump (though it will make the darn thing a good $20 more expensive and won’t be covered by insurance).