T-Slim or T-Flex and Occlusion Alert

So, immediately after posting my update and success I started having more occlusion alerts (figures, right?)
This corresponded to moving my infusion site slightly forward to a part of my upper hips that had been used slightly more often in the past. I feel like, at least for me, the likelihood is starting to fall towards my older infusion sites being slightly compromised perhaps with slight lypohypertrophy (although I feel no bumps).
Doing a google scholar search for papers on this it looks like thereā€™s not a whole lot of research but I did find some pearls here and there
https://scholar.google.com/scholar?as_ylo=2016&q=rate+of+Lipohypertrophy+with+insulin+infusion+set&hl=en&as_sdt=0,5

I liked this paper in particular:
http://online.liebertpub.com/doi/full/10.1089/dia.2016.07281.sf

This may be an example of trying to convince myself that this bad news is actually good news, however It occurs to me that I may have been previously having silent occlusions on my medtronic pump (i.e occlusions that the pump didnā€™t recognize as such or alert me to) Obviously Iā€™m making a lot of wild guesses here. Hopefully someone smarter than me will make some smarter guesses :wink:

Older thread, but relevant.
I had some alerts early into getting the X2.
After a few months, I finally figured out when I was getting them.
If I put the pump into my pocket, which I do when I get home/off work. I have a higher chance of having an alertā€¦

Now, I use the spibelt ALL the time. I VERY RARELY get an alert if itā€™s in the spibelt. Maybe a couple since I had it. And I think those were probably real alerts do to my infusion sets having issues.
Every once in a while I will still get an alert if I have the pump in my pocket. But I think that is the only real time.

I am a little different how I fill cartridges. I pull the air out with an empty syringe first. Then I fill my syringe, and pull out more air AGAIN. This second time gets very little actual air, BUT, with a vacuum on the insulin in the syringe, I can tap it against my desk/table a couple times, and it takes out a lot of the entrained air that is suspended in the insulin.
I do all of this pretty quickly. I donā€™t take super long, and after doing this a few times, I find it works good enough that I donā€™t really NEED to be all that meticulous to get good results.
To the point that I donā€™t think any of the alerts are really based on air in my cartridge/infusion set.

I used the Tslim and then Tslim X2 for about a year and a half with no occlusion alerts. Then suddenly I started getting them every 2 or 3 hours. I replaced the nearly full cartridge and everything went back to normal. I suspect the piston was maybe sticking in the cartridge.

I too have had soooo many occlusions from the tslim. Iā€™ve had various pumps over the last 20 years, but this one is by far the worst for me yet. Iā€™ve changed infusion sets 3 times looking for the best one. I thought tru steel was the answer because there could be no kinking in the canula but occlusions have continued and maybe even more frequently. Insulin comes out of the tubing fine, but somewhere between the anchor and needle it gets clogged and sometimes just hours after inserting a new site. One weekend while out of town I had to change sites 5 times in a 6 hour period and when completely out of options, got up and drove home at 3 am. Iā€™m a bit frustrated! I leave for out of the country travel in less than 2 weeks and I want a solution. Iā€™ll be following your thread.

Iā€™m really surprised by the problems you are having with a Tru Steel. I say that because it has been my supposition that the Unomedical Tru Steel is totally identical to their Sure-T with the exception of course, being the connector to the pumpā€“the former being an offshoot of a Luer Lock (T-Lock), and the latter being a proprietary Medtronic connector (which I love, BTWā€“the connector, I mean).

For years I used cannula sets and eventually I had a rash of occulusionsā€“so many that I nearly quit pumping. As soon as I switched to Sure-Tā€™s the problem went away with just about 1 occlusion occurring every 1 to 2 years apart. Thatā€™s several orders of magnitude better than with the Quicksets I used to use. Iā€™d get as many as 2 per week.

Does anyone here have any knowledge of any differences, however minute, that exist between the Tru Steel and the Sure-T, from the disconnect point to the tip of the needle?

Dave,

Today they decided itā€™s because Iā€™m not changing my cartridge every other day because I use less than 30 units a day and it holds 300 unit. I change my infusion set every other day though. I canā€™t imagine that would be the case because Iā€™ve done that for 20 years with various pumps. I hope theyā€™re correct tho. This am the tech said sometimes the needle gets skin in it!!! What? Ya itā€™s a needle that goes into your skin!!! If my skin is clogging needles I have all kinds of problems. Lol. Anyway, I do like seeing a real steel needle vs Canula for sure. Thank you for your response. Iā€™ll keep following.

Jacqueline Bills

I had this problem when I started using the T-Slim, occlusion alarms every day. It was nothing to do with infusion sets or kinked tubing or the site. I would just restart insulin & it carried on happily delivering insulin. It turned out to be something to do with the internal pump temperature. I wasnā€™t using the pump case supplied with the pump, I found it too difficult to put on. But Tandem support persuaded me to try it. Viola, since then Iā€™ve had no more occlusion alarms,

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Jacqueline, you should be able to go at least 3 days on a steel needle set. My wife goes more than 4 or 5, but she and I both use a Medtronic pump. If you were on a Medtronic pump and was using the steel needle (Sure-T), and had issues within 2 days, then Iā€™d conclude that you have some serious scar tissue going on, as that isnā€™t in the least bit ā€œnormalā€. Iā€™ve no idea what the occlusion pressure alarm is rated at, compared to a Medtronic. For all I know, it might be more sensitive to back pressure. Iā€™ve never heard anyone quote the ratings or actual-tested back-pressure alarm values.

FYI: her total daily amount is less than yours.

Are u saying it canā€™t deliver when it gets too warm? That would be a heck of a problem for me and if it happened much, Iā€™d be giving up on that brand.

As soon as I put the pump in the case provided by Tandem the problem stopped. It is not the external pump temperature, but internal temperature. I think this is not a common problem, as I know several people using Tandem pumps who have never had the problem. I wear my pump in a Spibelt close to the skin. The interruption was short, as soon as it alarmed I restarted insulin & it carried on pumping. As it was usually during a bolus I just had to add the insulin that hadnā€™t been given, the pump tells you how much was given, It didn,t happen for every bolus, maybe once every other day.

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Using the Spibelt was what caused the problem, or NOW you use a Spibelt?

No, I used a Spibelt with my Animas pump for years, when I started using the Tandem I carried on using it, when I put the pump in the Tandem case I carried on using the Spibelt. I still think my occlusion problems had nothing to do with how hot the exterior of the pump got. Others live in much hotter climates & donā€™t have this problem.

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I know this was forever ago, but your story (and a few others on here) is identical to mine. I wish I would have found this last year. My story is exactly like yours with knowing what Iā€™m doing, properly rotating sites, trying new infusion sets (on the 8 mm tru steel currently), relatively thin but definitely enough real estate, no scar tissue issues, good insulin, good pump (was replaced), etc. etc. and no one to figure out whatā€™s going on. I had daily/multiple times daily occlusions, or every other day from last March through October-ish. I took multiple pump breaks and went on injections. Finally, some time in October 2018, they stopped randomly with no further changes. I had been through the ringer. 3 different endos, no lie hundreds of hours on the phone with endos, CDEs, tandem supervisors, etc. and no help. Iā€™ve called in and done the ā€œsite testingā€ so many times, I could train new employees. We never figured it out. I was starting to get depressed. Then it ended. Now (August 2019), it seems to be happening again. Iā€™ve had 4 occlusions (and 5 sites) in the last 24 hours. Iā€™m so scared. That was the most miserable Iā€™ve been in my life last year. The constant unpredictable numbers because of occlusions/bad sites. The never going through the day without that awful alarm. And Iā€™m in dental school. I am starting up my 2nd year next week and am terrified of this happening again. My a1c is generally right at 6.0. I care, Iā€™m on top of it, I know the rules, and Iā€™ve been at it for a long time. Whatā€™s worse, my a1c never went above 6.3 last year, so every Endo was not concerned and essentially laughed at me for having nothing to complain about. I think having to change our your site multiple times a day, hearing that dreaded alarm, then chasing down a number in the 200s all day long, hardly eating carbs because you donā€™t know if your site is working and will even help is bad enough. Forget my a1c. Iā€™m not sure how it stayed low. Anywaysā€¦

Please tell me- did you or anyone else on here find any solutions?? Iā€™m going crazy. Thanks in advance. Hope all is well.

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@Riley23 Iā€™ve heard/read a lot about steel needles. Have you used them?

Edited to fix: @Dave44 (not @MM1) I think it is you who often speaks so highly of a SureT steel needle infusion set, yes? Can you explain more for Riley23?

Ahh, and welcome to TuDiabetes!

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I exclusively use steel needles! Thatā€™s what the tru steel are for tandem pumps.

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@Riley23
You need to learn how to fill the cartridge properly. Iā€™ve had the X2 since it was introduced. I use the t90 or whatever name Tandem has given those sets since they introduced the proprietary connector, and have never, not once gotten an occlusion alarm.

Back to the proverbial drawing board!

Iā€™ve had tandem pumps for 5 years now. I promise I know how to fill a cartridge. No bubbles, follow all instructions, etc. Itā€™s not a cartridge issue.

But Iā€™m happy they work for you.

Obviously not.