LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Tuesday, April 10, 2012

The third time is not the charm

New Pump Redux II made it through the night with no trouble. Checking in with myAssistant before even dragging my lazy ass out of bed, I could see I was red-lining my insulin. Low reservoir. Time for a site change. One thing I find that I miss about my CoZmo is that it had both a site change reminder alarm, and a site status screen that told me exactly when the next change is due. Site changes give me a headache because they happen every three days, but there’re seven days in the week, so they never happen on any sort of schedule that I can plug my brain into.

And there’s no point in just writing them on the calendar in advance, because sooner or later, a passing door knob will rip an infusion set right out of your body and ruin your best-laid plans.

That said, I’m finding that for me, and this won’t work for everyone, that myAssistant has once again created a great workaround for what I regard as a failure of engineering in the pump’s design. That sounds harsh, but if the damn pump alarms were loud enough in the first place, I wouldn’t have needed mySentry at all, now would I? Sorry. I’ll get some more coffee and stop ranting. After all, Sentry has proved to be much more than a workaround for the piss-poor alarm volume issue. It, for me, has become nothing short of the command and control center for my real-time diabetes decision making.

And I gotta say, one of the things that’s either good or bad about the Sentry system, is that you don’t really bother to look at your pump anymore. Why would you? Everything you need to know is on Sentry TV in living color, in more detail, and in a friendly large size—good for aging eyes.

Some people will think that tuning out the pump is a bad thing. But to be honest, for me at least, it’s a good thing. Look, some people check their email first thing in the morning. Others, the news, sports, or weather. All of us pump-packing people should be checking our pump status and blood sugar levels before our feet hit the floor, but I’d bet 35% of you check your email first; another 35% of you check the news, sports, or weather; and the last 30% of you hit the snooze alarm and fall right back asleep having checked nothing at all.

But Sentry makes checking the whole personal diabetes news, sports, and weather thing a snap. One glance takes in battery status; exact insulin level; your current more-or-less blood sugar; the direction you blood sugar is traveling, and how fast it’s on its way; when you need to calibrate your sensor; and the age of said sensor.

Could you find that info on the pump? Sure. If you go to no less than three separate screens. If you leave your pump set to not “time out” so the screen says on (and why wouldn’t you?), and if you leave it on, say, the six hour sensor screen, you can get your current sensor glucose; the trend over the last six hours; and those little up or down arrows that tell you if your diabetes weather is about to go to hell. Ut-oh. Hypo-storm coming. Better break out an umbrella. Also, in case you thought your pump’s screen was broken, those little squares on the bottom of the sensor trace screen mark insulin boli.

This same six-hour CGM screen (along with the 3, 12, and 24 hours views) also gives you a battery icon; and a more-or-less-how-much-insulin-you-have left in the pump icon. If you want to know exactly how much insulin you really have, you have to go to Home then hit Escape twice to get to Status. Next scroll waaaaaaaaaaaaaaaay down almost, but not quite, to the bottom to learn the actual number of units left in the reservoir. To learn when your next calibration is due the recipe is Home, Escape times three to Sensor Status, and it’ll show you the time your next calibration is due—not how many hours are left before you need to calibrate, like Sentry—and how old the sensor is. Again, the pump shows you, for instance, that the sensor is 1 day, 11 hours old; whereas Sentry shows how many days it’s still good to go.

This difference might drive some more technologically driven people batty (you know who you are), but frankly, I find the Sentry approach more user-friendly. Also, I really prefer one glance at one screen, without giving my fingers an early morning workout. If I actually took the time to take all those steps above every morning, I’d be chronically late to work.

Anyway, I got off track. Revel number 3, like both 1 and 2, is a Model 523: The little one. It holds a maximum of 180 units of insulin. I go through about 23 units of basal a day. For three days I need 69 units. In theory, I should need about the same amount for food, as half a type 1’s daily insulin requirements are basal and half are bolus. So over three days I’ll normally run though a little less than 140 units. The Model 523 gives me a good forty spare units of insulin just in case I’m invited to the Never Ending Pasta Bowl at Olive Garden, or an all-you-can-eat Chinese Buffett.

But that also means by the time my site is due, the reservoir is getting pretty low. This morning the little insulin icon on Sentry was red. It was warning me that heading out into the world with less insulin than I need to get back home alive is probably not the best of ideas. I’ve never actually paid attention to when Sentry decides to red-line me, it might be a percentage of the capacity, or it might be related to the low alert is set on my pump. It don’t think it’s the later, however, as I can’t recall getting a low reservoir alert from any of the three pumps, and I’ve been using the red light as my reminder that it’s site change day.

So you’re probably wondering how on earth I could need a new site on the first morning of a new pump. Did I go to three all-you-can-eat Chinese Buffets last night? No. Bummer.

During last night’s debut of my third Revel pump in three weeks (Ummmm…. These things are supposed to last longer than a week, right? I mean, I’ve read about the possibility of disposable pumps in the future, but I had assumed the price would come down…) I decided to just slap the cartridge from pump number two into number three. I’m trying to make my supplies last. This morning the red vial icon told me it was time to change.

Now pump three is miss-informed about the age of the CGM sensor because I lied to it last night to boot up the sensor. I sure as hell didn’t want to break in a new pump and a new sensor on the same night. The sensor is actually geriatric. Even though it’s green on the Sentry screen, it is actually five days old. I’ll pull it tomorrow. Hmmmmmm…. that makes me wonder. We all know the new six-day wear next-gen Med-T sensor, called Enlite, is in the pipe line. They have it over the Pond and in almost every other civilized and un-civilized place on the planet not ruled by the FDA. Will mySentry be able to recognize the change? Instead of three day count downs will it switch to six? One can only hope.

When I jumped out of the shower, I pre-inserted a sensor into my left leg for tomorrow, and covered it with a Tegaderm. Then I did an infusion set change. I filled a new reservoir from a Novolog vial using the clever little Apollo-Soyuz-style docking collar, snapped the Quick set onto the top, re-wound the pump, clicked the reservoir into place, confirmed that I was NOT hooked up, and held down the ACT button to fill the set’s tubing and…

No Delivery, said the pump.

My heart sunk to my shoes.

I pulled the reservoir out. Unhooked the infusion set. Hooked everything back up again. Then I re-wound the pump, clicked the reservoir into place, confirmed that I was NOT hooked up, and held the ACT button down again to fill the set’s tubing and…

No Delivery, said the pump.

Can your heart sink lower than your shoes?

So I’m liking Sentry. Loving it, even.

I just wish I could get a pump that would work right to go with it.


Anonymous Anonymous said...

The only No Delivery alarms that I have ever had with my Medtronic pumps are reservoir problems, especially when I try to fill the reservoir to the brim. Usually it will prime part way and then alarm with No Delivery. I usually try again, but most of the time I need to use a new reservoir. This has only happened a few times in 7 years of pumping. It has never happened to me once I get a reservoir up and going.

So if I were you I'd try a new reservoir before assuming that you have a bad pump again. Either way, it makes you wonder about the quality control at Medtronic right now....

11:53 AM  
Blogger Jessica said...

WOW, this is seriously out of control! I've had the Revel 523 for about 2 years, and other minimed pumps before that. I have never had a problem with it, but you are really scaring me!!

I have had no delivery issues once - due to the reservoir not being able to get insulin to the tubing because of bad it possible your batch of infusion sets or reservoirs is the problem? Seriously though, this is crap for you!

6:48 PM  

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