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

My Photo
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!).

Friday, July 26, 2013

They ain’t twins

There’s something funny about a box of infusion sets from Asante. Here take a look:

 How many differences can you count between the two labels? (I’m told that these find-the-differences games are all the rage).

OK. See you next week. I’ll post the answers on Monday.

Juuuuuuuuuust kidding! Each box is 50% infusion sets and 50% cannula sets. Huh? OK, so here’s the deal. A proper infusion set is made up of an inserter needle, a connector hub with a cannula that has sticky tape to hold it on the skin of a person with diabetes, and a length of tubing to connect that same person with diabetes to a reservoir of insulin inside a pump. Although not technically part of an infusion set, we often include the pump reservoir and fill needle in our minds when we think of these things. So in the vernacular, an infusion “set” is all the disposable supplies needed for the pump site change that generally happens every three days.

But, you need to remember that Snap is different from every other pump in this regard. Thanks to the insulin being in a glass penfill, you can legally and safely (more on that in a bit) use it longer than you can legally and safely use insulin in a plastic reservoir. Bottom line: You don’t need a traditional full infusion set every three days; nor do you need to replace the tubing every three days. You only need to replace the part on your skin every three days. The rest of the rig you can wear six days. Or longer. I’ll talk about stretching that envelope on another day.

Back to the box of infusion fun. Asante gives us two things: what they call “Infusion Sets” for the complete changes that happen once a week or so; and “Cannulas” for the changes that happen every three days. The full Asante infusion set has the tubing and the special connector that mates with the body and the penfill of insulin. We need to talk about that device in a separate post, but they smartly realized that we don’t need tubing as often as we do with other pumps. So you get half a box of traditional infusions sets and half a box of tubeless infusion “sets,” or what I’ve decided to call Infusion Lite. ®™ by me!    ;-)   Those of you who worry about landfill overfill will appreciate this lack-of-waste approach.

Now, as promised a moment ago, I’ll address the issue of how long insulin can stay in a pump. Any pump. Is this week-in-a-pump thing of Asante’s really all that special? Maybe. Maybe not. There’s a good reason insulin comes in glass vials. It holds up better that way. Insulin does degrade in plastic, but how fast it really does so is anybody’s guess. The pumps with plastic reservoirs are approved for 3-day wear. Is that the best that they can do, or did no one bother to pay for the studies to get FDA approval for 4 days? Or five?

Asante didn’t need to do that because the glass penfill already has a longer use indication.

Of course, lots of people extend the use of insulin-in-plastic inside their pumps for reasons ranging from economy to necessity, with laziness in the middle. I myself had some supply issues with t:Slim cartridges recently and ended up not only having to extend them, but even to re-use some. That’s strictly off label. How did the insulin hold up? Geeez… I wish I knew. My life has been so… umm… stressful lately that my BGLs suck. A lot. Pinning down the true cause of that suckiness is no easy task, and on top of that, I’ve had more than the normal number of cannula issues lately, on both the t:slim and the Snap. Check out this blood-filled Snap cannula, for instance:

 But, infusion sets aside, as to age of the insulin in my (temporarily?) retired t:Slim pump, sometimes on day 5 or six it seemed that the insulin wasn’t doing its thing: my BLGs were running high and corrections were sluggish. But on other days, I’d see the same thing on day two of a reservoir. And at yet other times I was sailing along just fine on “old” insulin. Heat can also come into play. Just keeping insulin in glass is no help if you are spending all day playing tennis in 108 degree heat or canoodling with drug reps in a hot tub every day at lunchtime.

Not that I’ve ever had that opportunity!

Monday: Invasion of the Body Changers, a graphic novel
(or as they are called south of the border, a Photo Novella)


Post a Comment

<< Home