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!).

Wednesday, January 30, 2013

Severed lifeline

[Note to readers: this little miss-adventure happened, was written up, and scheduled before the BIG event I posted about on Monday. In keeping with my New Year’s Resolution to post every Wednesday, I’ve decided to go ahead and let it run, but just know it is out of sequence and happened before the killer low.]

I was freezing my ass off. Literally. And my hands. And my nose. And my toes. I could see my breath, cigarette smoke-like, hanging in the frigid air.

No, I wasn’t out on some Artic adventure, I was in my frickin’ office. The janitor had unplugged the heater. The outside temp was 1° Fahrenheit. The inside temp was 1° Fahrenheit. It was so cold my computers didn’t want to start. The faux leather of my chair stung my skin through my jeans. The frozen keyboard burned my fingertips. My aluminum clipboard was a knife.

It was time to abandon ship. Today, I’d have to find a spot to work in the main clinic. I grabbed my stethoscope and discovered that it was, like the carcass of a snake that had been run over on the highway the night before, stiff as a board.

So the day was off to a great start even before it all went to hell on me. The really crappy part of the day started when the rise rate alarm went off on my CGM.


So I fished Mr. Pump out of my pocket to take a correction, and that’s when I discovered:

Massive life support failure. My tubing had snapped. My pump was pumping insulin into my pocket, rather than into my body. I’m sure an astronaut would have the same sort of emotion if he (or she) noticed his (or her) air hose drifting by his (or her) helmet.

We really need a gender-neutral pronoun in the English language.

But back to the story, because I haven’t even gotten to the interesting part yet. In lieu of the traditional syringe-style insulin reservoir, the t:slim has a bag-in-a-box, like cheap wine. Connected to this box is a short length of tubing, about an inch-and-a-half long. At the end of this run of tubing is a female Luer lock hub. It’s actually one of the more bizarre design elements of the t:slim. Every other pump has you hook your infusion set right to the reservoir on the pump.

Tandem and their assorted reps are a bit vague about this design oddity. I’ve heard that they did it to keep the pump slim, but I don’t think it’s so slim you couldn’t have come up with something else. The male side of the Luer lock is not something a porn star would be proud of. Frankly, it’s pretty thin and a bit short.

I’ve also heard that female dFolks with babies asked for this feature so they could more easily carry their papooses on their hips without worrying about delicate baby skin getting scratched by a pump-mounted hub. While I acknowledge that this might be a (rare) side benefit, I have a hard time believing this was really considered in the design phase. To me, it sounds more like the marketing department trying to make lemonade from lemons, after the fact.

Actually, before buying the pump, I worried a bit about this oddball tube-and-hub; but like many t:slim things, in practice, most pre-purchase worries evaporated for me. The oddball location of the hub hasn’t been an issue for me. At least in the winter. But I’m still worried about the summer.

For you to understand why I’m proactively seasonally concerned, I have to detour and talk about my wardrobe. And to do that, I have to talk about my environment, because that dictates my wardrobe. I live a mile above sea level in a dry desert. Summer temps at my house are often in excess of 100 degrees. In the shade. But in the winter it’s freezing. Literally. Like in damn-fucking-cold freezing. So in the winter I favor heavy jeans. Wrangler brand, if you must know. But in the summer Wranglers are too frickin’ hot. In fact, at home, where keeping inside temps below 85 in the summer is a challenge, I generally wear shorts. But at work, shorts are verboten. And as I have a lot of crap to carry, being diabetic and all, I’ve taken to wearing cargo pants in the warm months. They are thin, and they have a lot of pockets to carry said crap. So it’s win-win.

My point here is, so far, I’ve only worn the pump with jeans. We are still months from the cargo pants season. And as I’ve already got a CGM on my belt, and a pouch for my meter, I really don’t feel like adding one more thing to my waist. Although the various t:slim cases and clips look highly serviceable, I’ve yet to test-drive any of them. I’ve just been carrying Mr. Pump in my front pocket, on the right-hand side, and all is well. Oh, and my pocket is deep enough so the stupid hub is hidden from view, inside my pocket.

But cargo pants have a whole different pocket design. The front pockets tend to be deeper, and the tops of the pockets are farther from the waistline. I suspect the pocket-carry won’t work well for me with cargos—the pump will be too hard to fish out—so I’ll need to go the belt route. Of course, with cargos, I have a bunch of pockets on the legs for the meter and such, so there is more real estate on the waist at that point. But come summer, my hub will show, and I’m not sure how I feel about that.

Now, why did that sound vaguely pornographic?

Anyways, now that I’ve bored you to tears with fashion and climate, let me tell you what really sucked about this broken tube. Now, I gotta say, despite being hung up on countless door knobs over the years, I’ve never actually broken a hose. I had one spring a leak in my sleep once, nearly killing me via DKA, but I think a cat was to blame for that.

But look again at the photo. The tube has pulled out of the pump side of the hub. The infusion set itself, and its tubing, is intact. The severed line is between the reservoir cartridge and the female Luer lock hub.

In other words: no quick fix. Actually, no fix at all. The reservoir (brand new and filled to the brim with 300 units of 0.14¢ per unit NovoLog, of course) was shot to hell. There was no way to salvage it. I had to do a reservoir change… and you remember how long that takes, right? Plus, for whatever reason, once my umbilical cord was cut, the infusion line filled with air bubbles, so I had to do the whole kit-and-kaboodle. Luckily, even though I only lasted two days as a Boy Scout (a story for another day), as a proper D-Scout I’m always prepared and had everything I needed for a site change.

Well, everything but time.

Next time: Fat Finger Fuck-ups, a.k.a. F to the Third Power; and why you shouldn’t re-program your basal rate when you are hypo.


Blogger Scott E said...

So I take it you can't stick the syringe in the pump and pull out the insulin from the cartridge -- the same way you put it in the first time?

8:49 AM  
Blogger Jonah said...

Gender neutral pronoun system I like best:
replace he and she with xe
ie: When xe goes on a spacewalk, xe wears a spacesuit.
replace his and hers with xyr and him and her with xem;
Xyr parents are awfully proud of xem.

9:16 AM  
Blogger Scott K. Johnson said...

I can't wear my pumps vertically on my belt because the luer lock pokes into the substantial belly that hangs over my belt line. This design would allow me to *comfortably* wear my pump in pretty much any orientation I'd like... Just an observation.

6:53 PM  
Blogger Val said...

I actually really like the dangling leur lock thingy. Womens pockets tend to be a lot more narrow and shallower than mens pockets - that extra width for the lock meant I could never keep my Ping in my pocket, but I never put my tandem anywhere else. When I have pockets. (Q: why do men's clothing always have many many more pockets than women's clothing? A: uterus envy).

9:57 AM  
Blogger Wil said...

Val—My 87-year-old feminist mother has long maintained that the lack of pockets in lady’s clothing is male conspiracy to keep women suppressed.

10:14 AM  
Blogger Bernard said...

I've had problems with 'piggy tail' as I've hear Tandem folks refer to it. Several times I'Ve thought it was connected only to find the male end was misscrewed (don't go there). This happens only during a change.

Despite pumping for years, I had never thought to reuse the tubing and save myself 24+ units of insulin! I'll only using the tubing 2 or 3 times but that's still a lot of saved insulin.

BTW Wil, it was about 15 degrees here today with a wicked wind. Even our chickens didn't want to be outside.

12:56 AM  
Blogger Skye said...

@Scott, You can in fact suck the insulin back out of the cartridge, and I know it because I've done it. More than once. And I'm still alive. I'm sure its not "sanitary" or safe or recommended and all that jazz, but I refuse to throw away insulin that can otherwise be salvaged(un-insured for too many years, some habits just wont die). I also reuse tubing, or creatively via more unsanitary means "blow" the insulin out of the tubing and repurpose it back into the vial via handy syringe. I probably don't actually recommend that one, and I sure don't tell my doctor/CDE/pump people about that, but after 10 years of pumping I've not run into problems with it yet, so I'll keep doing it.

I also do not like the dangling luer-lock... my work-around solution was to dig back out the leather pump case for my Minimed pump (because the case is bigger than the t-slim) and "fold" the tubing so that the luer-lock ends up neatly contained in the case. I don't like the case though, because I'm so lazy that having to open it to get to the pump is too much work, and I see some sort of creative tape use in my future to secure the dangly bits to the pump.

2:49 PM  
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7:34 AM  

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