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, February 13, 2013

Bubble trouble

Somewhere I thought I read that the t:slim was supposed to be a bubble-free system. But I don’t recall where, and I can’t find it now, so maybe I was dreaming.

All I can find about bubbles in the official literature is the warning in the manual to be careful not to have any bubbles in the fill syringe when doing a site change. Well, duh.

Of course, your t:slim insulin lives in a plastic bag hidden inside a solid, dark cave of plastic where no eye can spy a bubble, should it lurk there.

But because I was bubble-deluded, thinking I had read it was a bubble-free system, I hadn’t been paying much attention to the issue until I had an unusual fit of boredom.

Now boredom isn’t usually an issue for me, as I’m an overworked workaholic. But a week or so ago I was actually lying on the bed doing nothing. My restless hands were fidgeting with my pump, running the infusion set tubing through my fingers. And that’s when I saw it. A stretch of clear space in the heart of the tubing. Then another. And another.

What the fuck?

Are those… are those… are those bubbles?

Now I’m totally on board with not adding any unnecessary chemicals into our bodies, but sometimes I wish insulin had a color dye in it. I don’t know about you, but I have a hard time seeing the clear insulin in a clear tube. And it’s even worse after I’ve worn the tubing a few days. As it gets bent, tucked, scuffed, and so forth, it develops a differential sheen that can be mistaken for a bubble.

So that was my first thought. They must be faux bubbles. This set was on its third day. (My skin freaks out under an infusion set after two days, but my insurance company doesn’t want to pay for changing my sets every two days, so I’m dealing with all sorts of skin irritation and trying to survive the third day by scratching frequently while I wait out a “prior authorization” for the number of sets I actually use.)

But these really, really, really looked like bubbles. To make sure, I marked one of the mysterious clear spots with a sharpie, placing a blue mark on either side of the mystery artifact and then biding my time, literally.

And sure enough:

The bubble migrated. It moved up the tube. There is air in my insulin sack. And that air is being sucked up by the micro pump. And that air is being sent down the infusion set tubing, taking up space where insulin is supposed to be. Damn it.

Now, in case you don’t know, the air is harmless in and of itself. It won’t hurt me, but where there’s air, there isn’t insulin. It displaces the insulin. That lowers the insulin volume I should be getting. So here, in the third day of the life of a set, I’ve got 3 bubbles each nearly an inch long.

That means I’m not getting the amount of insulin that I’m supposed to be getting.

Lovely. Just fucking lovely.

Well, whether I was dreaming or not about the bubble free system—even though I was lying in bed when I discovered them—these bubbles are no dream.


Anonymous Anonymous said...

Cold insulin?

12:46 PM  
Anonymous Anonymous said...

When you think about it, bubbles are either there when you fill the system or form afterwards when air disolved in the insulin comes out due to a change in conditions (temperature or pressure). This is much like how a coke can hold the fizz from when it was made until when you open the can. The opening of the can is the change in conditions that releases the fizz. Anyway, when bubbles form this way, the trouble is 2 fold. The bubble formation, displaces insulin and pushes it into your body. that is an over delivery of insulin you did not ask for. Then later if the bubble makes it into your body, that is an under delivery, you are not getting what you asked for. Control is hard enough without this added joy ride. How to avoid? let the insulin warm before filling, vent the insulin vial after filling, stay at the same elevation/altitude all the time, or use a pre-filled cartridge (if you have a time machine or an old D-tron pump).

11:10 AM  
Blogger Wil said...

Nope! Room temp insulin!

2:51 PM  
Anonymous Anonymous said...

I have had this problem with the tubing for YEARS and although I check the tubing fairly frequently I still miss sometimes! My total insulin use per day is 10 - 13 units so those charming air spaces are downright scary!!! When I take a shower there is always, always, always an air space right at the end of the tubing just before the reconnection point which I prime out prior to re-attaching. I just wonder if most other people just don't really look at the tubing--because it's not the easiest thing to observe--clear insulin against clear tubing. Yes, I see what both of the Anonymous people said but those are old solution ideas as far as I am concerned---been there, done that for everything I have ever heard suggested.

1:36 PM  

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