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Thread: New to pumping, having problems

  1. #1

    Default New to pumping, having problems

    I'm curious to know if you have a standard set of troubleshooting steps when your CWD is running high on the pump. If so, please share!

    My DD started pumping earlier this month. The first few weeks were dreamy... several site changes, good numbers, successful basal tweaks, etc. Then on Sunday we had our first bad site. It took us all day to troubleshoot! We saw air bubbles, got rid of those, but no change in her 300+ BG after a bolus. Gave an injection, no change after an hour. Assumed bad insulin. Gave injection with different insulin. Success! Changed insulin in pump, still had high BG after a bolus and another hour. So, we changed site and found the canula was just sitting flush against her tush. Problem #1 solved but not sure what lessons were learned...

    She woke up this morning with redness under half of her IV3000 tape, whether it was also under her set was not clear. Had very high BG after breakfast, checked for air bubbles, found some HUGE ones in the tube. Got rid of those but it took nearly all of our insulin to do so, so we just changed her site a little early (due for change in the a.m.). Site looked ok upon removal. Redness was only under tape, not under site.

    Now she's at 380+ after a meal/bolus on the new site.

    This is all incredibly frustrating. Medtronic customer service was very nice, but I am hoping to find some "real life" troubleshooting tips here in this community.

    DD is 3, we use the backside for sets. Minimed Revel and Mio 6mm sets, 23" tubing.
    Alicia
    Mom to Abigail
    dx at 2 1/2 years
    Pumping with MiniMed Revel

  2. #2

    Default

    Are you using room temp insulin to fill the cartridges? Cold insulin tends to make for more air bubbles in the cartridge.

    We've never taped down Mios, you might try going without the IV 3000 and see what happens. Also, if a site is wonky then she's not getting basal and the resulting high will take more time and more insulin to correct than just a simple under bolus.
    Sarah
    Mom to DD now 16, dx @4
    Cozmo pumper @6
    Minimed pumper @13
    G4 @ 15


    "Happy Birthday, Dr. Banting! Now... let's eat cake! Because, we CAN!" - MCS

  3. #3

    Default

    Yes, room temp insulin. Good to know you don't necessarily need the tape -- we are going without the tape on this new set for a test run. Even baths are ok without tape? (Newbie question!)

    Also, curious -- how do air bubbles present themselves in BG numbers? Is BG high and rising, or is insulin delivered intermittently giving numbers that range from normal to high?
    Alicia
    Mom to Abigail
    dx at 2 1/2 years
    Pumping with MiniMed Revel

  4. #4

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    Quote Originally Posted by abdabs View Post
    Yes, room temp insulin. Good to know you don't necessarily need the tape -- we are going without the tape on this new set for a test run. Even baths are ok without tape? (Newbie question!)

    Also, curious -- how do air bubbles present themselves in BG numbers? Is BG high and rising, or is insulin delivered intermittently giving numbers that range from normal to high?
    Air bubbles get into the tube and get "delivered" as insulin. The piston does it's thing and the pump "thinks" it's delivered x units of insulin when, in fact, it has just "bloused" air. This disruption of insulin flow causes blood sugar to rise until the whole bobble is "delivered" and real insulin begins to flow again. Make sense?
    Sarah
    Mom to DD now 16, dx @4
    Cozmo pumper @6
    Minimed pumper @13
    G4 @ 15


    "Happy Birthday, Dr. Banting! Now... let's eat cake! Because, we CAN!" - MCS

  5. #5

    Default

    Quote Originally Posted by Sarah Maddie's Mom View Post
    Air bubbles get into the tube and get "delivered" as insulin. The piston does it's thing and the pump "thinks" it's delivered x units of insulin when, in fact, it has just "bloused" air. This disruption of insulin flow causes blood sugar to rise until the whole bobble is "delivered" and real insulin begins to flow again. Make sense?
    Yes, makes perfect sense. So, effect on BG will depend on how frequent/how big the air bubbles are... (and therefore not so easy to identify!) Thank you.
    Alicia
    Mom to Abigail
    dx at 2 1/2 years
    Pumping with MiniMed Revel

  6. #6

    Default

    Try the sure t set - it helps rule out cannula troubles..
    Jane Mum of Rachel, 13, dx'd @11 months and Anna, 18, dx'd @ 17 .

    Keep Calm and Treat the Number

  7. #7

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    It sounds to me like you need to work on getting rid of bubbles period - Are you injecting air into the vial of insulin with the syringe before you pull out the insulin into the cartridge - I find this helps to minimize air bubbles.. I also do the insulin filling a good 15 minutes before the cartridge gets exchanged - that along with the tapping of the cartridge helps to get air out of it. Also remember to check the tubing for bubbles before you attach.I have two kids on pumps and bubbles are rarely if ever an issue.. I assume your child is on small amounts of insulin - has there been any suggestion of using diluted insulin in the pump - I am wondering if that might help a bit.
    One other suggestion - are you checking for ketones when you are getting these prolonged highs - I'm wondering if they are contributing to the highs - you may need to blast those out with a needle correction.

    Good luck - these things can get SOOO frustrating..
    Other suggestions is to pick a different type of set as I am hearing some site issues too...

  8. #8

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    We've never taped down Mios. Even with baths and lots of swimming. They've held very well. As far as the bubbles, try to make sure that they are out of the reservoir before filling the tubing. Flick it with your finger and turn it upside down to see if there are stubborn ones at the top.

    Stubborn highs take a while to get rid of. If the number is falling even a little bit, give it time. Also remember she's 3 and diabetes is unpredictable. Hang in there.

    Sarah Mom to...
    Holden 13
    Sydney 11
    Meredith 7 (dx 5/12/08) pumping 5/19/11 celiac 8/11 CGM 3/12 DEx g4 8/13
    Wife to Carl

    http://sweetceliacandsiblings.wordpress.com

  9. #9

    Default

    Quote Originally Posted by skimom View Post
    It sounds to me like you need to work on getting rid of bubbles period - Are you injecting air into the vial of insulin with the syringe before you pull out the insulin into the cartridge - I find this helps to minimize air bubbles.. I also do the insulin filling a good 15 minutes before the cartridge gets exchanged - that along with the tapping of the cartridge helps to get air out of it.
    This is all very good advice, along with the advice to make sure you are using room-temperature insulin to fill the reservoir.

    When my son was much younger, I tried to check the tubing for bubbles twice a day. Once in the morning and once when he was disconnected for bath time. Now that he is older, small bubbles do not really show much of an effect, but they did when he was younger.

    Sarah also had a good point in that you will find that when your child goes above 300, your normal correction factor may not work. You of course want to be cautious until you figure out what works best for your child, but we sometimes have to double corrections when my son gets that high, or do a regular correction along with an increased temporary basal rate for an hour or so. If you do increase the correction amount, you should test frequently for the next few hours to monitor BG. The other thing you will find is that even if you dose properly for the meal, if your child eats while they are high, it may just push them even higher. We try to do low carb/no carb when my son is quite high until I see him coming down.

    Hang in there. It takes a little while to feel completely comfortable with troubleshooting on the pump, but you'll get there.
    Mom to J., age 10
    Dx 2007 @ age 3
    Medtronic pump and CGM (4/2008-6/2013)
    Tandem t:slim and Dexcom G4 CGM (current)
    CGM in the Cloud 7/2014

  10. #10

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    When my daughter was much younger I stopped using the mio equivalent called the inset, because there were too many times that they would kink, or would simply pull part of the way out (while still under the tape,so I couldn't see it had happened). It seemed not to be a good fit for my wriggly kid.
    Sure-ts worked much better at this age for her. And as pp mentioned you don't have to worry about kinking,
    Dd uses the mios now, and I do tape, but I cut a hole in the tape so she can disconnect.
    Mom to:
    Dd, 15
    MM 530G, Dexcom
    G4

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