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Need help...pump problems

Discussion in 'Parents of Children with Type 1' started by WendyTT, Oct 24, 2008.

  1. WendyTT

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    Okay, so I am going to turn to the real experts.....the CWD folks! Our endo's office is out of ideas of how to help us. Lindsay, age 8, started on the pump (Medtronic) this past June.....the last time we went for our endo appt. was 9-30-08 and her A1C was 7.9. However, we were still at the time having three day cycles in there with really high numbers, obviously telling us that we are having "site/absorption" issues so the endo told us to try the Silhouette site (we were using Quick Sets). Since then, we've had a bad month with just numbers out of range more than in range, even with increasing basals/ bolus. The silhouette was no different. We use the stomach a good bit and so this past weekend I put the site in her behind/butt and had great numbers for a day and a half, even a couple of lows, then all of a sudden at school she shot up in the 500s (no ketones). When she got home I changed her site, she dropped down to 120 within an hour and a half. Then had great numbers again on Wednesday, then yesterday stayed in the 300 and 400s at school all day again with no ketones. So changed site again last night and dropped down to range within a couple of hours. This is a pretty predictable pattern on her now....endo said today that the pump just might not help her and we might have to go back to shots. NOT going to happen! Anyway, anyone have any ideas/ advice? We are beyond the frustrated point--had a meeting with her teacher yesterday and her grades are going downhill. I truly feel like I am going to have a nervous breakdown.....I don't know that I have laughed in a month.
     
  2. StillMamamia

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    I'm sorry for your frustrations:D

    Would it be possible for you to give us her basal rates, her I:C, etc etc, as well as a few days' worth of bg readings? Maybe it can help in helping you out.
     
  3. Abby-Dabby-Doo

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    My first thought goes to kinks or bubbles- are you having either of those problems?
    If you are having trouble with kinks in the cannula- I would switch to the Sure T set by MM. It's a steel needle and can't kink.
    If it's bubbles- I would use room temp insulin, and check the tubing a couple times a day.

    Or there is a chance that her body isn't liking the cannula- I might sound a little biased by saying this- but again the Sure T is a steel cannula and her body might tolerate it better.
    Or start changing the sites on day 2. I know a couple others on the forums change every 2 days.

    Edited to add- If it's always occuring on Day 3- my bet is on the site. I'm sorry this is so frustrating for you. :eek:
     
    Last edited: Oct 24, 2008
  4. hawkeyegirl

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    Another plug here for the SureTs. At least that way, you could rule out issues with the cannulas.
     
  5. AmyMcCracken

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    I'm sorry you are so frustrated. Trying the different infusion sets isn't a bad idea. When we were having problems with Kaylie's sites I had my husband do the insertion. He got them at a different angle and it made a big difference. We use the silhouettes and our CDE said it works best if it is just under the skin. We have always inserted manually. You might see if your endos office or pump trainer could go over your insertion technique to see if you can insert differently. Please don't take this the wrong way, I'm not saying you are doing it wrong, but a change in angle with the silhouettes can make a big difference.
     
  6. melissajm

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    Does she use Humalog or Novolog in her pump? Lilly used Humalog for a while but we started having similar problems so we switched to Novolog and that seemed to do the trick. I agree that you might want to try the Sure-t's too. Ben & Lilly both use them & we hardly ever have problems with them. They go in very easy too! A lot of times Ben & Lilly don't even feel it!
     
  7. momtojess

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    I am going to say it is definately the sites.. I would keep trying them all until you find one that works more then a day.
     
  8. kiwikid

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    Its worth giving the Sure T a try. Ivan's Mum had these problems with her son reacting to the teflon cannula. A steel needle set fixed it for them.
    How often are you changing the cartridge? Do you change it every set change? I find we have our worst numbers after a cartridge and tubing change, I wonder about tiny bubbles etc even though I can't see any. Could you try filling the cartridge with more insulin and not changing it for one site change just to see what happens?
    I do hope you get it sorted soon :cwds:
     
  9. ecs1516

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    We had to switch from Humalog to Novalog too.
     
  10. bgallini

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    Could it be possible that she needs a new site every day or 1 1/2 days? I'd try different sets first and definitely change after 2 days.

    Have you asked the pump company? Maybe they have ideas.
     
  11. WendyTT

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    It's interesting (and encouraging) that you all are pushing the Sure T's so much with a better site because when we were doing the Quick Sets the endo's office kept saying that we should try the Silhouette because it would work so much better with site issues. But you all might be right that the steel cannula works better for her.....we tried the Sure T's on day one of pump start and she said she could feel the "needle" still in her so we went to the Quick Set. So convincing her to try the Sure Ts again won't be easy.....not looking forward to that. Also, we use Humalog in the pump.....and endo suggested we try Apidra. Anyone have better luck with it? We definitely sometimes have problems on day 3 of site change and have had to change by day 2 a few times.....but with this week for example, we are only getting about 24 hours with it so I feel like there is another problem somewhere. This week I put the site on her butt and I'm wondering if she is pulling up her pants and loosening the site?????
     
  12. Tori's Mom

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    We also changed from Humalog to Novalog. There are a few on the forums on Apidra who will hopefully chime in.
    And....we too use the Sure T's. Like pp's, there are benefits.
    It really does take the site out of the equation. You can always be certain it is not a site issue then you can concentrate on if it is an absorbtion issue, air bubbles, etc, etc.
     
  13. hawkeyegirl

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    Jack didn't like the SureTs on his bottom - he complained that it hurt, but he hasn't complained at all since we started putting them on his tummy. You may just have to experiment with different sites.

    I'm sorry you're having such a time with this. It must be really frustrating.
     
  14. Ali

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    There are also steel angled sets. I believe the MM one is called Polyfin??Good luck. I agree sounds like sites and bubbles. Try a steel set first (shortest length, straight in first then angled), then switch insulins, check out bubble issues on this site for answers, finally if you have to use the angled teflon sets try a shallow manual insertion.:) Ali
     
  15. Flutterby

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    could she need basal increases or ratio changes for school?? how are weekends? how have the sites looked when you've taken them out?

    also, we went through a time that we needed to change out every two days for a while, then we went back to every third and all was well.. we use quicksets.
     
    Last edited: Oct 24, 2008
  16. DylansMum

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    Hi, Dylan has been on the Medtronic Pump since April. We use the Silhouette Combo Sets, and have found them to be fine. Maybe try a different angle perhaps. I put the site in just under his hip above his bum, just under where his trousers sit, and change sides twice a week. Make sure you test the tubing and no air bubbles etc. We use Novarapid.

    Also maybe use a temporary basal rate or adjust your basal rates a little. Do you have a pump nurse you can text or call? I usually text the pump nurse and she calls me back straight away, she is fantastic and is available practically 24/7.

    Good luck.
     
  17. StillMamamia

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    I reread you OP.

    I don't think it is the set.
    She goes back down at home, but high at school, right?
    I think she may be getting really stressed at school. Do you know if something is going on there which may be stressing her?

    If it is this, then you'd need a separate basal profile for weekdays.
     
  18. WendyTT

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    Tell me about air bubbles......do they go away on their own or do you have to change the site and resevoir? How long would air bubbles affect blood sugars?
     
  19. Sarah Maddie's Mom

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    An air bubble will simply create a "ghost" delivery for as long and as big as it is. The pump will be pushing the pool of insulin at the correct rate, but the bubble, once it gets to the canula will be a delivery of air, not insulin.
     
  20. hawkeyegirl

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    You can disconnect the pump and prime them out if you see them in the tubing or reservoir. (Tap the reservoir with a pen to get them to the top.)

    For us, if an air bubble disrupts basal, it's a disaster. It takes forever to get him down - he gets "stuck" high. If an air bubble disrupts a food dose, it's not as big of a deal.

    I'd do a lot of checking of the tubing for bubbles if you think it's a problem. It's not like they travel instantly from the reservoir to the site. You will be able to catch them if you're vigilant about it, and if you suspect this is part of the problem.
     

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