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Nurse Educator visit today--Not Going Ping, changed to T:Slim (CS concerns)

Discussion in 'Parents of Children with Type 1' started by SandiT, Jun 14, 2013.

  1. Sarah Maddie's Mom

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    I think the OP has the notion that there is an "out" when insurance covers a $6000 device, an out that doesn't exist. "Irreconcilable differences" are not medical necessity, and even "medical necessity" would be a very hard sell in the vast majority of cases in which what's really going on is that something bright and shiny is on the market and most insurance companies just won't play that game. Short of committing insurance fraud most of us are just stuck picking a pump and living with it for four years.
     
  2. Mish

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    In the past two days, I've read more hysterically incorrect things here on CWD than in the past 8 years.

    Jeff, these threads are going to be great for searching. :)
     
  3. Sarah Maddie's Mom

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    So, the infusion set had a tail? So did the ancient Rapid-D... Could someone who actually uses this pump chime in? As in someone who has actual experience with this "revolutionary" feature?
     
  4. Beach bum

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    Well, we go to the endo practice right across the street from where you go and Animas never came to our school to educate the nurse. It is not standard practice. They did come to our home to educate us and then we trained school staff. When we transitioned to school the nurses studied the manual and went online to the website. Then they attended a class for school nurses at our clinic. Honestly, the nurse doesn't need to know more than how to correct and enter carbs, so it would be fairly easy to train them.
     
  5. Mish

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    Sandi and ChazDad have gotten every stupid nurse/rep out there. Amazing.
     
  6. Megnyc

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    Hopefully someone who actually uses it will chime in but I'm going to answer here just to attempt to clear up the misinformation. I fooled around with the pump for 48 hours last week so don't have a lot of experience with it....

    It is not a "revolutionary" feature. All it is, is that the luer lock connection is moved about 3 inches down the tubing. It is supposed to avoid the reservoir connection rubbing against your stomach when the pump is clipped to your pants I believe. I would personally not disconnect from it under any circumstances. You would have 20+ inches of tubing hanging off you and it would be really tough to quickly reconnect. It would be like disconnecting the tubing from the reservoir on your medtronic pump to take a shower. Just doesn't make sense to me....

    Can someone who actually uses the tslim please clarify this for us?

    ETA: I know several people using the tslim and no one has mentioned tightening the cartridge to tubing connection every morning. Can that be clarified as well please? Thanks :)
     
  7. misscaitp

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    I think it's the luer lock that she's talking about, or at least that what's I'm getting from "a tail". Which is featured on the Animas pump and the retired Cozmo, just with those it wasn't as visible in pictures because they had caps. My friend uses the T:slim and she said it's just the luer lock set.

    To the OP: Luer Locks are not meant to be disconnected from that tubing, but from the actual insertion site. Luer lock infusion sets just allow a person to have multiple options of insertion sets.
     
  8. Megnyc

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    Ok, I found a picture to better describe this.

    [​IMG]

    The disconnect feature I believe we are discussing is the luer-lock connection between the cartridge and the infusion set as you can see in the picture. The only difference between this and the "ping" or really any other pump is that instead of being directly attached to the cartridge containing the insulin it is attached via tubing.

    Regardless, you would never disconnect from there so I am not really sure why the nurse even brought it up :confused:
     
  9. Sarah Maddie's Mom

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    Ok, so it's a tail at the pump end not the set end... odd but not revolutionary by any means.
     
  10. rachabetic

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    I always disconnect from the infusion site. The pigtail is not meant to be disconnected during use. It creates and air pocket in the tubing which would then have to be primed out. It is there so that it doesn't stick out at the connection like other pumps do. It won't poke the user when bending over or whatnot. I personally would never disconnect from the pigtail and then just reconnect.

    Not sure if this is advise from Tandem, but from my experiences, it's what I've found out. Disconnecting and then having a large air bubble would be DANGEROUS, especially to young kids with a tiny basal. The pigtail is very secure though, and doesn't disconnect without a good tug and twist.

    Hope this clears a few things up. :cwds:

    ETA: I did get a new pump through insurance before the 4 years was up...ONCE. To be perfectly honest...it was hell. I was only about 12 or 13, so I'm sure it was even harder on my parents actually doing the work, but I remember being in tears over it a few times. When I started on the minimed, the only pump they had was the 5 series (small cartridge). The larger one came out right when I was in the thick of puberty, needing 100 units or more a day sometimes. So yes, it was a medical necessity. We needed letters, and approvals, and appeals, and tons of fights. It took forever, and was horrible! If you want a different pump for some reason in a year or 2, they are not going to be very supportive, especially if it was something that was out when you started on your pump. They are going to wonder why you didn't think of that before getting the pump you did, and then say TOUGH LUCK.
     
    Last edited: Jun 14, 2013
  11. ecs1516

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    No, this was around years ago with the Minimed Sof-set. It was around when we first started pumping, but we did not use it. It had a disconnect like that. But many people using that would have to tape down part of the tube.

    http://www.applied-medical.co.uk/PDF/SofSet_Insert-Rev3-140409.pdf
     
  12. hawkeyegirl

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    If that's what she is talking about, Tandem tells users to NEVER disconnect from the luer lock. When you disconnect, you are always to disconnect at the site. Meg is right - they designed it that way so that people who wear the pump on their belt don't have the connection digging into their skin. We actually find it slightly annoying, as we have to jam it into the pump pouch along with the pump.

    It's kind of funny, I just got my monthly "tnews" email today from Tandem, and this was one of the little articles in there:

     
    Last edited: Jun 14, 2013
  13. Megnyc

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    Thanks! I was hoping you would answer. That is really useful to know for people considering the tslim as well as new users.

    Do you find you need to tighten the luer lock connection every morning as suggested above?
     
  14. mmgirls

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    If carbs are involved the t:slim does not reduce the bolus at all, not even from a correction portion of a bolus.
     
  15. hawkeyegirl

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    Well, there would be no correction if you're below target.

    So if you're 80, and you're eating 30 carbs, and your target is 90, the tslim will bolus for the 30 carbs, right? I don't have a problem with that, but like I said, we never allowed our MM to shave off insulin for a low, so I'm not bothered by this. We would just bolus for 25 carbs, for example.
     
  16. Jordansmom

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    The two chambered pump would have glucagon, not glucose. And while I'm really excited about the potential of a dual chambered pump, and watching Tandem closely, the bigger hurdle to a glucagon pump is the fact that no one has been able to bring a premixed glucagon that lasts more than 24 hours to market. So the "next natural step" doesn't happen until someone figures that out first.
     
  17. rachabetic

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    You are correct on the reason it is there, and the examples of what it's like.

    For your clarification on the tightening of the pigtail luerlock, I don't tighten it every morning. I seem to tighten it up well during site changes, and just kind of leave it alone until the next site/cartridge change.
     
  18. mmgirls

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    but what if you had correction IOB going? what if you gave a correction an 1.5hours ago and are now re-testing and eating ? wouldn't you expect your pump to suggest a reduced bolus if the current BG correction/reverse correction was less than the correction IOB?

    THe t:slim warns you but does not give a suggested reduced bolus.
     
  19. Megnyc

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    Awesome thanks!!!

    Thanks for taking the time to answer my questions. It is great to be able to get info from someone with personal experience with the pump. I'm glad you are having such a great experience with it :)
     
  20. hawkeyegirl

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    I guess I just don't think settings are that exact. If he was high 1.5 hours ago and I corrected, and he's below target now and eating, there are just way too many variables there for me to expect anything that the pump recommends to be accurate. I understand that you think that the pump's calculation would be better than what a child could come up with on their own, and that may be true, but I wouldn't want a child handling a situation that complicated on their own to begin with. Make sense?

    ETA: It's part of the reason I don't care about how a pump figures IOB. It's such an inexact calculation anyway that I think it all comes out in the wash.
     

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