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Tslim cartridge notes

Discussion in 'Parents of Children with Type 1' started by RomeoEcho, Jan 12, 2014.

  1. RomeoEcho

    RomeoEcho Approved members

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    I am trialing Apidra right now, I have very low expectations but I have a large stockpile of Apidra and I'd hate to see it go to waste so I need to at least try it.

    Cartridges can be reused in an emergency. Go through the usual process, you do not have to actually remove the old cartridge, similar to restarting a sensor. Disconnect before doing it. The insulin remaining gage may not work properly, so be wary when getting low on a reused cartridge. If you do this, the usual fill rules still apply: you must prime at least 10 units and there must be at least 50 units remaining after priming. But if you're in a pinch, there is no interlock preventing it.

    Also for emergency use, you can withdraw from the cartridge to a syringe. I tested it when my display said 5u remaining, and was able to draw out 24 units to a syringe.

    I am not advocating using these techniques, but they have both been used to save my butt many times in my pumping career so I am relieved to know that the cartridge design does not prevent this.
     
  2. mmgirls

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    Thank you.

    When looking at the T:slim those were some of my questions for which the rep was unwilling to answer. We have always reused Animas cartridges.

    Are you successfully using Apidra in the T:slim, or are you just using it to experiment?
     
  3. RomeoEcho

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    30 Hours into the first cartridge of Apidra. So far, it looks exactly like Novolog. We'll see if that continues, and I'll keep you updated as to whether it works or not. It seems that some people are able to go two days, so I guess I'll know more in a day or two.
     
  4. Ali

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    I found Apidras performance very different in a pump from Novolog but only because for me Apidra was a different insulin regardless of being delivered via syringe or pump. For me Novolog in terms of use in a pump had the longest site use and most consistent curve. My body started disliking Humolog after two days, clogs in pump tubing and site issues. Apidra, a very different action curve regardless of pump or syringe delivery and no real difference in tubing issues but maybe some site reaction resistance so I sometimes need to switch site location after two and one half days on Apidra. I use Apidra cause I can dose and eat on it, compared to a 15 to 20 minute pre bolus time on Humolog or Novolog and much longer to correct highs on Hum or Nov. Trickier to set basals on Apidra, bubbles and site issues cause bigger problems but I still prefer Apidra. I was worried about the T Slim and Apidra so interested in your results.ali
     
  5. mom2ejca

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    We tried to make Apidra work in the T:slim and it was a huge PITA. If we were religious about changing the cartridge right at the 48 hr mark, most of the time we were okay. We were using contact detach, and we could generally still get 3 days out of the site. Try to go over 48 hrs with the cartridge and 95% of the time we were going to see bg heading for 300 within a short time. There were also a few times we got an occlusion alarm before the 48 hr mark. And yet, there were times when there was clearly a problem if we tried to stretch past 48 hrs, but there was no occlusion alarm. My guess on that one is that there was just enough insulin getting through to keep the occlusion alarms from being triggered.

    We tried for several weeks to make it work. We just got to the point that we were tired of guessing; how long is the cartridge going to work, do we need to change early to not interfere with social events, is the site bad too, etc. It was too much of a crapshoot. We put the MM back on until we use up our extra Apidra. I did also try Novolog in the T:slim to rule out it being a pump problem, and it was smooth sailing.
     
  6. RomeoEcho

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    Well, I think I see what people were talking about. About hour 32, the spike happened. I attributed it to a miscalculation and a short prebolus. Correct, and move on. Two hours later, not a dent. Correct again. Hope that if I can get it down it will stay there. Repeat for 12 hours. Very large boluses would start to bring down, but nowhere near what they should and then creep back up again. Hour 45, occlusion alarm. I disconnected from the site and tried a bolus, no problem. Pulled the site and tried to bolus through it, nothing, and got another occlusion alarm. I listened to the pump motor through this, and it sounded different while it was occluded. It appears that the occlusion sensitivity is approximatley 1.5 units missed for the alarm to go off.

    I think this counts as a failure. I'd had excellent results for the past 5 days before this. I'm now questioning whether this was part of the reason why things were going so well on Novolog, that the Apidra in my Animas may not have been working out as well as I thought.
     
  7. GChick

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    While I have only been using it since December 29th I have had no occlusion alarms yet (wasn't even sure it had one to be honest... glad to know) and have had no troubles with absorption either and have kept one set in for four days. All highs are generally explained by misjudging carbs or overcorrecting a low which were "fixed" with a reasonable amount of insulin.

    Humalog/Novalog is your best bet.... but I totally understand not wanting to waste the insulin. Maybe make it a point to change sets every day??? But meh... then that'd be wasting sets. <shrug> and if the occlusion is at the cartridge level then I guess it wouldnt help.

    Only things I usually can't explain as easily as I'd like is actually the lows (4 hours after eating). Just keep dropping the basal only to drop it more the next day. Don't get me wrong, I have highs, I just "get" the highs, particularly since my basal is so much less than my Lantus dose was.

    Good luck with figuring out how to get the most out of your apidra surplus.
     
  8. RomeoEcho

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    Totally not changing every day to use apidra. My insurance won't cover that many sites and cartridges, and even if they did, it would be cheaper to buy new insulin. Already back to Novolog and considering options to use the apidra. I had 5 solid days of between 60-150 on Novolog, (by dex so it was real) it's been years since I could do that. Mostly, I think I'm realizing that it doesn't work as well for me as I thought it did. I wish it were easier to donate insulin to people who need it. If anyone could use it, PM me.

    GChick, are the lows at a specific time, or reliably 4 hours after eating? Even if it is only after a particular meal, if you eat two hours later for example, does the time of the low shift or is it always at the same time. It is possible you are seeing a tail of the bolus four hours out rather than a basal issue.

    Occlusion alarms should be very rare, which is why I'm so ready to attribute this to the insulin. I'd say less than every six months, and I'm really bad at regular site changes which is usually why they show up. Now that I think about it, I think I was getting more than that after the switch to apidra before tslim.
     
  9. GChick

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    It's almost always at the 4:00pm mark (with a few other "oopses" here and there), at least when the dropping becomes evident, even if not low. However I almost always eat at 12:00-12:30, so I don't know if it shifts with it.

    I'm good after breakfast (which actually has a higher basal etc and slightly higher bolus for the carbs than other times) and usually (though not always) good after dinner... its just that pesky 4:00 or so spot.... which I have lowered the basal a few times already... also I'm a little high but good enough for me at about 2 hours after eating lunch... often in the low 200s, so I wouldn't think bolus could be reduced unless I wanted to go really high after lunch in order to be "normal" by dinner.

    Today however I got everything wrong for that timeframe :). I got the dose wrong (too little) for lunch at about 12:30pm (which was obvious when I redid the math later for how much rice I was eating) and ended up at 285 at about 2:45pm and corrected way too aggressively (1:50... but still had a lil IOB from lunch but ignored that, figuring I may have also overdid the lowering of basal... which I'm pretty sure now that I didnt) and ended up at 37 right before dinner (about 6:00pm)

    It's "possible" that my bolus may be too high, but I think for a woman my size (average/not overly thin but not "fat") that a 1:15 ratio isn't usually overly aggressive (even with ydmv), and I'd also think I'd be consistently under 180 or so (when I'm oftentimes not) 2 hours after eating if it was the bolus that was the problem? But I'll look into it.
     
  10. RomeoEcho

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    I'd try a basal test for the lunch/afternoon period. Ideally skipping lunch, or if that's not possible for you, moving it by a few hours. Either way, it should be revealing. That dramatic of a drop is probably not tail, but if the timing is off, it's possible. Basal test will tell you. When adjusting basal, are you remembering to adjust the basal 2-3 hours prior to the start of the drop? CGM really helps here, but if you can figure out when the fall starts rather than just when you get to low, that will tell you where to start backing up from.

    Are you prebolusing lunch, at least 15 minutes? (20-30 minutes works for me, I spike otherwise) If not, than I would not at all be surprised by an off bolus causing highish at 2 hours and low at 4, especially if your basal was even a little off. If you are, than it's probably basal. Also, I wouldn't blink if you had said that for an average build 34 year old woman your I:C was between 1:8 and 1:25, people vary a lot.
     
  11. GChick

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    I keep meaning to do a proper basal test for all the times (not in one day) but have not gotten around to it yet. If I remember I'll try for this Sunday, just for lunch and possibly the evening... even though it's a bit of an "oddball" of a day (no work... not much planned), it'd probably give me a good enough idea.

    As far as pre-bolus goes, sometimes I do, much of the time I don't (unfortunately)... particularly for lunch, which is also why I don't bat an eyelash too much over a 200bs reading 2 hours after lunch... if I didn't pre-bolus then that's just part of the game, as long as I come down to a decent number (without going low), I don't freak out over it. If I were ending up "close" to low but not low, I could still see the bolus being the culprit, but I often end up low, and then treat... and then still low.

    Also I adjusted the basal for only one hour prior to the normal start of the drop. 2 hours might be more appropriate though.
     
  12. StacyMM

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    Thanks for posting this! We were down to our last cartridge when the last shipment came in and found myself wondering about reuseability. Didn't need to do it so I still had no answer. I read this the other day, though, and when DD announced "Oh, I only have 12 units left" 7 minutes before the bus arrived yesterday, I felt perfectly comfortable filling the old cartridge and sending her to school. And she made the bus stop on time! When you say that the insulin remaining gage might be off, do you mean that you think it may show more or less than is actually remaining? Just curious since we'll be changing the cartridge tomorrow.

    Thanks!
     
  13. RomeoEcho

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    Honestly, I'm not sure. I think it might read extra, but it could just be wrong. The insulin remaining operates on a pressure signal, unlike the other pumps that are based on how far the piston is advanced. Dosing is based on pumps of the micro piston and is unrelated to this potential discrepancies. If you're curious, after you change the cartridge, pull out the excess with a syringe and see what you get. You should get 20 units of unpumpable insulin, plus whatever is listed on the screen.
     
  14. sparty87

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    I know this is an old thread. DD is trying to make a decision on the tslim. She occasionally "tops up" her cartridge on her current pump. (I'm not advocating it, but in her circle of T1 friends, this is not uncommon). The tslim cartridge fill procedure for pumps sold after 4/20/2015 calls for filling the cartridge out of the pump, utilizing the syringe to pull out air. So, have anyone tried the new procedure and noticed any difference in estimated insulin remaining in pump ?
     
    Last edited: Sep 23, 2016

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