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Tslim occlusions

Discussion in 'Parents of Children with Type 1' started by RomeoEcho, Feb 13, 2014.

  1. RomeoEcho

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    Anyone else having problems with occlusions on the Tslim? Have you found a solution? Even with Novolog, I've had more occlusion alarms in the last six weeks than in 10 years of Medtronic and Animas. It's not enough to make me not like it yet, but I find it odd that I'd only ever had a handful of occlusions ever, and now they are a regular thing.
     
  2. wearingtaci

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    Yep,us. She has been having at least one a day for the past 2 weeks. It always happens with a bolus
     
  3. Melissata

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    That is worrisome, as we are in the process of getting a Tslim for our daughter. What do they have to do when this happens?
     
  4. hawkeyegirl

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    I don't think we've had a single occlusion since starting the t:slim.
     
  5. mamattorney

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    We haven't either.
     
  6. mocha

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    I've read that Apidra is a known problem for the Tslim and that many people have problems with occlusions. Switching to Humalog or Novolog seems to help the issue.

    Part of the problem seems to be the cartridge design which has the insulin under pressure.
     
  7. RomeoEcho

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    I was aware of the problem with apidra, but this is with Novolog. I am hoping this is a fluke rather than a problem with all insulins. Hopefully it doesn't continue since I haven't had this happen before.
     
  8. MissionsMom

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    We've only been on the Tslim for a few weeks, but never had an occlusion. Have you called your rep? Maybe they have some ideas.
     
  9. mocha

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    People have still been having problems due to the cartridge design, no matter the insulin type. Apidra is the worst, but people have been having problems with Novolog and Humalog as well, which is a shame.
     
  10. RomeoEcho

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    I talked to tech support for a while, they were very polite and asked the right questions, and seem to be genuinely interested in figuring this out. They had no suggestions at this point for how to fix it but are gathering as much information as they can, and are sending some extra supplies. Unfortunately, this is one of the problems that can happen when a product starts being used in the real world instead of trials with small sample sizes. I don't hold it against them at all and I hope they are able to figure it out. Not taking risks like this are precisely why all the other pumps on the market are nearly identical to the ones available 10 years ago.

    It does happen the most with Apidra, but there have been others with the same problem on Novolog and Humalog. The things they are trying to track right now include temperatures, weather when the cartridges were delivered, days in the cartridge, days on the site, insulin level in the cartridge, battery level, lot numbers for cartridges and sites, whether they are real occlusions or sensor errors (mine were all fully blocked), where the blockage is occurring, doseages/insulin throughput and any pattern you may notice yourself.
     
  11. RomeoEcho

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    In my frustration, I impulsively filled with apidra instead of Novolog. My first try with Apidra was an occlusion on day two and I never tried it again. It's been a solid three days with Apidra now with no occlusions after a week of constant occlusions with novolog. I have no explanation.
     
  12. mmgirls

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    besides it being Apidra was there any other significant changes?

    Did you bolus more? or more often?

    When my dd was younger and on Humalog she would get clogged cannulas but if I "Super bloused" the basal ever so often I would clear it.

    I really liked the look and feel of the t:slim but did not like the programming and the issue with occlusions runs right up there with squealing pods.
     
  13. piratelight

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    We had this problem while using Apidra. Once we switched to Novolog the problem stopped.
     
  14. GChick

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    Ive been using it for about the same length of time (slightly longer) as you and have only had one occlusion, and that was probably because I had been using the same cartridge for 8 days... and probably the same tubing for just as long (though I believe I was at least changing my set every three days at the time) I was just testing it out to see what it could take... and it seemed to be able to take a lot.... for me anyway. I'm on Humalog btw.

    Good luck with figuring it out.
     
  15. StacyMM

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    When you first posted this, I thought, "Oh no! Not another pump with failures!!" We hadn't had one...but we've had three this week. Sunday, Monday and Wednesday...two during boluses and one after several hours of non-responsive highs. I called Tandem and they were really nice. They asked about wear time, insulin being used, site locations, how long we'd had these cartridges, weather, what we were doing when they happened, etc. They are sending out a new box of cartridges for me, which I appreciate, and even though the occlusions were inconvenient (one at school, one at a restaurant) I feel liek Tandem was responsive and concerned. Turns out it isn't the OmniPod failures that annoy me...it is the customer service. Took this experience to teach me that :)

    Anyway...the weird thing is that we get 3 months worth at a time and I dump the entire supply in a bin so they are all mixed in. We are down to 3 cartridges (including the one she's using right now), so it was cartridges #45, 46 and 47 that occluded. The first 44 had no problems. It's like they aged, or the temp where I store them is off or something else in my house affected them. Her next supply is scheduled to arrive Monday, and we have the replacement box coming, too, so I'm thinking about storing them somewhere different. And because I store them right next to my OmniPod supply, I'm thinking about moving those, too. Or I could be completely crazy :)
     
  16. wearingtaci

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    We actually had the exact same experience. She had been on the pump for almost 3 months when the occlusions started. We literally would get 1 everyday. After the first couple of times and changing it all out I would just restart the insulin and the pump would be fine for 24 hours then another alarm. I spoke with Tandem for 22 straight days,because I called in every alarm. We tried new cartridges,and even switched infusion sets from Cleos to comfort shorts. Nothing made the alarms stop. Finally our CDE put is in contact with the local rep who really pushed the Director of Customer Service to send us a replacement pump. We have had the new pump for almost a week and haven't had an alarm since. The rep thought it may have been the pump had an occlusion threshold that was too sensitive.
    I was super frustrated with Tandem during the end of our 22 days of daily chats,the techs refused to believe it could be the pump and were getting pretty belittling
     
  17. RomeoEcho

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    I'm quite convinced that a new pump will not fix it. I've had a few stretches that were ok, but the past couple of weeks have had a lot of occlusions. It's not an alarm sensitivity or a false alarm problem. When the occlusions happen, I can find them either in the tubing or the site. Sometimes it's tubing and trying to prime means no insulin comes out of the tubing. Sometimes it's the site. There have been times where it's been in the site that I try and push through insulin with a syringe and encounter *extreme* resistance, that it's just solidly plugged up and there is no way the pump could be expected to overcome it.
     
  18. RomeoEcho

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    Storage conditions and exposure to temperature extremes was one of the things they were interested in when I talked to them, so you might not be crazy. Out of curiosity, what are the conditions like where you are? Mine have been stored in probably 55-65 degrees. I'll be trying one of the new cartridges they sent me today since I just got another occlusion.
     
  19. StacyMM

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    I keep them in a bin in the dining room. It's against a wall without a heating vent and they aren't exposed to direct sunlight. The house is typically around 70 degrees but we did have a cold spell when our furnace died. I was thinking about moving them to the basement where it's cooler and darker and just bringing up a box at a time. The delivery came earlier than I expected - today instead of Monday - and I was home so they didn't sit in the cold (below freexing here) at all but our last box sat on the porch all day on a cold, rainy, windy day...I remember because when I saw the box I thought it was the test strips and insulin box and wondered if the test strips would be affected.

    So your issues aren't the cartridge? It's tubing and site? One suggestion I got was to disconnect and run a 5 unit basal after an occlusion alarm. If it works, it's the site and we can start there. If it doesn't, disconnect at the luer lock and try again. If it works, it was the tubing. If not, it's the cartridge. I wasn't sure where DD's issue was - didn't see anything in the tubing, the cannula wasn't bent, etc. I wish I had thought to do that so I would know if it's the Cleos. We've been having issues with them not sticking when we insert them and I've been trying to convince DD to try a different style.

    They also had me check for anything that could be a hairline crack along the bottom of the cartridge. This alone was a few minute discussion so I wonder if that's a pattern they are seeing.
     
  20. RomeoEcho

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    Yeah, I've never seen one that was in the cartridge, it always runs fine out at the luer lock. There is never anything visually wrong with the tubing or site (sure-t) but these are the places I've not been able to prime through. And as I said, the force required to force through with a syringe was shocking.

    They told me to look for cracks too. They thought it might be a temperature fluctuation effect.
     

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