Insulin Pump Set Change Process

Been a long while since I've blogged.  There's a lot behind that and I'm not sure how to get back "in to" it except for to just jump right in.  I may have written this before but I just don't like to focus on my diabetes all of the time.  I'm glad that there are diabetes blogs out there for others to read should they do so but I don't always have the head space to make it MORE a part of my day than it already is.  I'd rather focus on living my life as the normal person that I feel I am.  That isn't to say that I don't focus on taking care of myself because I certainly spend plenty of effort doing that, I just don't care to blog about it (or even talk about it) constantly.  You won't see much about diabetes on my Facebook page or on my family blog.  There is MORE to ME than just diabetes, diabetes news, diabetes articles, diabetes research... I am so much more interesting than all of that.. and again I don't mean that in a negative way.

ANYWAY, I have realized recently that there are some people who are interested, possibly curious, about my life with diabetes.  And that, I don't mind sharing.  I have lived in my new location for just about a year and many of the people I now associate with, my friends, don't know a whole lot about diabetes like some of my friends whom I've been associated with longer have already learned from me about my condition.  So, for their benefit I've been posting little snippets on my Instagram and Facebook.  When the reaction is positive, I tend to be more willing to share more... a little.

SO... Here's what I've recently shared.  It's nothing new.  It's stuff people who wear insulin pumps already know, but for some of my new friends, they were fascinated. They had no idea I could chose where I want to put my site, that I could move it every three days, and that I could wear my pump in any place I want to.  I wear my insulin pump on the belt clip and apparently in the same location on my waistband that one of my friends thought it was permanently in that spot at about four o'clock on my belt.

Without further ado, I give you the process of changing out the insulin pump set in a step by step post.

Going from right to left, top to bottom here are the steps of changing out my site- or my pump.

1. (not pictured) I rewind my pump, remove my old site and throw away the tubing, reservoir, and infusion set.
2. (top left) fill the reservoir with enough insulin for three days (300mL for me)
3. (top middle) attach the reservoir to the tubing (the little blue thing that's on top of the insulin vial in photo 1 is thrown away
4. (top right) I insert the full reservoir (now attached to the tubing) into the pump... I should have taken a different photo.
5. (bottom left) Fill  or prime the tubing by holding down the ACT button.  In this photo you can see 2.6 units being primed into the tubing.  I hold that down until it reaches about 14 units and then I see drops coming out of the needle and no air bubbles in my tubing.  Sometimes it takes more units and sometimes it takes less.  I like the longer tubing ( I think it is 42 centimeters long or something) so it takes a few more units of insulin than the shorter tubing but that length just works better for me.
6. at this point I attach the insulin pump- see next photo

7. This needle goes into
8. my arm, hip, or stomach (let's be honest, I NEVER use tummy sites- bad experience)
9. I pull the needle (blue piece and attached metal needle) out and the plastic cannula 6mm long stays inside of my body for the next three days.


Just as a bonus here's a BRIEF explanation on  how pumping insulin works.

I use fast acting insulin only mine is called Humalog but there are a few other brands and names.  I have programmed my pump with the help of my doctors and logging my blood sugars to meet the needs of my body without food or exercise throughout the day.  This type of insulin delivery is called BASAL insulin.  It is like my baseline.  So hypothetically if I am fasting all day long this is the amount of insulin I need throughout the day and night.
The second way I give insulin is through BOLUSING or a BOLUS.  I give a bolus of one unit of insulin for every gram of carbohydrate I eat.  So, if I eat a meal of 30g. of carbohydrates I need a bolus of 4.2 units.
To take it a step further, my pump and my glucometer (blood tester) communicate with each other wirelessly (blue tooth) so at a meal time I will test my blood sugar and the value gets beamed to my pump.  Then I count the carbs in my meal and enter my bolus.  If my blood sugar is high I need one unit of insulin for every 25 points over 100 mg/dl that my sugar is.  So... if I were eating a meal of 30 carbs and my blood sugar was 125 I would need 5.2 units instead of 4.2.
Conversley, if my blood sugar is low then I need a little less insulin.  So if I tested and my blood sugar were like, 65 then I would take about 2.2 units instead of 4.2.

Wow!  It's a good thing I know how to do a little math!  But don't worry because really my insulin pump has all of my own calculations entered and it really does all of the math for me!  ;) Maybe I'll do some screen captures and photographs of insulin deliver for my next series of Instagram photos.

PS: If you're still way down here reading this entire post you can look up on this blog for my tag "a day in the life" and see the series of posts I did back in 2007 for a more comprehensive look at my daily diabetes routine.  Not much has changed even though it's been 7 years, diabetically speaking.

Busted Pump

Went to take my lunch bolus the other day when my pump just up and broke.  The most ironic thing about that was on my to-do list for that very day was to call Medtronic and see if I needed to replace my pump due to a crack in the battery chamber that had been there for over a month.  I was probably going to make that call about an hour after my pump just quit working on me.

So, I went to take my bolus for lunch and my pump wouldn't deliver the insulin.  This is the error I received.

The crumbs on the table give it a special touch, don't you think?

So, I did what any reasonable diabetic would, and commenced to FREAK out.  I rewound the pump and reloaded the reservoir (after disconnecting) and came upon the Motor Error again.  A good friend was helping me through the freak out and suggested I try new tubing and reservoir.  I did that and still got the same error.  I tried it with a new battery and still got the Motor Error.

I called Medtronic in Singapore after searching for their number.  Left a frantic voice mail and continued freaking out.  I was pretty well panicked but somewhere in the mix I took an injection to cover my lunch.  I called my husband and he was able to dial internationally and connect me with Medtronic in the US.  

Thank goodness, because I hadn't heard back from the "local office" at all.  

I went through with support at Medtronic and they confirmed that my pump was indeed busted.  They told me that my pump is covered under its' warranty until June of 2015 so they would send me a new pump.  THAT'S when I told them that I don't actually live in the United States and that I in fact live 9,000 miles away in Singapore.  The customer service representative wasn't really quite sure what she should do but she said they'd send me a pump through their global office and that "global" would be contacting me soon.  

I searched through my diabetes cabinets for my back up pump and couldn't find it.  I guess I gave it to Hurricane Sandy victims?  I can't remember.

With the help of a friend, I was able to calm down enough to figure out a reasonable number for a Lantus dose and take that (about an hour after my pump died).  I called my local doctor and left a voice mail for him to call me back so that I could make sure I'd taken that Lantus shot correctly, to let him know that I was taking injections, and to tell him that my pump was broken.

Busted Pump aftermath 

By the way, if your pump breaks, it's good to have a back up pump.  But if you don't have that, it's a wise idea to have some long-acting insulin on hand.  I'd also suggest having your basal rates, correction doses, and carbohydrate ratios written down.  Luckily, I had a Lantus pen in my refrigerator so I was able to switch over to Multiple Daily Injections (MDI) until a new pump arrived.   I didn't have Humalog (or anything similar) in pen form, which kind of sucks, but I had syringes and plenty of bottles of Humalog so for boluses and corrections, I just used that method.  

I'm not sure if it was just by coincidence or what but later that day, the Medtronic rep was at my doctors office and after I called them back a second time, the two of them returned my call.  My doc told me that I was taking my Lantus the way I was supposed to and that the Medtronic rep had a loaner pump I could use until my new pump came from the states.

Here's how I figured out how much Lantus I should take.  I added up all of my basal rates to find my daily basal total.  I took that amount divided by two every 12 hours.  Technically, you could take the whole thing in one shot every 24 hours but Lantus doesn't quite work as well as fast-acting insulin so if I only took an injection every 12 hours, then I could adjust that amount in 12 hours instead of waiting an entire day to do so.    

It wasn't until the end of the next day that the Singapore office received word that the US team had received a report on my pump being broken and that a new one was en-route.  They figured it would take about a week.  Something I hadn't realized before was that ALL Medtronic pumps come out of California.  Asian, European, Australian, and American pumps all come from the same place.  Huh.  Guess that just hadn't occurred to me before.  At least, I'm pretty sure that's how it works.  

Anyway, about a day and a half later, the Medtronic rep came to my house with a loaner pump.  I was sure relieved to go off of MDI even though it had only been about 36 hours.  I hooked that sucker up and was off and running.  

The next day, in a moment of clarity, I suddenly remembered where I'd stored my back-up pump.  I felt like an idiot for not remembering, but was still comforted by the fact that I did indeed have a back-up should I ever need it.  Since I was already using the loaner pump, I didn't bother getting my own back-up pump out. While thinking I had donated it to the Red Cross was a lovely idea, I'm glad I have a back up.  Especially now that I know a replacement is going to take a week to get here.

It was exactly one week to the day that my replacement pump arrived.  The rep was nice enough to come out to my house again and deliver it.  I gave him back the loaner pump and hooked in to my new pump.  It's been working well since then.

When I tweeted, posted on Facebook and Instagram a picture of my "Motor Error" I was really surprised to hear from many Medtronic users that they'd experienced the same thing.  One follower told me he's had SIX pumps with errors needing to be replaced.  With the exception of my 508 having an unfortunate run-in with the banister thus cracking the screen, I've never had to have a pump replaced until the Revel.  This is now my third Revel pump.  I'm really curious if they'll be a recall on this pump due to the motor error sometime in the near future, but I suppose time will tell.  

Part 2: New Doctor, lots of Tests

So my new Doc, Dr. Lee, decided to have me get a full panel of blood work.  I was to be fasting and have all of the blood in my body drained out for testing.  Not really, but this list was LONG!  I was actually really glad though, because I've been wondering about some things and feeling like others weren't properly treated.

Anywho, I got a taxi after 40 minutes of waiting in the rain and headed down to the medical center for labs.  Little did I know, the results were gonna be scarier than that dang needle.

The same day that I had my labs done, I went to my doctors office to have a CGM inserted for my blind trial.  Again, he wanted a blind trial so that I wouldn't be interacting with the CGM but rather to collect the data and make adjustments to my insulin regimen.

One week later, I went back to the doc to upload the CGM data, review that, and talk about my labs.

The week that I was wearing my CGM, my doc wanted me to be recording all of my blood sugars, meals, and insulin doses.  Introducing the mySugr app.  Very cool, highly recommend it!  It was a great little app on the iOs and I found it was easy to use and maybe even a little entertaining.  I logged everything really well for seven days and haven't used it since. What can I say?  I gave up on logging a LONG time ago!  Plus I log all of my calories on MyFitnessPal so that's just way too much time on logging!

I digress.  So, I went back to see Dr. Lee.  First we went over all of my labs.

Testosterone & Estrogen tests were normal: no PCOS (whew!)
Lipids (Cholesterol): bad (CRAP!)
Hashimotos (thyroid): still uncontrolled even though I take thyroid meds (SIGH)
Uric Acid (proteins in urine detecting kidney function): high (SHIT!)
Celiac (allergy to wheat): Positive (double SHIT!)

Then we went over my CGM and it was fine.

So, basically, my blood sugars are under control and I don't have PCOS but other than that I'm a complete mess.

This was REALLY HARD news for me to swallow.  Really.  Hard.

I'd seen a doctor about my thyroid and possibly having Celiac previously but I was never actually tested for Celaic.  I played around with gluten free for about a month and then I decided to move across the globe and basically forgot about all of it.

This time though, it's time to face the facts and realize what I already thought I knew.  Celiac. Positive.  And no more wheat for me! That SUCKS!

As for the Cholesterol, I'm just gonna go ahead and say that I had already had a high cholesterol come back and this one wasn't really a surprise.  In the states though, my beloved Dr. Day told me I could wait until I was 35 before starting on any medications.  Not this Doc.  He wants me on a low dose of Statins.  It took me almost a week to take that first pill.  So far no bad side effects so I think I"m good there.  And if it protects my heart, then I'll do what I gotta do.

Hashimotos.  or hypothyroid.  So I've got that.  I have been taking thyroid meds for quite some time and I knew they weren't enough.  I saw some whack job at the beginning of last summer and he wasn't doing it for me so I quit him and ignored it.  Until now.  I'm on double my dose from before and finally able to wake up in the morning!  Hooray for that!

As for the Uric Acid, I got to do the ever so enjoyable 24 hour urine collection.  I never heard back from them so I'm assuming that test was fine.  Geez!  I don't want to find out that my kidneys aren't working well.  Guess I gotta stay vigilant and do everything I know to keep this dreaded diabetes under control.

Celaic.  Damn. I can't believe I have Celaic.

Switching over to gluten free has been difficult.  I think that's compounded with the fact that I live in a freakin expensive country and it's hard to pay for regular groceries let alone switch it all up and eat a different way.  I had some really good go-tos back in the states when I tried this before.  Some of those things just aren't available here and I've resorted to eating eggs all the time.  Not really, but... really!  I am so bored and need some good gluten free meal ideas.  Particularly lunch.

I guess after a few months of focusing on the big move, and home-schooling my oldest due to some unforeseen circumstances, it is time to focus on me and my health again.  It's hard when you're a mom and have another life outside of taking care of diabetes 24/7.  But it's wake up calls like this that kick your butt into gear.

I didn't reach out to many in the DOC about all this, but it's time I put this story out there.

Update on my progress to follow.

Making Friends

Met a new friend.  Decided to go on a hike with this friend.  The hike was intended to be a long one.  About 3 or 4 hours.  So, naturally, being diabetic, I had to think about ways to prepare for low blood sugars along the way.  My sugars were doing really well, staying within the normal ranges so I decided to lower my basals by 50% like I would during any exercise and carry three packages of mentos with me.  That's more than enough to cover any lows I may have had on the trail, as well as share some with the boys, and their new buddy.

It's really awkward, you know, meeting someone new and having to jump right in with, "so, I'm diabetic and..." But... I feel like, when doing this kind of activity, it's probably better to bring it up right away rather than, you know, try to explain while having a low or something.  

New friend has a kid.  This kid is basically a big fat brat.  He's asking for my stash of candy pretty much right away.  I tell friend that it is hard to have candy in front of kids when, you know, they're gonna want you to share, but that I always explain to my classes (substitute teacher) that they'd much rather NOT have the disease than share my candy, or juice, or orange or whatever it may be that I'm treating with.  And, I don't go out of my way to openly eat it in FRONT of the kids, but sometimes you have to, especially in my profession.  

So she says to me, "yeah, and I guess if they eat too much candy they can get diabetes too" UGH!  Really?  So I politely say, "no, not really, actually you're more prone to get it by genetic predisposition than by eating too much sugar"  "Oh, I guess I don't know that much about diabetes anyway".  

Right, I hadn't noticed.

Had tea with another friend and when I explained to her that I wear an insulin pump because I have diabetes her reaction was, "Oh, you have it THAT BAD?"  "yeah", I said.  

I mean, I don't expect everyone to know everything about diabetes, not by a long shot.  But since moving, I've noticed this kind of becoming an issue for me.  

I'm usually one to meet friends pretty easily.  I'm outgoing, friendly, talkative, and usually that ends in me rapidly making good friends with a lot of people. I'm usually really open about diabetes.  Don't mind telling poeple about it, don't mind people asking about it.  Until recently.  

I've had kind of a hard time adjusting to my new life here, in Asia, thousands and thousands of miles away from home.  For some reason, well, I know what the main ones are, but anyway, it's just been... difficult.  Add to that the fact that making new friends means they don't already know about diabetes like my friends back home already know about it... it's just added to the stress of it all.  

I mean, how do you just go up to a person and explain that you have this chronic condition?  It's so damned awkward.  I'd take the silly questions my OLD friends had over explaining it new for the first time any day.  

Traveling with Diabetes

Below are my experiences in traveling with Diabetes. Recently, I moved to Singapore from the United States. I was in four air ports around the world. I have taken many flights previous to this journey whilst having diabetes. I've also been on road trips and have blogged about my pumping vacation last summer for a trip to the beach here: http://sugarfreesweety.blogspot.sg/2012/07/pump-vacation.html

Disclosure: I am not a doctor nor a TSA agent. These experiences are my own and as always, your diabetes may vary.

I've got SLC International Airport down to a science when it comes to wearing an insulin pump. But, I had never taken a year's worth of insulin across the world with me. So, I was a little bit worried about how that would all play out but it turned out fine.

I looked it up on the TSA website as well as asked them on twitter (and they responded!) about how to travel with diabetes supplies.  There I found out that I could indeed take a year's worth of insulin as well as the ice packs necessary to keep it cool on the 21 hour journey.  The website just said that I had to declare my insulin before putting it through.  Easy enough, I thought!

As I approached the security check, I told them that I had insulin and ice inside my bag.  The TSA agent asked that I separate them.  I pulled out both my insulin and my ice and put them in the totes provided and sent them through security.  I hid my pump under my shorts and easily walked through security. No issues and on to boarding.

The reason I choose to hide my pump is purely from experience.  The insulin pump has NEVER set off the alarm.  But, I've been leery of taking it through before, thinking it would set off the alarm.  A couple of times, while traveling through SLC int. I showed them my pump, told them what it was, and then proceeded through the metal detector.  Because I had shown them my pump, and NOT because it set off the alarm, I got the pat down.  As security measures increased, and full-body scanners, and full body pat downs came around, this process also involved an extensive full-body pat down.  Personally, I do not think a simple insulin pump warrants such treatment.  It is a medical device, OBVIOUSLY  a medical device.  It is also VERY COMMONLY worn and used by millions of diabetics in the United States. Therefore, I see no reason why a pat-down is necessary.  Especially when it doesn't set off the alarms.  The entire process would make me more and more frustrated and I just HATED the entire process. The ONLY positive side was that my husband had to deal with the kids, their shoes, coats, bags, the stroller, and whatever else our family of four was traveling with... for just a few minutes, while I was held up in security.  He usually had it under control by the time I finished and all I had to do was put on my shoes and follow them to the gate.

So.  One time when traveling to see the in-laws, I decided to hide my pump by wearing it clipped to my underwear (I ALWAYS wear my insulin pump with the belt clip) underneath my jeans.  No issues.  Whatsoever!  so... that's what I've done from now on!

But.. I digress. In San Francisco, we didn't have a lot of time.  So little, in fact, that unbeknownst to us, our bags didn't make it.  Security at the International gate at SFO was basically a nightmare.  It was HOT and extremely crowded.  The line was moving very slowly.  If we hadn't had business class priority, we probably would have missed our flight... maybe.  I followed the same procedure I had done in SLC but this time I made the mistake of ASKING the TSA agent whether or not I should separate my ice from my insulin inside of my carry on.  He agent told me that I did NOT need to do so.  And... of course, my bag was held up.  The boys' bags were also held up for some reason which they decided NOT to tell us about.  Damn those crayons!  ha ha ha.  Anyway, The woman on the x-ray side started chewing me out about not separating my ice from my insulin and I got right up in her face.  I was NOT losing my cool, but very firmly, and calmly, I said to her, "THAT is why I specifically asked about it.  I asked him, (pointing), right there, if I should separate my ice and insulin inside my bag before I sent it through the belt because they told me to do so in Salt Lake City and he told me that I did not."  "And that is why I ASKED SPECIFICALLY".
"Well," she responded "you should always do that."
"Well, that's why I asked" I told her again.
Eventually, our bags were all cleared through security and we were on to the gate at Singapore Airlines.

Our layover in Korea wasn't really long.  I think we had about an hour.  It was like 4:00 am our time and we all did very well with being awake at that time.  I have to give it up to the Koreans, their Incheon airport was fantastic.  Security could not have been easier.  It was 6:00 pm local time and there was no line whatsoever.  A nice man helped us all put our belongings into bins and carefully guided us though security.  No issues with the insulin, ice, or any other bags!  Quick, easy and so friendly.

By the time we made it to Singapore, we'd been en route for 21 hours.  My blood sugars did very well the whole time.  I did check them quite frequently, as recommended.  My insulin was still cold by the time we made it to our hotel and everything arrived safely... except for our bags.  ALWAYS carry on your diabetes supplies, even if you are taking a year's worth!

Thyroid the back story

I've always had issues with my Thyroid and didn't feel that my Endocrinologist was properly treating that aspect of my endocrine issues.  So I sought out a new doctor who would take some more time on my thyroid and leave my diabetes up to my regular doctor.  I did a little research and decided on two local clinics.  One clinic didn't take insurance, so I went to the other one.

Some of the symptoms I've struggled with having low thyroid are typical, and others, I didn't realize were because of low thyroid.  Here's a list from Web MD, suffice it to say that I have MOST of them.  

Symptoms of Hypothyroidism

Symptoms of hypothyroidism may be vague and can often mimic other conditions. They may include:

• Changes in the menstrual cycle
• Constipation
• Depression
• Dry hair and hair loss
• Dry skin
• Fatigue
• Greater sensitivity to cold
• Slow heart rate
• Swelling of the thyroid gland (goiter)
• Unexplained weight gain or difficulty losing weight
• Carpal tunnel syndrome

The clinic that did take insurance, we'll call them "Fancy Thyroid Place" came highly recommended.  I knew a lot of women who have their thyroid treated there.  So, I booked my appointment for Fancy Thyroid Place and showed up not really knowing what to expect. The lobby looked like a spa and all of the employees dressed in black- felt like a fancy spa.  Anyway, I met with the doctor and right off the bat he was pretty rude to me.  I tried so hard to keep an open mind and I feel like I did eventually warm up to what he had to say.  We agreed to get some blood work done before making any changes to my regimen.

I had my blood work drawn and scheduled an appointment for three weeks later to have a look at things.  He opened up my file and right away said I had Hashimotos (hypothyroid) and that I needed to be gluten free.  He went over the rest of my thyroid numbers with me, told me they were all out of whack and wrote me a prescription for a different thyroid medication.

I took to the internets asking for help with this and was surprised when an endocrinologist friend told me that Hashimotos and gluten free don't necessarily need to go to there.  I wanted to be a good patient though and so I cut out gluten and started taking the new medicine.  I corresponded with this doctor friend a little more and she advised me that the medication this Fancy Thyroid Place was giving me, wasn't really a recommended or trusted treatment.  So.  I really had some decisions to make.

I kept with it and did the follow-up blood work about a month later.  In the mean time, I felt.  like.  crap.
I wasn't sleeping as well, I just wasn't myself.  But I sure was trying.

Follow up blood work suggested nothing.  Basically no change.  So in the end, I quit this doctor and went back to my old treatment plan.  And back to eating wheat.  (for a while at least).  See the continuation in these posts: New Country, New Doctor (part 1) and Part 2: New Doctor, lots of Test 

A Day in the Life

A Day in the Life of a Type 1 Diabetic

January 6, 2007

The following is a series of posts I've created to document one day in my life with diabetes. I hope that you will find them interesting. I’ve enjoyed putting this together and I want to thank my husband, Colin for helping me take these pictures throughout the day. Diabetes is such a huge part of my life, and I guess I just want to share some images and words with you so that you can maybe realize the impact that it has on me each day. I was diagnosed with diabetes in April of 2001, nearly 6 years ago. It has been a struggle at times, and at other times it has been a blessing. I think I’ve become more aware of my eating and exercising habits because of the disease. I’ve also probably become a little more stressed out and perhaps more obsessive-compulsive about other aspects of my life because diabetes is something that is so difficult to control. I am not mad that I have diabetes, but some days I wish I could take a diabetes vacation. The star of most of the images that will follow is my mini med 508. I love my insulin pump and would suggest all type 1 diabetics get the pump. Anyway, I could talk about diabetes all day, but I’ll just let the blog do it for me. I hope you will enjoy it, and I hope that you’ll leave a comment telling me what you think about it. Also, if you know someone who may like to read this, please feel free to forward them the link.

Thanks!

Jen

The first thing I do each morning is take out my meter and test my blood sugar. This sort of sets the tone for my day, but I try not to let it bother me if I am off. There was a time when all of my morning tests were very high. I had what is often referred to as "the dawn phenomenon" but, the pump has helped me cure this, and I wake up with much more regular or normal blood sugars.
I have to gently squeeze my finger to get the blood to come out. My hands are shaky and taking pictures is difficult so I know my reading will be low.

I put the drop of blood in the top of the test strip and it will read my blood sugar in 5 seconds time.


Normal blood sugar levels are between 80 and 120 points. This is the amount of glucose in miligrams per deciliter. Low blood sugars, like this one, are the absolute worst part about having diabetes. I hate the way they feel. To explain it to a non-diabetic, would be hard, but I guess if you have ever gone without food for an extended period of time, and you get toward the end where you feel weak, shaky, confused, and tired, it's like that for me. I can't think straight, I get angry, my hands shake, sometimes my tounge goes numb... lots of symptoms can happen. Some people pass-out, others act like they are drunk.This is 2 cups of fruit loops, about 56 grams of carbohydrates. I take 1 unit of insulin for every 7 grams of carbohydrates. Because my blood sugar is low, I can take one less unit to help bring my sugar back into normal range.

To give myself a dose of insulin or bolus for a meal, I have to push the select button. I then have three different types of bolusing optioions, I choose normal then dial up the amount of necessary insulin.
9.0 units for breakfast.

Taking off the pump for my shower. I just leave it on the counter and re-connect as soon as I am done bathing.