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.  

adjusting to a new schedule

Keeping good control over diabetes means making frequent adjustments.  A friend of mine, and diabetes podcaster recently asked the question; "How often do you make changes to your basal rates?"  This questions means making adjustments to the amount of insulin your body receives throughout the day.  Basal rates are the amount of insulin your body requires at different times in a 24 hour period.  Each time I visit my Endochronologist, like I did about 2 weeks ago, we look at my blood sugars, analyze my A1c, and examine my basal rates.  Usually, we make some little adjustments.  My doctor has taught me that there needs to be a minimum of a 10% change in basal rate for an effect to take place.  I see my doctor every 3 months.  Occasionally we don't make any changes, most of the time however, we do.  I rarely make adjustments to my carbohydrate ratio (the amount of insulin I take for the amount of carbohydrates I consume) but in the beginning I made those changes more frequently.  I also made carb ratio changes when I was pregnant because EVERYTHING changes and gets really wacky when you're pregnant and diabetic.

Anyway, recently, my weekend schedule has changed.  I wouldn't say that it has changed dramatically but it has changed enough for me to notice a pattern of change- for the worse.  So, I've got to decide what I'm going to do to make some changes and adjust to this new change.

Each year, our church schedule changes.  We attend church for a three hour block of time.  Each "ward" or congregation, is assigned a different start time so that the buildings may be shared by more than one ward.  This year, its our turn to attend the 12:30-3:30 block.  AND I HATE IT!  I absolutely detest this schedule.  It's not good for me, and it's not good for anyone else in my family.  Last year we were lucky enough to attend the 9-12 block.  Yeah, it's nice to sleep in on Sundays but I'd much rather be finished with church by noon.  Also, when do you eat?  Either you sleep in and eat a big, late breakfast; or you wake up early and eat two small meals before attending church.  This is what has been really whacking out my blood sugars.  In the 5 weeks we've attended church in 2012, I've had ONE Sunday where my sugars were under control.  The other weeks, I've had one issue or another.  I've been high, I've been low, I've been quickly rising and falling fast.  Ugh.  I cannot figure out this schedule.

Yesterday, it finally clicked that something had been off for five straight weeks, each and every Sunday.  Yesterday I took the day to sleep in.  I slept until 9:00 am like a total slob (for a mom) and didn't eat breakfast until 9:50am.  At that time, my blood sugar had dropped to 59.  I didn't even feel it.  I almost always feel lows. Not this one.  So I ate.  And I ate.  And I probably did eat too much.  And I didn't take any insulin.  So, 2 hours later, my sugar was like 280.  Then I got to take my naked and free shower (where you aren't wearing a pump site or sensor) and put in a new site after my shower.  I bolused and figured I'd come right on down.  Only no.  1 hour after my bolus I checked my sugar and it was 316.  I felt super dizzy.  And super thirsty.  And it just happened to be the first week of the month which means that everyone is fasting.  So I'm taking down at the water fountain when all the adults around me are fasting from food and drink, including water, for 24 hours.  Ugh.  But you do what you have to to take care of yourself, right?
Eventually my sugar came down and I spent the rest of the day fighting lows.  Which leads me to tomorrow's post.

So, let me get to the point here, I know I've got to make a change.  And I hope it will be an easy one.  I just need to wake up earlier.  No more enjoying the ONE BENEFIT of this stupid late schedule, I've got to get up at my regular time and eat breakfast at my regular time.  As for lunch, I don't know.  I think I'll just go for a little carbohydrate and protein combo snack before church and maybe another portion when I get home and then have dinner at the regular time.  That should do it.

I'll let you know how it goes.

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.

Dinner and Evening Snack (Okay, Dessert)

A Day in the Life Continued: dinner and evening snack- okay dessert

Testing on my left hand index finger for dinner.

A normal reading. I will not have to take any extra insulin at this meal, only that needed to "cover" the carbs.
Half of a Cafe Rio grilled chicken salad with rice, pinto beans, tortilla strips, lettuice, tortilla, tomato, and creamy tomatillo dressing. I'd guess about 50 carbs so I took 7.0 units of insulin to cover this meal.
2 oatmeal cookies, about 35 carbs.

Deliver bolus of 5.0 units