Throwing an idea out there - please feel free to shoot me down if this has been said before

[tim2000s]

ST5 (whatever that means) endocrinology trainee

A quick google search reveals that this is someone in their 5th year of specialty training to become an endocrinology specialist.

 

[Fayefaye1429]

It's all interesting points everyone has made and equally valuable. I guess for me I remind myself keystones sticks are not 100% as are pumps or test strips. I unfortunately as I feel a bit cured have occurred errors in all of the above and have found d k a even if my bloods weren't high. It's all rare cases but it keeps me mindful that technology can breakdown As easy as my body and sometimes a hospital trip is needed

 

[iHs]

A quick google search revealbasal bolus regimet this is someone in their 5th year of specialty training to become an endocrinology specialist.

5 yrs is no time at all and I bet the only knowledge gained is through the basal bolus regime using analgue insulins with no experience using the older more predictable action with animal or the other older variations. l

 

[donnellysdogs]

My point is that if you test at the required amount of times then you will catch any rise in blood sugars that need to be addressed..
If a pump bolus doesn't fix it then you inject as per the manual of pumping.

Not all the time if a pump fails at night.. Despite doing a 3am test but not waking up till 9pm my levels along with waking phenomen sky highed... By the time you first change everything because you don't know its a failure.. And could assume set failure, battery etc and despite a bolus you have gone without insulin for a long while (as its only short acting).. Levels can rise to DKA nigh on 30 very, very quickly...

Same as I was in 5's pre driving as a passenger.....bolused for food before left... No alarms... Set faulty but didn't know it...Was on a motorway..tested and due to eating was at 28 by time I tested two hours later....no where to pull over and get needle out back of my car...only had sweets actually in handbag. Car was jam packed and could not get to injection....got set out and repositioned it and slammed through high bolus's until could pull over at services which- when you want them seem miles!!!

You cannot define when you are going to have problems... I had another one in a cafe... After I had bolussd it alarmed... I had 6 layers of clothes on due to working outside... And you never know when these things will happen.

Fortunately for me as I was such a prolific tester I caught early) and got levels reduced very quickly and never tested ketones (never have to be honest)...

On MDI I actually value knowing the insulin is in me!! If I don't want to test 2 hourly I don't have to..

 

[ann34+]

Not all the time if a pump fails at night.. Despite doing a 3am test but not waking up till 9pm my levels along with waking phenomen sky highed... By the time you first change everything because you don't know its a failure.. And could assume set failure, battery etc and despite a bolus you have gone without insulin for a long while (as its only short acting).. Levels can rise to DKA nigh on 30 very, very quickly...

Same as I was in 5's pre driving as a passenger.....bolused for food before left... No alarms... Set faulty but didn't know it...Was on a motorway..tested and due to eating was at 28 by time I tested two hours later....no where to pull over and get needle out back of my car...only had sweets actually in handbag. Car was jam packed and could not get to injection....got set out and repositioned it and slammed through high bolus's until could pull over at services which- when you want them seem miles!!!

You cannot define when you are going to have problems... I had another one in a cafe... After I had bolussd it alarmed... I had 6 layers of clothes on due to working outside... And you never know when these things will happen.

Fortunately for me as I was such a prolific tester I caught early) and got levels reduced very quickly and never tested ketones (never have to be honest)...

On MDI I actually value knowing the insulin is in me!! If I don't want to test 2 hourly I don't have to..

Diabetes seems very individual - different insulins - i use porcine - and different delivery systems suit different people's diabetes. I have never had a blood test get to even 20 in nearly 36 years of Type one, on injections or on the pump, testing many times a day, every day. But I have had the lowest level of ketones on the pump a couple of times, and on injections i had medium ketones when ill at only 13 blood glucose several times, and medium high ketones when i had shingles, and on injections i had hypo problems. For me, knowing what insulin is in me is not necessarily a great deal of help, it is how my body is using it that would be important to know, and i cant - this is difficult as i am sensitive to insulin and so may end up with either too much or too little very quickly. I remember one of my consultants explaining how complex things were, and that insulin is circulating in the presence of numerous different hormones which, together, can have all sorts of effects on insulin use, opposing it, or facilitating it....and that it would not be possible to have test strips to test for all of them.

 

[Spiker]

The advice from Medtronic is here, it's more or less what I was told at the start..http://www.medtronicdiabetes.co.in/highbloodglucoselevels

Maybe my pump training on DKA was ****. We didn't have anything like the aggressive protocol shown here. Go to pens / syringes in one hour if BG does not fall and immediately if ketones are positive? That is incredibly aggressive (or conservative, depending how you look at it). Yes if I had been taught that protocol I would probably never had DKA on a pump.

I amazed they advise giving up on a pump that easily because a non pump bolus creates a lot of problems. IOB is screwed immediately which means the bolus wizard is screwed immediately. In fact the bolus wizard is at risk of giving you hypos - potentially more serious than DKA. Also means you can't test if delivery is working properly after a set change. Which you are going to do in such circumstances. So you are changing one set of problems for another.

 

[Spiker]

I can't quote that diapedia quote for some reason but I see potential weasel phrases.

"Incidence now lower" - lower than it was before on pumps, or lower than MDI? It's sure to be the former not the latter but is ambiguously phrased.. How about stating whether or not the incidence on pumps is or isn't higher than MDI?

"Pump failure is less common now". Yes but so what. It's whole system failure that matters. Infusion set failure is an unstudied problem. There is almost no data.

Alarms, same issue.

In the space of less than a year on the pump I have probably had fifty system failures of which no more than two or three triggered alarms and would be narrowly considered "pump" failures.

These statements and stats are highly misleading in my view. There needs to be empirical data on whole system failure, and / or specific studies on Infusion sets which IMO are by far the weakest link in the chain.

 

[azure]

Yes, the infusion sets are definitely the biggest problem. I'm suspecting I have a dodgy one today. No awful high sugars (yet) but my blood sugar is higher overall than yesterday, and, from experience, I suspect the site.

It's extremely frustrating to have a clever little pump sabotaged by the variables of infusion sets.

 

[Fayefaye1429]

All I can say is pumps are technology technology has a 5% error margin. Personally I will never trust my pump completely and I don't think it's a bad thing as long as I am awRe of what to do I. Emergancies

 

[Fayefaye1429]

I must admit I haven't had a bad set since moving pumps to non wired

 

[Spiker]

That medtronic protocol is amazing. They are basically saying in the presence of ketones or disease, any kind of resistant BG, ditch the pump for bolus. And how exactly do you get "back on the wagon"? What's the protocol for that? Serious question as we were not taught that either, which is another strong disincentive to use pen bolus when the pump bolus doesn't seem to be working.

What we were taught was if BG is unresponsive to BG then do a set change. If still unresponsive after set change replace everything. If still unresponsive go to pens. That's more like 12 hours before going to pens rather than 0/1 hour. Throw in a sleep period or two and/or some hyperglycemic confusion / stupidity into the mix and you have a recipe for disaster. And, like both of my hospitalisation cases, throw into the mix an unexplained BG drop, where the pump *appears to work* (briefly), and you have actual disaster.

 

[Spiker]

It's extremely frustrating to have a clever little pump sabotaged by the variables of infusion sets.

It's penny wise, pound foolish. Thousands of pounds worth of pump and many many millions of pounds of R and D, all undermined by poor quality assurance on 50p worth of plastic.

 

[Fayefaye1429]

I was told keep a record of basal so you can inject if pump has error turns off not working. They usually say split your basal so if you find it suddenly works you can plan to go back without a crash. I'll change the site once if no moved after 30 minutes in on the pens so I get down then figure out what's up or ring the emergency pump number. I would never wait longer than 1 hour thiugh

 

[Spiker]

Emergency pump number? What's that? We had DSN support for 2 weeks. If you call Animas they say "for emergency medical support call 999".

 

[Fayefaye1429]

Ah I am with omi pod if the pump gas any problems you can ring 24/7 to talk to someone about it. Medtronic were similar but I must omi pod also have nurses that can ring you back

 

[Fayefaye1429]

Each company should supply a 24hoyr helpline though

 

[Fayefaye1429]

Spiker I am not sure this might help maybe not

https://www.uclh.nhs.uk/PandV/PIL/Patient information leaflets/What to do if my pump breaks.doc

 

[ann34+]

Ah I am with omi pod if the pump gas any problems you can ring 24/7 to talk to someone about it. Medtronic were similar but I must omi pod also have nurses that can ring you back

Medtronic are very good - you phone anytime 24/7, and out of UK hours i am redirected free to Medtronic USA - i have not needed this line much but did contact them when there was a problem and the pump tubing detached from the pump .

 

[Spiker]

Animas also redirects to a 24/7 support line in the US but it is technical support not medical support.

 

[Fayefaye1429]

What medical support would you like spiked?