Pump (and Life) Upgrade

[aphex2k]

Morning all.

Been using the Accu-chek Spirit combo for three years. Lots less hypos but I'm at a bit of a low spot (burning out - 20 odd years of T1) and pretty bad at testing my levels at the moment. I do a couple of times a day, but not as often as I should.

Anyway, my health insurance has OK'd a pump upgrade so I'm switching to the Medtronic with CGM which I'm pretty chuffed about and should receive soon.

Just wondering if anyone has any tips that my team might not necessarily know or advocate? I carry my Spirit in my jeans pocket as it feels in the way clipped onto my belt - the Medtronic seems a little bigger? How does everyone else carry?

I'm assuming the kit will also have a glucometer as it seems I need to calibrate the CGM twice a day? Exciting times ahead and a bit of a kick up the bum for me to get back on track. My GP did me a bloods form but I've not done it as I know my Hb will be rubbish (but I guess a good time to do it as my levels should improve with the new pump and CGM?

 

[Juicyj]

Hello @aphex2k I use the Medtronic 640g but have never used any other pump so cannot compare to any others, personally I wear a pump belt with mine so it tucks in around my waist, I can then tuck any excess tubing in there too so keeps it tidy, Medtronic offers 'carelink' which is where you can download results from your pump which your healthcare team can view also, they can make recommendations when you first get going if adjustments need to be made or of course you can also. I haven't used the Enlite CGM with this due to cost, but believe it's a pretty accurate system and works with your pump to stop insulin supply when you hit a certain threashlold, which is quite smart. Have a look at youtube for videos as lots of users like to download clips on there which is good for new users.

I use the Contour Nextlink meter with the pump which bluetooth's the results straight in.

Good luck with it and I hope it does give you some fresh impetus to spur you on with your control

 

[aphex2k]

Worked out a few things and nearly got stung by some crafty marketing. Special introductory offers which actually weren't that cheap! Subscription service for transmitters and sensors mean it'll cost me $250 a month for a box of 5. Consumables are covered by NDSS which is local to Australia and discounted. Just got a pay rise at work which covers cost of sensors and of course insulin costs me too here ($35 for 5 boxes of Novorapid flex).

Rep from Medtronic has been ace. Phones and emails me (about 20 emails back and forth today).

Oh and the pump kit does come with a gluconeter... Yay more consumables.

Pretty excited (but also feelibg a bit cack as my bsl spiked at 24 for some strange reason. I'm normally a bit high but that's way too much.

Will try to report back when the pump arrives once I've figured it all out.

Thanks for replying JuicyJ

 

[aphex2k]

So a little update.

It's fair to say my control, even with my Spirit, was terrible.

I'm 5 days into my 640g and CGM. Wow.

First night I checked my pump. 7.2. But I felt low. A finger test showed me at 2.8. I thought that was odd, but I was paying more attention to the numbers, not the arrows. Quick lesson learned.

The CGM unit had a bit of blood around it, so I must have hit a blood vessel when it went in. I contemplated changing it but decided to leave it in. It wasn't sore and the readings appeared accurate.

Before disconnecting my old pump I checked my averages. Not impressive. 80% of the time I was higher than my range should be.

Five days in, my levels are 90% within range and I'm super happy. I've changed the cannula once and that was a breeze. I'll be changing the sensor tonight.

I'm really happy. I feel like this is a huge step forward and it's saddening that more people can't get this system through their health service. I am very fortunate to have health insurance (I live in Australia) and my "upgrade" was possible as I convinced my fund there was a clinical need to get CGM. I don't feel like the CGM is in the way, or have any trouble (2 small kids who like rough play and jumping on Daddy for cuddles etc).

Calibrating isn't a drama - it's all about timing. I got caught out once having to get up at 5am to do this but that was my fault for doing my evening calibration too early. I've had 2 alarms go off due to approaching low limit while asleep but as I'm a light sleeper, all good.

I carry the pump in a Spibelt around my waist. It's not perfect but it means there's no issues pulling down my shorts or toilet visits.

I find the option to put a "marker" on the pump when I eat things is great as I can see the effect of what I've eaten. I've done a few correction doses split at 60/40% and levels have corrected well.

All in all, I'm super happy. Glad to answer any questions if people are curious of want to know how I'm getting on. I'm also planning to get back into thai boxing and reached out to a Canadian UFC figher who is also T1 and uses a pump and CGM - I was surprised to get a long reply from him and it goes to show how well us diabetics across the world stick together to manage our illness.

Mark

 

[kitedoc]

So a little update.

It's fair to say my control, even with my Spirit, was terrible.

I'm 5 days into my 640g and CGM. Wow.

First night I checked my pump. 7.2. But I felt low. A finger test showed me at 2.8. I thought that was odd, but I was paying more attention to the numbers, not the arrows. Quick lesson learned.

The CGM unit had a bit of blood around it, so I must have hit a blood vessel when it went in. I contemplated changing it but decided to leave it in. It wasn't sore and the readings appeared accurate.

Before disconnecting my old pump I checked my averages. Not impressive. 80% of the time I was higher than my range should be.

Five days in, my levels are 90% within range and I'm super happy. I've changed the cannula once and that was a breeze. I'll be changing the sensor tonight.

I'm really happy. I feel like this is a huge step forward and it's saddening that more people can't get this system through their health service. I am very fortunate to have health insurance (I live in Australia) and my "upgrade" was possible as I convinced my fund there was a clinical need to get CGM. I don't feel like the CGM is in the way, or have any trouble (2 small kids who like rough play and jumping on Daddy for cuddles etc).

Calibrating isn't a drama - it's all about timing. I got caught out once having to get up at 5am to do this but that was my fault for doing my evening calibration too early. I've had 2 alarms go off due to approaching low limit while asleep but as I'm a light sleeper, all good.

I carry the pump in a Spibelt around my waist. It's not perfect but it means there's no issues pulling down my shorts or toilet visits.

I find the option to put a "marker" on the pump when I eat things is great as I can see the effect of what I've eaten. I've done a few correction doses split at 60/40% and levels have corrected well.

All in all, I'm super happy. Glad to answer any questions if people are curious of want to know how I'm getting on. I'm also planning to get back into thai boxing and reached out to a Canadian UFC figher who is also T1 and uses a pump and CGM - I was surprised to get a long reply from him and it goes to show how well us diabetics across the world stick together to manage our illness.

Mark

Hi @aphex2k , Glad to hear you are doing so well. I live in Adelaide as a retired saw-bones and have been on insulin for 51 years, nearly 7 on an insulin pump. Mine is an Animas pump and, as you will know, it is being phased out so next year I will be facing the choice of a new brand. Medtronics vs Tandem as my two front-runners.
Cost has been a factor in my decision to not so far use CGM. But it is heartening to know that at least the Aussie Government is subsidising CGM equipment for up to 18 year old diabetics on pumps via NDSS. My son is not a diabetic but has been a champion kick-boxer, now trainer in Sydney - but I cannot honestly imagine myself doing any form of boxing !! Kite-making and flying is enough for me ! My Best Wishes go to you in your chosen career, his your diabetes, pump and sport!
Please keep us posted on your progress and what you learn.
The sun should really not set without everyone on forum learning something new or different. !! Yeah ! Right !!!

 

[aphex2k]

Hi Kitedoc

Which health fund are you with? I was with HBF but they wouldn't fund a new pump initially. My nurse said switching funds would help so I jumped to Medibank - waiting fees waived and fairly smooth process.

The thai boxing is for fun not a profession (I'm 42 - too old for that) but I am a community psych nurse.

Fortunately I can afford the CGM cost ($250 a month) as the benefits for me are more than financial. I have no experience of the other pump but I'm very happy with the Medtronic.

Give me a shout if I can help in any way!

 

[kitedoc]

Hi Kitedoc

Which health fund are you with? I was with HBF but they wouldn't fund a new pump initially. My nurse said switching funds would help so I jumped to Medibank - waiting fees waived and fairly smooth process.

The thai boxing is for fun not a profession (I'm 42 - too old for that) but I am a community psych nurse.

Fortunately I can afford the CGM cost ($250 a month) as the benefits for me are more than financial. I have no experience of the other pump but I'm very happy with the Medtronic.

Give me a shout if I can help in any way!

Thank you. I am with NIB who have been very good with the pump costs. For example, about 30% of the first pump and 100% of the second and third. I am sure I can claim on the cost of CGM but I have not followed it up recently. I think Medtronics talked about a cost of $4 per day as private-subsidised cost of their brand of CGM but unsure if that is USD or AUD. But that sounds a lot less than AUD 250 per month. Let us keep in touch and share info as we go ?

 

[tim2000s]

@aphex2k - are you aware that a combo can be used as a closed loop artificial pancreas system with AndroidAPS? There are more details here: bit.ly/loopguide

 

[aphex2k]

Hi Tim. I've not looked into this at all and it's hard to read on my phone.ill have a look at work in the morning, properly. Am. I right in thinking this helps deliver insulin rather than bolus, in a more natural way? As a lover of gadgets this appeals greatly. But, I'm less than a week into this new pump and cgm so I'll give it some time yet. Early results are impressive. I'll have a proper read and we will see where it goes! Thanks for the info.
Matk

 

[aphex2k]

Had an alert to say sensor not working properly, insert new sensor. I've done this but it didn't reset the 6 day warning and it still says I have 1 day left.. Can't find how to reset the 6 day timer? I stopped the previous one and it showed new sensor warming up and calibration. What have I done wrong?

After the error I disconnected the lot, disabled the sensor in the pump settings, recharged the transmitter and added new sensor. Tried to turn off the sensor again and re-added it, but it still shows < 1 day left.

 

[Sweetheart66]

Had an alert to say sensor not working properly, insert new sensor. I've done this but it didn't reset the 6 day warning and it still says I have 1 day left.. Can't find how to reset the 6 day timer? I stopped the previous one and it showed new sensor warming up and calibration. What have I done wrong?

After the error I disconnected the lot, disabled the sensor in the pump settings, recharged the transmitter and added new sensor. Tried to turn off the sensor again and re-added it, but it still shows < 1 day left.

I would ring the helpline and also see if they will reimburse you for any sensor that still had time remaining.

 

[aphex2k]

Well I managed to get it working. For some reason... I removed the transmitter, then re-added it. It wouldn't find it while it was in the charging dock, but I found that if I removed it and hit search on the pump, while the transmitter was flashing, it sync'd back up. Now showing 6 days left and a new sensor is in place.

 

[tim2000s]

Well I managed to get it working. For some reason... I removed the transmitter, then re-added it. It wouldn't find it while it was in the charging dock, but I found that if I removed it and hit search on the pump, while the transmitter was flashing, it sync'd back up. Now showing 6 days left and a new sensor is in place.

Looks like you've discovered the mechanism - when you remove the transmitter, to reset it you need to charge it. If you don't it retains a state memory (mainly as a mechanism for stopping people restarting and extending the sensors beyond six days). If you remove the transmitter, charge it for a bit, then put it back on, you can get more than 6 days out of each sensor. That's particularly useful when you have to self fund the sensors.

 

[aphex2k]

Looks like you've discovered the mechanism - when you remove the transmitter, to reset it you need to charge it. If you don't it retains a state memory (mainly as a mechanism for stopping people restarting and extending the sensors beyond six days). If you remove the transmitter, charge it for a bit, then put it back on, you can get more than 6 days out of each sensor. That's particularly useful when you have to self fund the sensors.

That's the thing, it was fully charged. The lights had stopped flashing. (I disconnected befote my dinner and put it on charge for about 30 mins).

All working now, happy as a pig in.... Mud.

 

[aphex2k]

So a couple of weeks now. Now showing I'm 94% within range. Super stoked!!!

And starting back at training on Weds and Thurs this week. Brazilian Jujitsu on Weds and Muay Thai on Thurs. Will be really interesting to see how this goes. Been advised to check before, keep some Gatorade type drink handy. Disconnect the pump and bolus the amount I would have had for that hour if the pump was connected. I'm probably going to have to experiment with sensor and transmitter placement as it's currently L side belly but it *might* be in the way there. We shall see!

 

[aphex2k]

Did my first BJJ class last night. Checked my levels before I started, all good. Disconnected the pump and removed cannula but left the CGM in place. Forgot to silence the pump so it started beeping in class, quite a lot and it took a while for me to figure "oops, that's me!".

Anyway, levels increased rapidly towards the end of the session and ramped to just over 20 around 45 mins after the session and I understand this is a physiological response to an extreme workout. I wondered if in these circumstances I should get hold of some ultra fast acting insulin like Actrapid or Apidra? What are your thoughts?

 

[kitedoc]

Hi @aphex2k, I am afraid that is the downside to energetic sports. I would see what your Canadian pal does to manage it as he has the best way to compare with you. I have tried bolusing in some of the short-acting pump insulin 1 hour before energetic sport in the past whilst dropping the basal 20 % or more for approx. 4 hours as I know that the BSL will drop around the 6 + hours mark.
The thing is that that I find the effect of adrenaline on BSL (usually from a hypo but in the past from really vigorous exercise also) can take 2 + hours to peak in BSL level.
Actrapid is what I used way in the past before pumps and its peak was too late to deal with food.
The short acting insulin in the pump is what I have always relied on for correction and bolus. For that I am on Novorapid for which I allow about 1/2 hour, between bolus and eating.
With your CGM, may be some bolusing and some trial and error, all in conjunction with your doctor/DNE, you might to able to successfully blunten the BSL rise from adrenaline surge.
Fingers (and toes) crossed !!

 

[aphex2k]

Hi @aphex2k, I am afraid that is the downside to energetic sports. I would see what your Canadian pal does to manage it as he has the best way to compare with you. I have tried bolusing in some of the short-acting pump insulin 1 hour before energetic sport in the past whilst dropping the basal 20 % or more for approx. 4 hours as I know that the BSL will drop around the 6 + hours mark.
The thing is that that I find the effect of adrenaline on BSL (usually from a hypo but in the past from really vigorous exercise also) can take 2 + hours to peak in BSL level.
Actrapid is what I used way in the past before pumps and its peak was too late to deal with food.
The short acting insulin in the pump is what I have always relied on for correction and bolus. For that I am on Novorapid for which I allow about 1/2 hour, between bolus and eating.
With your CGM, may be some bolusing and some trial and error, all in conjunction with your doctor/DNE, you might to able to successfully blunten the BSL rise from adrenaline surge.
Fingers (and toes) crossed !!

Oddly actrapid and apidra have the same sort of timescale as Novo rapid. 15 mins to start, and hour at peak and around 2 hours tailing off.

Also oddly, just got back from the Thai class. Bsl is fine. No spike. Probably more cardio than the bjj class. I also have mountain biked for many years and never had such a rise after activity that the bjj class did. Very strange. I feel absolute fine now and been back an hour and a half. Thus time yesterday I was shooting up to 20.

 

[kitedoc]

Oddly actrapid and apidra have the same sort of timescale as Novo rapid. 15 mins to start, and hour at peak and around 2 hours tailing off.

Also oddly, just got back from the Thai class. Bsl is fine. No spike. Probably more cardio than the bjj class. I also have mountain biked for many years and never had such a rise after activity that the bjj class did. Very strange. I feel absolute fine now and been back an hour and a half. Thus time yesterday I was shooting up to 20.

I guess the manufacturer's peak and duration times are based on averages. Also I forgot to mention that I believe Actrapid is not as reliably absorbed as the newer insulins. I wonder whether the BBJ class requires more mental concentration and this "stress" caused the high BSL. It may be that over time the routine becomes more familiar and thus less stressful ??

 

[aphex2k]

I guess the manufacturer's peak and duration times are based on averages. Also I forgot to mention that I believe Actrapid is not as reliably absorbed as the newer insulins. I wonder whether the BBJ class requires more mental concentration and this "stress" caused the high BSL. It may be that over time the routine becomes more familiar and thus less stressful ??

Yeah maybe. I'm on a 7 day trial of all the classes. I've done Thai before, albeit 20 years ago before diagnosed. I'm happy just doing this 2 nights a week. I can cope with that. Although I'm going to be sore tomorrow!