Pump (and Life) Upgrade

[aphex2k]

So another week or so in, still great.

One little niggle is I've found the Mio cannula can be a bit hit and miss as to how well it goes in, if at all. I've watched all the vids, know not to press to hard or pull out before the sticky has stuck, but twice now I've installed a new cannula, my BSL has crept up, I've bolus'ed, and it's kept going up. I've then changed to cannula and it's started working again. No air bubbles etc, just seems very delicate? This is with the flexible plastic cannula - has anyone experience with the stainless ones?

Also, is it possible to get the cannula and some sort of insertion device seperately from the tubing? Seems and awful waste of plastic to have to keep replacing the tubing, or discard new tubing to safe totally resetting the cartridge. Actually there seems to be a whole heap of wasted plastic throwing away the Mio case - is there an alternative?

 

[tim2000s]

The Mios are not great in terms of the insertion device. The Mio Advance are the new ones and have a separate tube, but they are more expensive.

I wondered if in these circumstances I should get hold of some ultra fast acting insulin like Actrapid or Apidra? What are your thoughts?

In regard to your class, Actrapid is regular human insulin and is slower than Novorapid, Humalog or Apidra. Fiasp is faster.

If you are doing anaerobic classes (HIIT for example, which is what the BJJ class sounds like), you may be better off not taking your pump off, and running a low basal rate before the class, then leaving it on during the class so that you have insulin on board for the end of the class, stopping that spike.

 

[Juicyj]

Hi @aphex2k I didn't get on at all with the mio, had lots of failures with sets not inserted properly and kinking and and also suffered rashes and lumps, I now use the Sure T which is a stainless steel tip and had very little issues with this, also much easier to insert.

 

[aphex2k]

Hi @aphex2k I didn't get on at all with the mio, had lots of failures with sets not inserted properly and kinking and and also suffered rashes and lumps, I now use the Sure T which is a stainless steel tip and had very little issues with this, also much easier to insert.

Yeah the Mio seems hit and miss. They seem to be "miss" when I'm using the last one I have with me, but luckily I work in the community so I can nip home and pick up spares - not idea though.

I find the tubing is a much softer plastic than my previous Accu-Chek setup and I wonder if it might kink / occlude while I sleep as I put my pump just under my pillow.

I was looking at the Sure T but couldn't work out why there were 2 parts to it. The site says something about easier to clear blockages (what blockages? Never had one!). Are they easy to insert? And do they come with a ridiculous amount of plastic packaging? Pains me every time I throw another chunk of plastic destined for landfill.

I've not seen the MiniMed Mio Advance here in Oz yet. Looks a more suitable system for insertion but I'm guessing it's yet more plastic waste? (IPC are heavily subsidized here, as are test strips. I pay $250 a month for the sensors though but I can deal with that. I'm sure it won't be long before the Advance cannula are available)

 

[Juicyj]

Yeah the Mio seems hit and miss. They seem to be "miss" when I'm using the last one I have with me, but luckily I work in the community so I can nip home and pick up spares - not idea though.

I find the tubing is a much softer plastic than my previous Accu-Chek setup and I wonder if it might kink / occlude while I sleep as I put my pump just under my pillow.

I was looking at the Sure T but couldn't work out why there were 2 parts to it. The site says something about easier to clear blockages (what blockages? Never had one!). Are they easy to insert? And do they come with a ridiculous amount of plastic packaging? Pains me every time I throw another chunk of plastic destined for landfill.

The sure t has 2 parts which means you can disconnect from the pump for events such as bathing/swimming, also if you do get a block (i've had a couple) then you can do a cannula refill by removing the pump and 1 part of the cannula and checking for blockages more easily in doing so. The crucial info is that the sure t is much more reliable.

Sadly in regards to the 'eco friendliness' of such systems is that they need to maintain a sterile cannula set so waste is an unfortunate issue which is what it is and it's vital to avoid potential for infection.

 

[aphex2k]

Cheers - looks interesting. Cost wise they're the same for me. Do they come in boxes of 10 like the Mio?

Totally understand about infection control etc, but tonnes of medical consumables come in sealed paper/plastic packaging and have things like colour coding so you can tell if the pack has been damaged. Still waste, but soft plastics are more recyclable compared to the amount of waste there is from a Mio cannula / inserter.

Fundamentally the design of the Mio delivery system leaves much room for errors. I notice that when you prime it before insertion, the delivery "needle" doesn't always remain straight and central. Also, you have to be super careful removing the white backing from around the sticky dressing, as this can dislodge the cannula and also leave it the insertion needle off centre. If you don't spot this, you can line up the device as straight as you like, but it's not going to go in straight. What an odd system. The Accu-Chek was far simpler. It could just be me but I've watched the vids over and over. I've got one Mio left so I need to order more, probs the T's. As far as sizing goes - I'm using the 6mm Mio, I guess the 6mm Sure T are the ones to go for. $16.70 a box of ten which equates to about a quid each.

Cheers for the info

 

[Juicyj]

Hi @aphex2k Yes 10 in a box and I get the shortest tubing available on the set, so the total length is 46cm however the attachment to the pump is only 29cms so less tubing to keep it neat:

6mm Cannula/ 45cm Tubing/ pack of 10, Product Code: MMT-862

 

[aphex2k]

All sorted. Found a pharmacy close by that has stock of various Medtronic kit so was able to get a couple of boxes of Mio's and some reservoirs. None of the other cannula in stock but they'll have them in tomorrow so I'll give them a whirl.

Updates will follow

 

[aphex2k]

So I'm a month in now to the the new pump.

Overall very happy, and my levels reflect this. Clearly stable sugars has a drastic effect on my mood which I hadn't appreciated and perhaps I was in denial or just "over" my previous system, expecting miracles, but I feel better in many ways with the new pump and CGM. I am more motivated and more aware of foods which I'd previously not given much concern to. Being able to see the graph / arrows on the pump has given me some real "ah sh!t" moments and probably fell into the "ignorance is bliss" attitude. After 20+ years I was definitely blase.

No problem at all with the pump. The Mio cannula's are hit and miss for me. Sometimes they work and go in fine. Sometimes not. I'm careful when inserting them, but still have a few issues. I've got myself a couple of boxes the Sure T cannula's but not tried one yet.

I've had a couple of weeks off from muay thai training due to a brief trip to Sydney and my wife being away at a conference so Daddy mode was in full swing, but going back to it next week and hopefully will kick (lol) back in to 2 nights a week. Managed a few hours out on the bike yesterday as it was Father's day here in Oz and I was due a ride in the sunshine as it's officially spring here now.

I'm also keeping my eye on the Medronic site and Facebook group as they are saying as soon as the 670g sensors have been approved, I will be entitled to an upgrade, which appears to be good news - hybrid closed loop system.

Feel free to PM me any q's or reply to the thread here if you want any info, happy to assist where I can. Also welcome tips and tricks from other users of the system!

Have a great day.

 

[aphex2k]

Ok so I'm not having much faith in the Mio. This evening my levels have gone up and up. Correction bolus x 2 with no effect. So I remove the cannula to see a bit of fresh blood. By the time I've opened a skin cleaning swap there's a big bubble of blood and it's dropping down. ***. I've literally sat on the sofa this evening and listened to music. Nothing vigorous. I'm not sure what's happening or why I'm not having much luck with the Mio.

So I watched a couple of vids on the Sure T. Straightforward. But why is the connecter from the pump tuning to the connector a different fitting? That seems daft! Anyway, 6mm cannula went in no problem close to my belly naval area, and the other sticky bit further to the side. 60mm tubing to the pump. I carry my pump on my right side and the cgm on my left side. Might take a few attempts to get used to placement as I do tend to sleep right sided. Will see how I get on with this one.

Let's see how I get on with this method. I wonder if 6mm is too short and I'd be better off with 8mm? Time will tell. I'm fairly slim but I do have a bit of belly spread! Haha age gets to us all.

 

[Sweetheart66]

Ok so I'm not having much faith in the Mio. This evening my levels have gone up and up. Correction bolus x 2 with no effect. So I remove the cannula to see a bit of fresh blood. By the time I've opened a skin cleaning swap there's a big bubble of blood and it's dropping down. ***. I've literally sat on the sofa this evening and listened to music. Nothing vigorous. I'm not sure what's happening or why I'm not having much luck with the Mio.

So I watched a couple of vids on the Sure T. Straightforward. But why is the connecter from the pump tuning to the connector a different fitting? That seems daft! Anyway, 6mm cannula went in no problem close to my belly naval area, and the other sticky bit further to the side. 60mm tubing to the pump. I carry my pump on my right side and the cgm on my left side. Might take a few attempts to get used to placement as I do tend to sleep right sided. Will see how I get on with this one.

Let's see how I get on with this method. I wonder if 6mm is too short and I'd be better off with 8mm? Time will tell. I'm fairly slim but I do have a bit of belly spread! Haha age gets to us all.

Have you ever tried the Quicksets?

 

[aphex2k]

Have you ever tried the Quicksets?

Another method.......? Looks like I'd need another plastic inserter tool? I'll see how I get on with the sure T. So far so good. Just woke up and it's still in place, I'm not slowly bleeding to death, and my bsl has been stable over night.

 

[aphex2k]

Just had a review at the GP - bloods all good. hb at 8.5 but would have been higher I think with the previous pump and non-cgm testing so I'm happy with that. Bloods again in 3 months and referral for podiatry checkup. Clean bill of health.

 

[aphex2k]

Still getting on reasonably well. It's warming up here (30c now) so my levels are going a bit ping-pong. High, correction, low, eat, high. This usually happens.

Installed a new sensor last night. Felt ok going in, then noticed I was bleeding all down my leg - quite a lot! I was sure it was level and went in right but due to the amount of blood and the soreness afterwards I removed it and put a new on in. Another $75 down the drain. I emailed them this morning to see if it can be replaced. Worth a shot.

Went down to 2.2 at 2.30 last night. I heard the beeps and the vibration, I was just super tired and kept turning off the alert, but the pump stopped delivery thankfully, and I dozed at 2.2 - 2.5 until 5am when I got annoyed by the beeping and got up, had a slice of bread with jam on and went back to bed.

Have found that 2 x 1 hour classes of muay thai drop my levels by around 4-5 so I have been starting the session around 10mmol/L and by the end of the sessions I'm down to around 5mmol/L which works for me. Doesn't seem to significantly drop much after this and I have dinner once I get in - I should have a shower but I think the hot water might lower me more, so a good feed gets priority.

Still doing the cannula on the right and the sensor on the left. Would be interested to hear where others put their sensors? I usually change the site so that a new sensor/cannula is a good 2-3cm away from the old site.

 

[Sweetheart66]

Still getting on reasonably well. It's warming up here (30c now) so my levels are going a bit ping-pong. High, correction, low, eat, high. This usually happens.

Installed a new sensor last night. Felt ok going in, then noticed I was bleeding all down my leg - quite a lot! I was sure it was level and went in right but due to the amount of blood and the soreness afterwards I removed it and put a new on in. Another $75 down the drain. I emailed them this morning to see if it can be replaced. Worth a shot.

Went down to 2.2 at 2.30 last night. I heard the beeps and the vibration, I was just super tired and kept turning off the alert, but the pump stopped delivery thankfully, and I dozed at 2.2 - 2.5 until 5am when I got annoyed by the beeping and got up, had a slice of bread with jam on and went back to bed.

Have found that 2 x 1 hour classes of muay thai drop my levels by around 4-5 so I have been starting the session around 10mmol/L and by the end of the sessions I'm down to around 5mmol/L which works for me. Doesn't seem to significantly drop much after this and I have dinner once I get in - I should have a shower but I think the hot water might lower me more, so a good feed gets priority.

Still doing the cannula on the right and the sensor on the left. Would be interested to hear where others put their sensors? I usually change the site so that a new sensor/cannula is a good 2-3cm away from the old site.

You could put on a temp basal while exercising. I lower mine to 50% when I'm at work.

 

[aphex2k]

But the problem is, it's physically attached to me, and could get kicked or kneed. Starting off at 10mm when I start training, usually keeps connection to the sensor so I can still see the graph/trend when I grab some water.

 

[aphex2k]

Ah soooo

Last Tuesday my levels at work kept going skywards. Correction dose, not doing anything. So over the course of the morning, meetings and appointments, I ended up at 22 and feeling really rather unwell. Used a ketostix and a lovely shade of dark purple. Dizzy, sick, blurry vision. Got taken to ED by a colleague, triaged and seen immediately. Blood work all good. Levels peaked at 23 but starting to come down now. Sat in ED for about 4 hours. No infection, cold, flu, illness etc... Just strange. The only thing they could think was the cannula was not inserted correctly or had dislodged, but that didn't explain why my levels were coming down nicely. Very odd. So was discharged from ED and went back to work for the afternoon.

Went to muay thai class when I got home, didn't feel 100% accepted that I had spent the morning in ED. But when I got home I had the WORST stomach ache and spent (what felt like) three hours going to the loo.

Next day, fine.

Really odd. I've had high sugar before but never ever felt that unwell that I needed to go to ED!

 

[Keep Smiling!]

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

 

[aphex2k]

New pump arrived this morning. The option to have vibrate and audible alarms went haywire and would do one or the other and the volume was stuck on max. Will be spending the evening setting up the new pump.

Totally switched to the Sure T infusion sets. Way easier than the Mio. Less plastic waste too.

Problems with shipping new sensors too. Out of stock and waiting for deliveries at the warehouse in Sydney, then another 3-4 days to deliver to WA. Constantly having to contact them to send more. Not the smoothest of systems.

 

[kitedoc]

Good to hear you are getting here with the new pump @aphex2k. I am using the equivalent infusion sets from J&J.
So far the only problem has been leaks around the metal cannula on day 2 with one set.
I am wondering whether with the hot weather either the adhesive patch is lifting and causing the needle to dislodge enough to allow the leaking over time or whether with heated skin the needle slides around more easily.
Today I will be walking through Adelaide city for an hour or so both to and fro a meeting in 33 degrees C max. temperature and have some small cold gel packs which I am going to apply around the adhesive patches.. (an old gel set looking like glasses which is supposed to be used around the eyes. so there is a gap for the needle site and the secondary patch site)
Not sure if it will work but if at least it keeps the sweating down that might help!