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Accuchek airbubbles

As to why insulin ends up on the piston rod, is more to do with the user than the manufacturer to be honest, when we expell the air out of the cartridge when we are filling it, a mixture of air and insulin comes out, and this tends to run down the side and who wripes there cartridge off before putting it into the pump chamber? I tend not to I must admit..

The cost to the NHS service is not really here or there when it comes to lost insulin due to priming and wouldn't amount to a lot over a year...

I would agree that changing sets due to failure has a bigger impact on overall costs, I've been pretty lucky on this score and not had that many sets fail but I'm sure this is because I self insert as this avoid kinking the cannular hitting muscle underneath, as so far I haven't had a set fail to kinking...

Oncclusions are probably my biggest concerns, due to having to have missed 3 units of insulin before enough presure is on the pistion rod to trigger the pump alarm as this for me can mean I haven't recieved any basal for over 6 hours :shock: But thankfully the couple of times I've had this I've picked up on a bolus so avoided problems so far...

At the moment it's probably beyond any manafucturer due to not only available techonology but sheer cost if technology if it was available to implement us earlier warnings of a failed infusion set or non delivery, I should imagine that all the verious manufacturers are working with this, as they know who ever comes up with a cost effective method of doing so launches themselves into the king pin position of insulin pumps..

Perhaps the differnce to how I view these problems with insulin pumps (as it's common to all manufacturers and not just Rouche) is that I had to fight a 3 year battle to get my pump, and you were lucky enough to have yours offered without fuss as soon as it was indentified you were a suitable candidate for one! Due to my battle I was aware of these niggles, you wouldn't really have had the time to do similar background research, so had a slightly clouded misguide perspective?

And I don't mean that in any insultive way, just an explination to why our views are so different
 
this is one area I dont have problems with lol....

Just ensure the cartridge is taken out of the fridge a couple of hours before use. Tap it on the worktop to get the bubbles to the top before putting it in the pump. I also tap the pump on the worktop whilst priming and continue stopping/starting the tapping till all buubles are clear.

You actually need to wait until the pump pusher thingy is properly set in the cartridge, this can take a few units. I'm usually ready once I get to the 18/19 mark. All the bubbles are gone by then.
 
There are two of us at our household that are both type 1 diabetics and have both been on the Roche Accu-Chek Spirit Combo since it was first released and have both had numerous issues and problems.
Like all you others we have both seperately complained to the Pump Care Line Team, The Rep at the Hospital, Senior Marketing Manager for Infusion Sets in UK for Roche UK etc, and every time about every problem it is only us that has had the problem. We have at different times had different problems but yet it is still us. Keep going back to the Hospital and have it all checked out that we are doing everything by the book no short cuts are being made to make all the air bubble problems happen that have happened. When Roche changed the infusion sets manufacturers last October we both had raised levels at different times. We were told it is only us. Had to send some of the infusion sets back to be tested. sent out more and the glue was different and I am allergic to the new glue and plaseter used. Again was told only me it happened to it has not changed had to go back again to hospital to prove to the Roche Rep and DSN to find out I was right the tubing was also thicker and of a stronger plastic. Had to show was not working. BIG PROBLEMS. Contacted Head Quarters in Switzerland and they passed it back to the Senior Marketing Manager in the UK. Was asked to try the Rapid D which was absolutely uncomfortable and being slim built found it so irritating and could not rest no matter how I walked, sat or laid every time caught it it felt like I was being stabbed this did not last.After second day had enough. Then yet another infusion set tried had problems again with the glue and plaster still had bubbles at the leur lock end and in tubing. Was told to try a different length tubing that was obviously the problem because the tubing was too long. This made no difference still bubbles in same place. Constant priming, changing sets, irritable because of lack of insulin with it not working properly, having to have numerous manual pen injections to try and get levels down and stop ketones. On one occassion it was disasterous did end up in hospital A&E could not do anything. Checked for Ketones, infections, blood tests etc, sent home then hypo within 4 hours of being home due to faulty infusion sets and equipment.
We both tried Apidra insulin and it still caused Air bubbles at the same place the Leur Lock end and tubing. Senior Marketing Manager at Roche UK and Hospital Rep has now told us to go elsewhere because they can not provide any further help or infusion sets due to the Accu-Chek infusion sets they have avaiable and causing us both serious problems with our Diabetes Management not being able to control the Air bubbles which is clearly out of our hands. Was assured by Senior Marketing Manager that if we go to another supplier for our infusion sets it will not affect or invalidate our Pump Warranty as they told us last year that the warranty would not be valid for our infusion sets. I have this in writing from Roche UK Personnally and have issued this to our hospital.
We are currently trying infusion sets from elsewhere eg. Metronic, Animas etc and we will keep you all updated how we both get on with these other infusion sets we are trying.
 
ACCU-CHEK COMBO INSULIN PUMP

TWO OF US IN THIS HOUSEHOLD HAVE THE SAME PUMP TO PREVENT PROBLEMS BY USING A NORMAL SPIRIT INSULIN PUMP AND THE OTHER PERSON IN THE HOUSE USING THE COMBO SO INITIAL THOUGHTS WERE HEY WE MAY AS WELL BOTH USE THE SAME ONES SO WE BOTH KNOW WHAT TO DO IF EITHER OF US ARE HYPO AND THE PUMPS NEED AMENDING OR LOWERING OR EVEN STOPPING.
NUMEROUS PROBLEMS FROM 3MONTHS INTO BEING ON THE PUMP. THE PDA BLOOD GLUCOSE METER DID NOT WORK WOULD NOT RECOGNISE THAT BLOOD TESTS HAD BEEN MADE, CARBS ENTERED AND INSULIN BEING GIVEN. THE TARGET RANGE REPORT GRAPHS/TABLES IN MY DATA ON THE HANDSET DID NOT WORK ON BOTH OUR PUMPS AND HANDSETS. CONTACTED ROCHE PUMP CARE LINE TEAM WHO SAID WE WAS DOING SOMETHING WRONG AND THE PUMP AND METER HAD NOT BEEN SET UP PROPERLY WHEN INITIALLY PUT ON IT BY THE ROCHE REP AT THE HOSPITAL. CONTACTED HER BY PHONE AND LATER TO BE TOLD TO CALL BACK THE CARE LINE TEAM AND SPEAK TO TECHNICAL IT WAS NOT KNOW WHAT WAS WRONG AND THEY WOULD PUT THE PROBLEM RIGHT MEANS AS WE WERE THE ONLY PEOPLE TO GO THROUGH HAVING THIS PROBLEM.WHAT A LAUGH NO-ONE AT ROCHE KNEW. THEY HAD TO SEND OUT TWO COMPLETE NEW PDA'S /HANDSETS AND WE HAD TO PROGRAMME THEM UPTO THE PUMPS THEN RETURN THE FAULTY ONES FOR TESTING TO ROCHE UK. WHAT DO YOU KNOW LOTS OF PEOPLE HAD THE SAME PROBLEM EXCUSES IT WAS A NEW PUMP TEETHING PROBLEMS OCCURED AND THOUSANDS WERE ACTUALLY RETURNED AND REPLACED ON A RE-CALL. PLEASE SEE MY OTHER LISTING ( ACCU-CHEK AIR BUBBLES) WITH REGARDS TO AIR BUBBLES IN BOTH OUR INFUSION SETS. DIFFERENT LENGTHS, DIFFERENT SIZE CANNULAS WERE ALL TRIED, ALL THE OTHER INFUSION SETS SUPPLIED BY ROCHE WERE ALSO TRIED ALAS DO NOT WORK FOR EITHER OF US. AGAIN TOLD BY EVERY MEMBER OF THE PUMP CARE LINE TEAM INCLUDING SENIOR MARKETING MANAGER OF THE ROCHE UK ASWELL AS THE HOSPITAL REP THAT ALSO INFORMED OUR DSN IT WAS ONLY US IT HAPPENED TO IS A COMPLETE AND UTTER LIE. ALL IS EXPLAINED IN THE OTHER LISTING. BOTH BEEN ON THE ACCU-CHEK SPIRIT COMBO SINCE JULY 2009. BOTH BEEN ON INJECTIONS FOR MANY YEARS I MYSELF HAVE BEEN ON INSULIN FOR 26 YEARS AND THE OTHER MEMBER IN OUR HOUSEHOLD HAS BEEN DIABETIC FOR THE LAST 15 YEARS ON INSULIN.
 
I also have now notified Roche 3 times (originally flexlink plus's) and with rapid d's a further 2 boxes that I was having problems with. Supposedly the last two batches were sent back to Switzerland for testing...and I asked specifically to be informed what the outcome was. So far I have never heard anything.

I still get problems with airbubbles, but this is rectified by repriming after 4 hours when putting in new cartridge now, and only loading up 1 cartridge at a time and keeping the bottle of insulin at room temperature that is in use after I have remoed it from the fridge. I no longer get problems after 5 hours, as I used to.

I still get huge problems with the rapid d's giving me pain quite often, even after they have been in for 24 hours they can all of a sudden hit me so strongly with pain that I have to immediately have to remove the set. I got caught out going on a day trip out last week, and depsite having had new set in for 4 hours, when I got out of the car the pain was so bad from it I could barely walk. I was in the middle of an NCP car park, and had to try and get past the pain barrier to get myself to M&S where my friends got the coffee whilst I sat down in the cafe to remove my set-which was in my bum. I had already put in 6 sets within the previous 30 hours due to pain and high levels....fortunately, as I had problems within the past 48 hours I had actually put a spare set in my handbag.

I sometimes note that when priming out airbubbles that the airbubbles actually make it as far as the rapid d connector, but then actually don't all come through the connector....this actually makes me wonder whether the connectors are all good, as sometime this happens and sometimes it doesn't. If air comes out of the connector instead of through it...then so will the insulin....

I have not informed Accuchek of the air not going through the connector problem yet, but the next time it happens I will definitely report it and send it back for testing.

Last week I had huge problems with sets, high levels and yet this week....absolutely no problems.

Fortunately I know that my own body with the pump and connectors and sets being good I will achieve brilliant levels....so if for any reason my levels now go above 9...unless I know that I have gone out ofr food and guestimated, or had something new which I am unsure how I react to...I actually look at the sets and tubing for my problems.

I am not actually suprised that you have been told that they can't help you further, as although I have had problems to which they stated in a letter to me that they would give me feedback, they never have......saying that, I have had quite good responses with them sending out replacement sets previously if I report to them that I have a particular problem with a batch they do send me out new sets immediately and ensure that they are different batch numbers.

It is certainly not just you that has had problems....I have and I have always reported my problems and advocated on this website so often that if there are problems then they should be reported...otherwise Roche or any other manufacturer will improve their reliability...and our health...

I hope that you may be able to find some other set reliability form other manufacturers that will work with the combo. I know of another person near to where I live as well that has had to go to a different manufacturer for sets rather than Roche. Please let us know what you find suitable for the lueur lock and comfort.....
 
My DSN told me to "tap the pump on the table a few times" to help get the air out. I find that I knock it quite hard on the table over and over again while the tubing is priming & have a nearly 100% success rate for getting rid of all the air before connecting up for the first time with a new set. It does use a bit more insulin to prme to set (usually around 20u for my 80cm tube) & I do sometimes wonder how much banging on the table my pump can take, but it works!
 
I now keep a bottle of novorapid out permanently at room temperature.

This week, and this week only, I found that despite banging during priming I had to prime out bubbles for 60ml when loading cartridge....thir was just so many of the tiniest bubbles going through the tube......first time I have found this.....

Would other combo pumpers prime out these tiniest air bubbles until completely out, or would they let them travel. This was the 2nd time the vial was used and have one more-but am a little concerned that the insulin isn't quite perfect as previously-and weathers have been slightly warmer-although here in Wales NOT above 20!!!!!

I also band the bottom of my pump middle, left and right to get the bubbles out-normally within 23mmol of primiing...but this time it was almost 50!!!!! Would you re-use this vial or try another?
 
I use humalog & take the vial out of the fridge as soon as I've emptied the one before (for me that's at least a week before I use it) I've never kept "in use" insulin in the fridge (17 years with diabetes now) I've travelled all over the world, stuffed all my spare insulin in a ruck sack & usually never had air con in the hostel room. It's travelled across India in 40c+ temperatures on the top of a bus & I've never had a problem with it going off.

I was told a while back that it starts to degrade above 28c, I doubt you need to worry about that in Wales, but as I've already said, I've never had a problem. I always take what the professionals tell me with a small pinch of salt, I assume they err heavily on the side of caution.

As for those teensy weensy bubbles, I don't worry too much about them either, I just check to see if they've collected into a bigger bubble a little while after my set change.

I also draw a tiny bit of air into the cartridge deliberately as (and I may be imagining it but...) I think it helps all the air collect into one big bubble as I flick/knock the cartridge a bit before siting it in the pump & expel it into the tubing by pushing the plunger also before siting the cartridge in the pump.
You may be able to tell, I hate air bubbles & wasting insulin by priming; plus I also dislike set changes, they eat into my precious leisure-time, if I can get an extra day out of a cartridge I will!
 
1st time it has taken 50+ units to prime out bubbles...and had soooo many small ones....insulin at room temperature for just one week... levels been good so not too worried, just that I too hate wasting insulin!!!!!! or anything!!!!!
 
I have to be honest and say that until now, there's rarely been a time that I've been able to use an Accu chek cartridge in the Combo pump without an air bubble appearing; usually 24hrs after doing a cartridge change. Most of the time I just leave it in the cartridge as I would be priming so much insulin just to get rid of it and even then, it can sometimes appear again.

What I have found to work is to get the cartridge of insulin at body temperature (for me it's inside my bra cup) for a good 12hrs and then to abruptly tap it up and down on a hard surface (table) with the cartridge adaptor pushed on and the tube attached. By doing this, the bubbles should start to go up the neck of the cartridge into the tube. I then put the cartridge inside the pump and start the priming off and then for good measure tap the pump up and down on the palm of my hand just to make sure.

The Combo is a lovely pump being able to be operated by the bluetooth remote etc but air bubbles are a problem with the cartridges and needs to be addressed by Accu chek with a better design .......
 
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