UPDATE Accu Chek Combo Pump

Hey Stoney, i remember you!

Great to read how well James is now doing with a pump.
My daughter is starting a saline trial with the same pump later this afternoon!
Hope we get on as well as you have done

Really pleased for James

Thanks Stoney

I'm fine with the theory as done a lot of reading in the last year!
It is more the practical stuff that i am nervous about, especially after getting saline everywhere yesterday trying to fill a cartridge.
Got the hang of the menu system from the computer based training.
She understands how to use the remote for blood tests and mealtimes so that side of it i think we will be ok.
She slept fine with it last night and forgot she was wearing a pump at school today so hopefully that feeling will last!
Will see how we get on with cannula and tubing changes later in the week.

Hi

I've just had a look at the Youtube video mentioned by Stoney and although the video makes everything look really easy... what isn't mentioned is that if people try to inject 315u worth of air downwards into an insulin vial that is new (full up) what will happen is that the force of air being pushed downwards will make the plunger come up before people have the chance to turn the vial and cartridge up the other way and a huge air bubble will appear in the cartridge that will literally mess it up and even though you can try to push the air back into the insulin, the cartridge won't be ok and the rest of the insulin in the vial won't be ok either and people may find that they get occlusion messages (failed delivery) because of air travelling to the top of the cartridges prevent insulin from being passed through it. :roll:

Hi

The pump will only bleep and go into a siren like alarm if it cant move insulin through the tube. Occlusions do happen but hopefully not too often but when they do... very high bg levels can occur which usually means that insulin hasn't been delivered for about 2hrs:shock: so the cause of the occlusion has to be identified, rectified by priming some insulin through the tube first of all and then if that is ok, then its the set that is probably not right so a new one needs to be put in. If no insulin is able to be passed through the tube, then a cartridge and tube change is needed with a new set as well. This is where testing bg levels very frequently gives peace of mind so is an essential part of using an insulin pump. I hope James is getting about 300 strips per month?? and that he gets up in the middle of the night to bg test which will indicate any would be occlusion.

If James found that the infusion set was wet with insulin then probably some insulin had been delivered but not all of it. It might be that the tube clip was not attached very well or maybe the set had been knocked and some blood had risen up the cannula which had dried and prevented the insulin from getting through all the way. Good thing that James was able to sort the problem out though so try not to worry too much. Tell James to always have an insulin pen or a syringe and vial within easy reach just in case problems happen..

stoney said:

iHs said:

Hi

This is where testing bg levels very frequently gives peace of mind so is an essential part of using an insulin pump. I hope James is getting about 300 strips per month?? and that he gets up in the middle of the night to bg test which will indicate any would be occlusion.

Good thing that James was able to sort the problem out though so try not to worry too much. Tell James to always have an insulin pen or a syringe and vial within easy reach just in case problems happen..

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Hi
Our Doctor and Pharmacy are very good in giving us supplies and James has everything he could possibly need kept in school for any problems and the Health Person there is very good and rings me with any concerns.

I noticed yesterday that James's fingers are looking very hard around the edges on the left hand will all the testing, any suggestions how we can soften these. I keep trying to get him to use his right hand (which he does say is difficult and I do appreciate that) but nevertheless with all the testing, he needs to do something, also I notice that he does not change the lancet each time, again I think a blunt needle could also be the cause.

Another thing, James will not go to bed with a BG reading in the 4's for fear of hypoing, even though he has had a 77g carb supper a half hour to an hour before bed. Last night his reading before bed was 4.3 and insisted of taking two jelly babies then going to bed. His BG this morning was 11.4, he then said he should not have had them. I said next time he gets a 4 something reading, I will get up and test him at 3am to see what is going on and then this may put his mind at rest.

The DSN has tried to get through to him that she will not get accurate readings to tweak if he is taking anything without bolusing, but he thinks he cannot run on 4's and would pass out !!!!!!!

Any suggestions to any of the above

Thanks

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Hi

The fingertips on my left hand are also showing signs of hole damage so I've started to prick further down my fingers and have also made myself use my other hand. Shame the Aviva strip needs the amount of blood that it does but cant very well use another bg meter as the bolus wizard wouldnt work very well. In time I can see myself going for cgm ............... Although I've always been a bit lazy in replacing the lancet myself, I've started replacing them a bit more often now as I prick my finger about 10 times during the day. Also, what might help James a bit is for him to use a handcream like Nivea every night as this should help to keep his hands supple (my friend has used Nivea since his was young and works on building sites (brick laying, plastering etc) and his hands are lovely and smooth.

Regarding the bg of 4mmol before bed.... that is a bit on the low side so James is correct in eating something to correct it but you really need to sit down with James and examine all his basal rates, bg levels, carb ratios, carb eaten etc to work out when to adjust the basal rate and when to adjust the carb ratio. James shouldnt be going down to hypo levels an hour after eating 77g carb so does sound as though the basal rate at the 1hr mark before he eats food and also the hr that he eats need adjusting downwards so that the 1hr and the 2hr bg level will be higher. You might also need to adjust the carb ratio for the supper so that less insulin is delivered which is another option if the basal adjustment doesnt do the trick . Everything with a pump is very much 'trial and error' though so you learn as you go along. If I didnt use a pump bg diary and log everything down, I wouldnt know if I was coming or going. Apart from seeing my D consultant, I've not needed to ask for help from a hospital DSN since I got my pump. Ive just used the internet, the instruction manual and a bit of common sense and sorted everything out myself. I suggest that James monitors his bg levels every 2hrs after he eats supper and then you should see what hours during the night his bg levels change and then you'll be able to adjust the basal rates 1hr before the high or low bg readings happen. Usually.. just small adjustments are needed so remember to write everything down and then do a re-test the following night to see what the bg levels do.

IHS, I spoke to someone at Accu and they are looking into the possibilty of doing a combo with cgms, but they are not sure when yet.

stoney said:

Hi Spearmint
:lol: I did that last week funny enough, but now got the hang of it. What we find helps is if you go to You ube and type in Changing a Cannula for Accu Chek Combo you will see a father and son going through the change albeit with a Rapid D as we use Flexlink but the procedure is the same and we now tend to make up a cartridge say the night before or at least a few hours before and any bubbles seem to settle and fingers crossed no problems as yet.

Hope this helps :thumbup:

Regards

Yvonne

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Hi Yvonne

Thanks for that, haven't looked it up yet but might in future.
We are using Flexlink too.
It was time to change the cannula Thursday evening, thought we might as well change the tubing as well to get her used to the priming pump feature, all done in 5mins which i thought was ok!
Then had a slight problem Friday night, when she went to bed she came back down shortly afterwards as she had noticed blood in the cannula and top of the tubing - i am guessing she might have hit a blood vessel maybe???
So that was another cannula and tubing change, also changed the cartridge as i wasn't sure how far blood could go! She did it all mostly by herself with me just reminding her, no air bubbles and all done in 10mins, couldn't believe it LOL
Saline trial finished last night and she has been happy wearing it and sleeping with it, she managed to set a TBR for double PE last week ok as well.
Now we have to wait 3 weeks til half term for the real thing!!