Always Double-Check Your Replacement Insulin Pump Settings!

I’ve had many replacement pumps in my years of pumping. To my recollection, I had:

  • 1 Disetronic replacement
  • 1 Accu-chek Spirit replacement
  • 1 Animas Ping replacement
  • 2 Medtronic Revel replacements
  • 5 or 6 Tandem t:slim replacements
  • and now, I’m on my second Medtronic 630G replacement.

So, as it should seem, I’m pretty well-versed at what to do. You know, upload the old pump if possible to save all of the history and settings. Once you have the replacement in-hand, go through the process of setting up the pump using that data you uploaded. However, I’m not usually one to look at the upload because my settings are simple and straightforward.

And, until this week, I have never missed a setting.

Rewind to Tuesday. I had missed the initial delivery of the 630G pump replacement because I had to take my daughter to her check up (which had gone well). I rushed to try to make it home so to avoid another hour-long trip to go pick it up, but alas, I missed them. And, at the time, I didn’t think I would be home Wednesday at the time they were going to deliver it, so we made the trip to go get it. Which, we almost didn’t, because UPS had some sort of problem releasing my package and I came thiiiiiiis close to almost having had it sent back, even though it was sitting right there in front of me. But, in a miracle event, somehow the UPS clerk was able to get it to release and we went home.

It was late, so I went through the settings to get it started up. I was more worried about whether I could save my 2-day old sensor than anything, which where the problem came in at. I rushed through my settings, forgetting ONE very important one.

For the last few mornings, I’ve been waking up with very high blood sugars. Wednesday, I thought it was my panic attack over the low I had to which I ate way more than I should have, but forgot to correct for after I started coming up. So, I was almost 600 mg/dL when I awoke and sick as ever.

But I came down within a few hours with some rather large boluses. I thought that would be normal since once I’m over 250 mg/dL, I typically need to add more to the dose.

I had been staying a bit high through the day, but I had been stressed a lot lately, and drinking way more coffee than water, so I thought that must have been the trouble.

Wednesday night before bed, I was high, but again, not terribly, so I took a bolus and increased my basal rate.

Thursday morning, I was almost 400 when I woke up, despite an increased basal rate and a bolus around 4am.

My day went relatively the same as Wednesday. My son had his summer reading camp awards ceremony that morning, and when I got home, it was full-steam into work-mode, with lots of coffee and Diet Coke. I still thought it was strange I was struggling to bring down some highs, but I mean, it could be anything, right?

I could be getting sick… It could be about the time for a mid-cycle bump due to ovulation… It could be that I really need some water in my veins….soooo many things!

So, last night, before bed, I took a bolus yet again for an almost 300 high (we had also eaten canteloupe and watermelon a couple hours before) that I thought should have been down by then, and I set a 125% basal rate, and went to bed.

This morning, I woke up sick yet again, and clocked in at 398 mg/gL. So, I uploaded my pump to see if I could spot anything at all that could be the cause. Then, that’s when I saw it.

I had a 0u basal rate.

I NEVER SET THE DARN BASAL RATE!

Again, I have had wayyyy to many replacement pumps in my life, and settings are crucial to set right away. Basal is almost always my very first one to set. I have NO idea how that happened. I’m still kicking myself. I mean, it’s set for sure now, but HOW ON EARTH!??? DID I MISS THAT!? Also, hoooowwww could I not realize that before? I mean, does that mean I, indeed, have too high of an insulin-to-carb ratio? So. many. questions!

So the moral of this story, kids: always have a check list. Always go back in and review those settings. Don’t think because you’ve done it lots of times before, that you’re impervious to a mistake like this.

Which leads me to a pump manufacturer request: Please make a plug-and-program option into your pump software? That would make switching over so much easier, and reduce human error such as this! Please, thank you 🙂

 

Our Decision to Switch to Medtronic Minimed 630G Insulin Pump – Part 2

This part may be a bit long, so go get some coffee and settle in. There is a lot to cover here 🙂

Ahhhh….coffeeeeeee…. (Pixabay)

I started on the Medtronic 630G pump on 5/1/17 – the day I received it. This is a bonus of having a small endo office – they can pretty much work you in at any time for device training.

So, in the boxes were the pump box, sensor box, and meter box. Along with lots of papers and training books. I had also already watched the training videos and played with a demo too, so I had a general idea of what to expect.

Using the pump wasn’t my concern at all since it worked pretty similar to other pumps — it delivers insulin based on your settings. Okay, no biggie. The biggie for me was whether I could trust the CGM or not. This is a big question for many, especially if you are die-hard dedicated Dexcom user as well.

See, I had the 530G before with Enlite. I did not have good success at all. It was rarely correct, and I was going through sensors every 3 or so days. It wasn’t worth the hassle it was giving me. But, I had been keeping my eye on the 630G since it was available, and I wanted to see what other’s were experiencing. The consensus was that the 630G was much better somehow. I believe they updated the algorithm a bit, and it was supposed to be a vast improvement.

The game-changer that helped the transition:

I made the decision that others had (CarolCluka and CoolReeRee ) to keep my Dexcom sensor attached until I was fully comfortable. This lasted about 3 weeks. I kept my Dexcom connected to my Glooko account because I can connect Glooko to Medtronic Carelink, and I could see how they both compared. I was pleasantly surprised, to say the least:

Of course, there are times when the sensors didn’t line up perfectly, but as you can see, they’re pretty on-point with each other.

I’ve had pretty good success, and so much that I disconnected from my Dexcom after 3 weeks and felt completely comfortable doing so.

The good, the bad, and the tips…

Now, let me tell you… it hasn’t been all cupcakes and rainbows for the last almost-two-months. I did go through about a week or so of wildly inaccurate readings. So much that I reconnected my Dexcom. See, the problem is that you cannot jump into the Medtronic system with the experience of Dexcom. You have to wipe that mindset out and start over.

First and foremost, you have to calibrate at least twice a day, but it is recommended to be 3 times at a minimum, and 4 max. So, I’ve developed a routine – I calibrate when I wake up, again before lunch, and before bed. The system stays pretty accurate if I do that, which is no problem really, because it’s not hard to do. I’ve never been one to feel comfortable enough to dose off of my Dexcom, so I always test before eating. All it takes is a click to calibrate, and then a click to go to the bolus wizard. No big deal at all.

Second, there are rules: (I’m sure they could apply to Dexcom too to help make it be more accurate, but these are sort of a must-follow in my opinion if you are on Medtronic’s system)

  1. Follow the “B” rule when learning your own calibration schedule: Before breakfast, before lunch, before supper, before bed. Find three of those that fit YOUR schedule and when you know you’ll be least likely to be trending wildly (aka – no arrows)
  2. Do NOT calibrate if you have bolused in the last 2 hours. The sensor is less likely to be as accurate since you have bolused in that time, and a calibration could confuse the sensor.
  3. If the sensor is “off”, especially when waking up first thing in the morning, try drinking some water and walk around a bit. This gets the interstitial fluid moving around the sensor again. It will likely re-align itself within 30 minutes or so.
  4. Be patient. I cannot stress this enough. If coming from Dexcom, you may be used to the instantaneous calibrations. The sensor can take 10-15 minutes to accept a calibration, especially if the values are very different (up to 60mg/dL). If it is above 60mg/dL, try the drinking and walking bit. If it doesn’t realign, call tech support for help or a new sensor. They can help you upload your pump and look for specific things that could be interfering with the sensor communication.
  5. When inserting the sensor and taping, BE GENTLE! Taping the sensor head down too hard or pulling the transmitter tape flap too hard and tight on top of the transmitter can cause the sensor to pull out just a bit from the skin, which can cause big trouble. If you set it up softly, it will be nice to you.

After I called tech support, I found that I was being too rough with taping, and not being patient with the calibrations. Since then, I’ve been able to go back to Enlight sensor values only, and it’s been just as good as it was when I first started. Heck, it’s even caught real, legit lows that the Dexcom didn’t.

In the past couple of months, I have been greatly impressed with the CGM of the Medtronic 630G pump. I’ve caught myself at times in awe of it, really.

Why the 630G now and not wait for the 670G?

One question I was asked already on Facebook was “why not wait until the 670G?” The reason is that I wasn’t sure I could trust the sensor to make the call to give me insulin if I were going above range. Cutting off my basal for a couple of hours is one thing — giving me insulin when I don’t need it is a whole other realm, and I wanted to be sure I could trust the system. I am on the list for the 670G, and I should be able to get it next month once my sensor order is due (that’s how they time when you get it if you’re on the pathway program).

I am on the list for the 670G, and I should be able to get it next month once my sensor order is due (that’s how they time when you get it if you’re on the pathway program). I can use the pump similar to how the 630G works now when I get it, and then wait to be trained on “auto-mode” later. I am cautiously excited to see how it works, but I’m also not going to be entirely upset if it doesn’t live up to the hype I’ve seen. Mostly, because I know the experience is going to be different for everyone, and I know it can be a learning curve even if you’re coming over from the 630G.

And, to be completely honest, it would be the same hesitancy whether it was the Medtronic system or one that incorporated Dexcom. Anything that augments how my insulin is delivered, I’m going to be very hesitant about. I guess I’m just old-fashioned and have been burned by eagerness one too many times.

Where to view more if you’re interested:

I’ve been trying to keep this to myself and a few close friends in the beginning just in case this new experience caused me to be upset and disappointed. I prepared myself for the worst, thinking it would be no different than the 530G. Maybe that’s why I’m so much more surprised than I thought I would be.

So, instead of blowing up their phones with text or Facebook messages, I decided to revive my Sugar and Sites domain for Instagram and Tumblr, and get my thoughts out there.

You can click on the image and it will take you to the Instagram page I’ve been using. Let me know in the comments what you think, and if you have any other questions. From those, I’ll make a Part 3.

Which brings me to my next thought: I may begin transitioning from Sugabetic to Sugar and Sites overtime. I’ll still keep Sugabetic alive, but maybe on a free WordPress site. I’ll handle the transition as smoothly as possible, but there may be a few days that things will be down. Until then, feel free to follow me on IG for updates about the pump experience 🙂 

 

Our Decision to Switch to Medtronic Minimed 630G Insulin Pump – Part 1

A few months ago, I was at home with the kids, and didn’t feel quite right. After a quick fingerstick, I saw that I was in the 20’s. In a panic, I couldn’t get anyone on the phone to talk with me until my sugars came up. I began to “eat the kitchen”, as it were. I finally reached my sister-in-law, who came to sit with the kids until I could get back to myself again.

After that day, I was scared out of my mind to go below 100 if I was at home with the kids by myself. So, I started running my numbers higher — much higher than I’m comfortable with, and I knew I would be risking damage doing so.

That’s when I realized, Dexcom Share wasn’t enough. It’s great to be able to Share and have people call to check on you… but what if they can’t actually reach you? My son and daughter can’t use my iPhone just yet (he can’t remember my unlock code), and neither know how to use a glucagon kit.

I looked into the Loop system, but honestly, while I love that everyone is so willing to jump on board, I’m not. I’m not confident in my own abilities to make this thing happen since it’s something done from home. I don’t mind tinkering and playing with Nightscout because it’s not directly affecting my insulin dosing, whereas the Loop system does. That’s a-okay if you’re on it – I’m not trying to down the system or anything. I’m just not comfortable with the idea of using it myself.

So, we looked into Medtronic. I know. It’s known as the big evil empire of the insulin pump world. And, while I am interested in the 670G, I was more interested it the 630G since it suspends insulin if the user is low. I know this is the exact same technology as 530G, but somewhere along the way, they’ve improved the CGM technology. I kept reading about how sucky the 530G was but that the 630G was much better on different sites, like Instagram and TuDiabetes, and a few others. People who had absolutely zero success on the 530G were being impressed and excited about the 630G.

After a lot of debate and hemming and hawing about it, I decided to take the plunge. I was going to trade in my Tandem using the Switch-to-System program, but I couldn’t afford the $1249 out of pocket to do the switch. So, on a whim and a prayer, we submitted for insurance coverage. Backed with letters from myself and my doctor, along with pages of blood sugars showing the amount and severity of the lows I had been having, we held our breath and waited.

On the evening of 4/28/2017 just after 5pm, we got the approval from my insurance. And, on 5/1/2017, I began as a Medtronic pumper again.