Monday, December 30, 2013

Three weeks and three days on the 530 G

So far: have worn six quick sets. The fifth one I put in on a Monday morning, bg started rising about three hours later and I bolused a lot trying to get it down; also I skipped lunch. It went down to about 240 before turning around and heading back up over 300; at that point I tested urine ketones, and they were very large so I pulled the site. The cannula had folded on itself completely. So, that explained that! I put in a sixth one and it worked okay, although when I pulled it there was blood in the cannula.

So far: have worn two silhouettes. The first one (at a 45 degree angle in my arm) had good absorption but it felt horrible and when I pulled it, the area looked like it had been worn raw. The second one (20 degree angle in my lower back) also had good absorption but about two days after I put it in it started bleeding again. I pulled it. The area has a fairly superficial bruise and it's tender and swollen and it hurts hurts hurts.

I put in my first sure T yesterday. I'm sure it went into muscle, but it feels okay-ish. Sometimes I feel it and it feels like I've got a needle in me, which I do, so that makes sense.

I met with the pump trainer on Friday and discussed sites. He thinks my best bet is silhouettes, to avoid muscle. I'm not so sure.

I really feel that wearing infusion sets has so far big a much more problematic and painful experience than people had led me to expect. Ouch ouch ouch!

I am finally wearing a sensor that's lasting. It's now on day 8, and performing well.

Saturday, December 21, 2013

Two weeks on the 530 G

Overall: Wish I had never gotten it. Sometimes feel okay or even cool with it, much of the time feel frustrated, scared, itchy, and tender.

My first infusion set (6mm quick set on my butt) had no delivery alarms and had to be pulled. My second infusion set (6mm quick set on my butt) was okay. My third infusion set (6mm quick set on my thigh) was okay although really tender, but when I pulled it, it bled so much that there was a puddle of blood as big as my hand on the floor. It was scary. My fourth infusion set (6mm quick set on my butt) was okay. My fifth infusion set (13mm silhouette on my arm) is still in my arm right now and it's pretty tender but working okay.

My first and second sensors I wrote about already. The third did okay through the fifth day but on the sixth day the ISIG:bg ratio went bad quickly resulting in false lows and finally in SENSOR FAILED shortly before the six day period was up. The fourth sensor has been performing with terrific accuracy (and is now five days in) but some WEAK SENSOR and SENSOR LOSTs have occurred.

My bgs have been worse than usual but not dramatically so.

Overall though I just don't like pumping. I'm not sure how much of it is the newness and how much of it isn't. I don't know whether or not to return it. I'm disappointed that it doesn't have a lot of features I think it should have (including features I expected because the Guardian has 'em as well as features found on other pumps and features that aren't found on other pumps that I just think it ought to have), and frustrated or annoyed by many of the features that it does have. 

Thursday, December 12, 2013

5th day on the 530 G

In the night I woke to find that the pump was reading Lost Sensor. I reconnected, but because I went back to sleep without calibrating, I woke up later to no data from the medT CGM almost all night. Even though I calibrated in the morning, I again got a "Meter BG now" and no data during a class I taught this afternoon. So there's another hour's data missing.

I thought I understood that the minimed CGM would give me gaps if I went for 12 hours without calibrating (unlike with the Dexcom) but I did n't remember or expect all these gaps. This is hardly CONTINUOUS glucose monitoring.

Pump worked okay and bg was okay-ish most of the day.

Wednesday, December 11, 2013

4th day on the 530G

The CGM performed better over the course of the day. Nothing failed. I spent most of the day outside my bg targets- the night high, the day low. Not low enough to trigger the low suspend. Saw my endocrinologist. Discussed site issues and so forth. He was encouraging.

Tuesday, December 10, 2013

3rd day on the 530G

The evening blood sugar after the supper with the combo bolus was a lot like if I had had shots- blood sugar was fine during supper but rose later. It didn't rise a lot though. I bolused a correction and for a snack at 9 PM.

At 4:45 AM I woke up to a Dexcom reading of 308, but happily enough my meter only read 256. I got a No Delivery alarm while trying to correct, and I took off the tubing from the site to really look at it. It still looked fine. I reconnected and told it to resume, then programmed in the basal that I wanted, and I went back to bed.

At 8 I woke up to a dropping blood sugar- Dexcom read 175. I decided to bolus for breakfast a little bit ahead of time, but a little over a unit into the ~9 unit bolus, I got another No Delivery alarm, and this time when I hit resume and tried to bolus again, I got a No Delivery alarm before it had bolused anything at all.

So I called the hotline. The person on the phone had me look at the stuff which still looked fine. She had me disconnect from the infusion site and try priming 5 units. The 5 units dripped out without triggering a No Delivery alarm. So she asked me to take out the site to see if maybe the tubing had kinked. I took out the site and looked. It was straight but there was blood in about 1/3-1/2 of the cannula. She said that was probably the cause of the No Delivery.

I cleaned off and put in a new site not far from the old one. I have 18" tubing and I don't think that would be adequate for very many locations. I had to stop myself from laughing at the lady on the phone's advise regarding sites on the abdomen: at least 3" from the belly button, and 2" from each other, and all around including up and down from the belly button. But that is not possible on this body of mine. My abdomen is roughly 11" wide. From the bottom of my rib cage to my hip bones is 3" if I'm standing up.  So yeah.

Anyways. I put in a new site. Being on the phone and doing the new site took me enough time that there wasn't any time left for breakfast, which meant my basals were way off for the workday because I have really different insulin requirements on days when I don't eat breakfast. I was cranky about it.
 I got home to two boxes and a letter from medtronic... and that is a start to day 4.

Monday, December 09, 2013

Second day on the 530 G

I went to bed around 10 pm last night with my Dexcom G4 going and the pump component of the 530G, but no enlite because the senserter broke. I had about a unit on board but I thought I had a lot of food in my belly still digesting, and my bg was 100 (yes really with two zeroes).
I woke up at 5:30 to a Dexcom that had run its battery fairly low going "LOW" since roughly midnight. If I'd had an enlite sensor on, of course, that would have been the perfect night to see how well the 530G could perform, but of course, I didn't.
I ate a small "let's get this low treated" breakfast and then went to the synagogue for morning prayers. While I was there the high alarm on my Dexcom went off (oops guess I overtreated that low) and I realized that I couldn't bolus without beeping unless I changed the alert types to vibrate instead of beep, which would require scrolling through the menu which would also beep. And I couldn't step out because I was needed for the prayer quorum. Sorry for beeping, everybody!
I had a second breakfast after prayers and my blood sugar dropped steadily until I ate lunch, leveled off, and then started dropping again. I ran a temp basal of 0.05 u/hr for an hour to try to head it off but that didn't seem to do much.
After work I set the basal for the 10 am to 3 pm period lower, from 0.325 to 0.275 u/hr (I have the midnight to 10 am basal at 0.450 and the 3 pm to midnight at 0.375 u/hr)
It had just come up (an hour after I ate about five fig newtons) when it was supper time, and I decided to do a dual wave bolus because supper was rice and lentils, a very favorite supper of mine that tends to cause late highs. Wouldn't you know it, a little after I put the pump down, still in the delivery of the bolus, I got a "No Delivery" alarm (my second one so far- and they were 36 hours apart FYI). I checked the tubing, which still looks fine to my inexperienced eyes, and hit "resume". But although that makes it resume basal, it had totally abandoned the bolus- both the remaining up front part, and the square wave part. So I looked at the bolus history, decided to guesstimate it, and that's what I did.

On another note regarding sites: the infusion site just now started feeling a little itchy and achey but is overall okay. I think I may have pulled on it too much. The place where I had a sensor is sore and the area where the overtape went- the extra square of tape- is still pink and tender. I think I need a different tape. Sigh! I'll try it as sent for one more sensor and if that one is also not so great, I'm going to try using Opsite Flexifix (which I don't love but which is OK on my skin).

Sunday, December 08, 2013

First 24 Hours on Medtronic 530G

Note: For new readers or those who've forgotten, I have never been on an insulin pump before this, but I have used three different CGMs prior to this system, I have worn I-Ports, and I'm more than comfortable setting pump settings for other people. And I've been using a jet injector for the last thirteen months. I use Novolin R.

My pump and sensors and infusion sets and manuals(!) and senserter and quick serter and reservoirs and charger and transmitter for the system came on Monday. I spent a few days talking to the trainer and starter and all those people going back on forth on whether or not I need training on the system and to wait and all that, and on when my 30 day return window counts down from.

Last night I decided to try wearing the system. Since I had already set up the pump with the settings I wanted, I put on a temp basal of 0.025 u/hr so as not to be giving myself basal in addition to the lantus, I took out the insulin from the fridge, I took a bath and shaved the areas where I intended to place the sensor and the infusion site, and then I assembled the stuff.

First: I loaded up the reservoir. I put in the full 1.8 mL of air into the vial of insulin, which was a mistake. It was too pressurized. I tried to draw out 140 units of insulin and to not have any bubble and I thought I had succeeded, but when I unscrewed the reservoir from the blue thing that connects the reservoir to the insulin vial, I could see a huge bubble. After attaching it to the connector with the tubing, I had some difficulty pushing the air out, but I think I managed that too. However, it was really difficult for me to tell when the bubbles were all out.

Putting the quick set into the quick serter was not as easy as expected- there was a bit of a trick to getting the set into the serter. And it hurt more than I expected going in. But- it's in. I put it on my left butt cheek. I took a short break before coming back to insert the sensor. The needle looked scary big and I have bad memories of sof-sensor insertions. The sensor went in pretty easily - I put it in my left abdomen. The sen serter hit the area around my abdomen with kind of the distraction thing going for it, and it didn't hurt much. I looked at the pictures of the taping up and tried to do it right, but wasn't sure I got it. I connected it with the transmitter.

The ISIG of the sensor took about an hour to really correspond with my Dexcom readings. Once I calibrated it, it gave readings that didn't agree 100% with my dexcom or my meter, but they were in the neighborhood. Feeling that the enlite sensor was working well, I took out my Dexcom sensor in the morning when the one week period of the Dexcom sensor was up Unfortunately, about 20 hours after insertion, my sensor abruptly failed. I got "weak signal" and they "sensor lost". I called the minimed 24 hour hotline and the woman on the phone said it might have been because I did tape it wrong, but they're replacing the sensor. Then I tried to put in another sensor... but the senserter did not deploy. I called the hotline again and they said my senserter had broken... and it broke that sensor with it. So they're replacing both.
I put on a Dexcom sensor.

The infusion site and tubing has been OK. It's been hard figuring out how to move in respect to it. I think I want longer tubing (I have 18"). I've been very relieved that I can't feel the insulin going in. In the evening my blood sugar rose a lot and I bolused four times to try to get it down, then gave up and did a shot with my jet injector, set an alarm, and woke up in the night ... and the blood sugar was fine! I woke up again around 6 am when my blood sugar was a little high (Dexcom read 161 and the pump read 148) and I tried to bolus 1 unit. The pump alarmed "No Delivery" but when I hit resume delivery I guess it did, because when I woke up again my blood sugar had dropped a lot. Breakfast spiked but came down and I had a mild hypo right after the sensor failed, so I guess I'm getting insulin.