More Reluctance by SugarVal

My last post told you about my decision to go on an insulin pump after 13 years as a Type 1 with steadily rising A1Cs, scary low blood sugars, and frustrating highs. My timing couldn’t have been better. The Medtronic 670g ­– the world’s first FDA approved pump to use information from its continuous glucose monitor to make basal insulin adjustments – was on its way to market. Billed as a hybrid closed-loop system, it represents a major leap forward in diabetes treatment. ‘Hybrid’, because the user still has to bolus for meals. Not quite an artificial pancreas, but close.

But the 670 wasn’t out yet, so last fall, I went on its predecessor, the 630g system: pump, CGM and glucometer. The three “talked” to each other. If I did a fingerstick on the glucometer, the results would pop up on the pump’s large color screen, which was also where the CGM graph was displayed.

However, the 630g wasn’t quite the miracle I needed. I’d put aside my dislike, almost phobia, of being attached to this little machine all the time, in the hopes that it would improve my health and make me feel better day to day. But as mentioned in the last post, my A1Cs rose by a tenth of a point during my time using it. Only a slight difference, but not in the direction I wanted to go.

Looking back, a lot of my problems could’ve stemmed from infusion sets. When I first started on the pump in November, I’d been given Pro-set infusion set. In February, Medtronic sent out an email saying the Pro-sets were basically being recalled due to a “higher than expected number of reported complaints related to kinked cannulas and elevated blood glucose levels”. I was a bit disappointed, as I’d never had a problem with them. I switched to Quick-sets, which were pretty similar and used the same Quick-serter, a spring-loaded device, to insert it.

A few months later, while traveling through Los Angeles on a weekend trip to see my family, I got my first ever blocked insulin flow alert. Crap! This is one of the “cons” of pumping: without a long-acting insulin like Lantus on board, if your pump fails, you’re in deep trouble, quick. As my fiancé drove through LA traffic, I inserted a new Quickset by hand. My blood sugars didn’t come down, and I got another blocked insulin flow alarm within an hour. Uh oh. I’d brought two spare infusion sets, which I thought was plenty for a two day trip, and now I was down to one. What if this one didn’t work either? I remembered the words of my CDE, “Remember, you always have insulin with you—if you carry syringes, you can draw from your pump’s reservoir as a last resort.” I also had an ace in the hole: once I got to my family’s place, my sister, also a Type 1, would have long-acting insulin with her. My second spare infusion set, this time inserted with the Quickserter, didn’t produce an alarm, but by midnight, I was in the 500s. I had been bolusing with Novolog all evening, both through the pump and with a syringe, to try to bring it down, but I had no way of knowing how much I’d actually gotten. Realizing that trying to maintain myself by giving endless shots of rapid-acting insulin over the course of the weekend would be a huge pain, I took a dose of my sister’s Lantus the next morning, and removed the pump for the rest of the weekend.

Once home again, I went back to pumping. Over the next two months, I had lots of highs, but didn’t connect them to the infusion sets. I dismissed that weekend’s problems as a fluke. Then in June, I struggled for three days with super high blood sugar as I went through six infusion sets in a row. All ended up having kinked cannulas. Medtronic sent me samples of different sets to try, but by that time I had been burned and didn’t want to take any chances. I felt disillusioned--the thing that was supposed to improve my health had jeopardized it. I had serious doubts about continuing on pump therapy, so I put my pump away and went back to shots, using spare syringes and leftover vials of Lantus along with my Novolog.

The email from Medtronic came a few weeks later asking me to confirm that I wanted the 670g shipped to me. I took a long time to mull it over. Not everyone gets a chance to use cutting edge technology to battle their disease. Maybe the 670g’s responsive basal rate would be the answer to my unpredictable insulin needs. If I could get the infusion set issues straightened out, I had to give it a chance. Maybe it would be different this time.

Taxonomy: