Insulin Pumps

The Missing T:slim Clip.

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When I unboxed my first t:slim two years ago, I knew there was absolutely no way that I would be able to use it with its horrendously chunky case. What was the point of having such a sleek pump if I had to encase it in something that made it look as bulky as the pump I’d just upgraded from?

There is an official answer, if I recall correctly. The case is there to protect the pump from sweat and other debris from getting into these six tiny holes on the back of the pump. Just don’t ask me what those six little holes actually do…

While I relished having a pump that was so sleek, I did have to sacrifice having a pump clip. Most of the time, I stash my pump in my left pocket. Which is fine when I’m wearing jeans or thicker clothing. But when it comes to more lightweight clothes like shorts, trackies and pyjama pants, I really miss having a clip to secure the pump to my pocket.

Over the past two years, I’ve learned to live with pumps sliding out of pockets while on the couch, at the outdoor setting, in bed and even slipping down my waistband while I’m at work.

Until I found this.

The Nite Ize clip is nothing new. It’s been around for years, it’s been mentioned by many other bloggers and I’ve even had DOC friends suggest it to me.

But I was still somewhat reluctant to do anything that might make my t:slim any less slim. Especially a solution that was so permanent.

What got me over the line was when Rockadex began stocking them locally, and I finally snapped one up when they were on sale before Christmas.

The Nite-Ize clip is simply a low profile metal clip that sticks onto the underside of any kind of mobile device through a VHB adhesive bond (which is apparently really, really strong…).

I’ve only been using this clip for two weeks, and I already love it. I’ve been clipping the pump to the inside of my pockets every day, and it’s so nice not to have to go fumbling through bedsheets or underneath couch cushions to find it.

It remains to be seen how the adhesive will hold up over time, but so far the clip is still holding solid.

This clip gives me the best of both worlds – a pump clip without the need for a chunky case.

This is, by far, the missing t:slim clip.

If you’re in Australia, you can get your hands on a Nite Ize clip locally through Rockadex Diabetes Supplies here.

**This is not a sponsored post – just a really, really great product.

The First Three Years on an Insulin Pump.

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Today marks three years since I first began using an insulin pump.

I can still remember just how excited I was for that initial clinic appointment. I had the feeling of somewhat ‘joining the fold’ with so many other pump users in the DOC. I also knew that I had so much riding on this, feeling as though it were my last chance to get on top of diabetes.

I initially wanted to go on a pump because I wanted better numbers. I felt like I owed it to myself to at least try it. I was also tempted by the promise of more even basal coverage. I never felt as though I could get my Lantus dose quite right.

In hindsight, I wasn’t really putting a lot of thought or effort into my (spontaneous) food and insulin dosing decisions at the time. I didn’t have a very good understanding of how insulin works. When I started on my pump, in some ways I was also learning some of what I should have learned a lot sooner.

There were a lot more variables in play when I started using a pump. Basal rates need to be configured, carbohydrate ratios need to be set, infusion sets replaced and insulin cartridges refilled. In many ways, moving to a pump was like learning diabetes all over again. I definitely lost my patience and got overwhelmed more than once.

The results didn’t come overnight. It probably took me three months to become completely comfortable pumping insulin, and at least six months to see my first sign of improvement. Three years later I never seem to stop learning new things when it comes to diabetes.

It is much, much easier to go low on a pump. Insulin needs to be adjusted or carbs consumed for something as simple as a walk around the block. I distinctly remember having to completely change the way I thought around insulin dosing during physical activity, or else I’ve found myself going low, low, low.

Pump breaks are okay. I’ve taken three lengthy breaks from memory over the past three years. Those breaks stemmed from a mixture of pump fatigue, and also from frustration when diabetes wasn’t playing along as nicely as I’d have hoped. Diabetes is extremely monotonous, and those changes to the way I managed were extremely refreshing.

The same level of management can be obtained using Multiple Daily Injections. It wasn’t until I began pumping that I truly began learning about blood sugars and insulin, and moving away from the spontaneously-eat-and-guess-the-insulin-dose. After transferring those skillsets to MDI during my pump breaks, I now know that the same level of management is possible.

My insulin pump has to work for me. My pump works for me when I know that I don’t have to constantly babysit it, or live in anticipation of something going wrong all the time. It works when I’m using manual infusion sets that don’t require insertion devices. It works when I’m using angled sets, that don’t kink so easily on my lean body. It also works because I can largely see what’s going on through the tubing and around the infusion site on my skin. If it didn’t work for me, I wouldn’t still be using it today.

I can still remember my diabetes educator stopping me in my tracks three and a half years ago and telling me that an insulin pump would not make managing diabetes any easier.

Today, a pump offers me more convenience as I go about my day. I like being able to give my insulin at the push of a button, without having to stop and lift up my shirt and pull out a needle and put it away again. I like having basal rates and profiles that can be customised around my life: such as when I want to eat, when I want to get to bed, when I have to go to work and when I want to go for a walk. I like that added level of precision.

While a pump has definitely helped me to ‘realise’ my potential, my diabetes educator was right. A pump hasn’t made diabetes any easier. It’s not a substitute for all the hard work I’ve put in to get the results. Today, I quite honestly see an insulin pump as my preference in insulin delivery.

A preference that’s definitely improved the quality of my life.

Filling a T:slim Cartridge: The Idiot’s Guide

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I must say that one of my ongoing issues with the t:slim has been filling those little pesky black insulin cartridges.

The empty cartridges still have some residual air trapped in them, which needs to be drawn out with your syringe prior to filling with insulin. I know from experience that when I haven’t properly drawn air out of the cartridge, my blood sugars run high and insulin delivery from my pump has been compromised.

I’ve had several moments over the past few months where correction after correction hasn’t been able to tame my blood sugars. There have even been some moments where I wake up high at 3am and in a ‘lightbulb’ moment realise that my cartridge needs to be replaced. Of course, I know I that I won’t be able to lay still until the problem has been fixed.

To my understanding, the empty black cartridges have two components: the chamber at the top of the cartridge which you can see, and an invisible plastic bag inside the cartridge where insulin is stored. When I caught up with the friendly team at AMSL Diabetes in March, I was shown a demo cartridge where I could see that the plastic bag inside was vacuum sealed. So no air in there. Which meant that the air that needed to be released was actually trapped inside the chamber at the top of the cartridge.

With credit to the T:slim Users Australia and New Zealand Facebook group, I’ve learned to fill my syringe with 50-100 units of insulin, draw the air out of the cartridge and then top up the syringe with additional insulin as desired. It’s far easier to withdraw air with an emptier syringe than a full one. I’ve also tried drawing air using a completely empty syringe, but I’m a bit paranoid and prefer to actually see the air bubbles come out.

Which brings me to my next dilemma. Last week I must have wasted at least half an hour drawing seemingly endless air bubbles from my syringe, leaving me feeling downright paranoid and wondering what I was doing wrong.

After a chat with the team at AMSL Diabetes, I’ve been told that it’s not possible to draw all of the air out of the cartridge, and that one pull of the syringe and a few big air bubbles is sufficient. I’d also add, with credit again to the t:slim Facebook group, to make sure that the needle on your syringe is screwed on tightly enough.

If you look closely at the cartridge on the right, you’ll see a fair few air bubbles in the chamber at the top. I replaced that cartridge at around 3am a couple of weeks ago after it was causing untame-able high blood sugars. Perhaps this is also a result of me over-drawing air from the cartridge. Sometimes I like to settle my paranoia by simply popping off a loaded cartridge just to confirm that there’s no signs of air.

I don’t like having to babysit my diabetes devices, when I already have my blood sugars to babysit all day every day. So I’m crossing my fingers and toes that this is the last of my issues with filling these cartridges. Because I really do love this pump.

Updated 7/10/19: One pull has been working perfectly. Overdrawing air from the cartridge only compromises insulin delivery from the pump. Same goes for refilling cartridges with insulin more than once or twice. As I’m filling my tubing, I also like to keep an eye on the nobbly bit for any air bubbles that sometimes get trapped there. Holding the knobbly bit upright while I’m filling my tubing, I sometimes give it a few little taps so that any air bubbles rise to the top and pass through the knobbly bit and out through my pump line.

Review: Two Months with the Tandem t:slim x2

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It’s hard to believe that I’ve only been using my t:slim for two months, because it already feels like much, much longer. In the short time we’ve been together we’ve enjoyed pizza nights, springtime basal adjustments, travel, work and will soon be celebrating our first Christmas together.

I thought I’d follow up on my last post (initial impressions here) with a few more thoughts now that the enthusiasm has waned.

The biggest adjustment from my late Animas Vibe has been the insulin cartridges. There were times over the first couple of weeks where my blood sugars felt like a struggle to manage – the kind of difficulty that can only be explained by spoiled insulin. I also had a lot of paranoia after learning that insulin is at greater risk of spoiling inside those uniquely designed black cartridges.

To sum it up, insulin gets drawn into a syringe, and then injected into the black cartridge. Little did I know that the cartridge also contains air, which also needs to be drawn out prior to filling (I partly blame myself for not properly watching the videos that were sent to my inbox…). So this explained the harder to manage blood sugars.

I’m also finding more air bubbles pop up during the fill process than I did when filling my Animas cartridges, while using room temperature insulin as instructed.

The cartridges can’t be reused as easily as my Animas ones, either. I don’t think I’m game enough to try refilling the cartridges, given that I can’t exactly ‘see’ what’s going on in there. I’ve been filling with the recommended 3-4 days worth of insulin, and am slowly working my way up to filling the cartridge with more as I gain confidence in the fill process.

My other issue is that the pump is WAY more alerty and annoying than Animas. (Speaking of, I really appreciated this post from Laddie at Test Guess and Go last week). Some of the pump’s alerts are just an insult to my intelligence and years of lived experience. Incomplete bolus alert? That’s because I decided against doing so. Temp basal that has dropped below half my normal rate? That’s because I know that my blood sugar is going to drop during my walk.

There are also SO many different screens to flick through when swapping out an insulin cartridge.

Change cartridge. Tick. Stop insulin. Tick. Is the set disconnected from your body? Tick. Changed cartridge. Tick. Fill tubing. Tick. Fill cannula. Tick. Finished. Tick.

Just yesterday, I received a vibrating alert well after a site change because I had tucked my pump away before reaching the ‘resume insulin’ screen. When factoring in my prior shower, I had been without insulin for some time.

Gripes aside, I still maintain that the adjustment from my late Animas has been fairly seamless. The t:slim has some much needed upgrades and modernness, while not asking me to change everything I know about pumping insulin. More on that in my earlier post here.

For me personally, my favourite thing about the t:slim is its wearability.

A mere few months ago, I was feeling really frustrated when it came to dressing with my insulin pump. Moreso when I was dressing for work and just wanted my pump out of the way. It was far too chunky to wear on my waist, but kept getting in the way every time I wanted to reach into my pocket.

Today, my new pump is so slim that I can simply ‘tuck’ it into my waistband with my shirt, and it doesn’t bother me there one bit.

I’ve been dreaming of this pump coming to Australia for a long, long time, and I’m happy to say that it is indeed everything I had ever hoped for.

When it comes to a device that is attached to my body 24 hours a day, it’s nice to finally have a sophisticated pump that looks and feels great to use.

Disclosure: Aussie distributor AMSL Diabetes bumped me to a priority upgrade to the t:slim, because, #TslimForFrank. As an existing customer using an in warranty Animas Vibe, I was eligible for the free upgrade as per their transition program. This included no agreement from me to write about the pump, and as always these thoughts are my own.

Lesson Learned: Don’t Overfill Your t:slim Cartridges

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Update: If you are having insulin delivery issues with your t:slim, please refer to this more recent post which I hope may help. 

Yesterday morning after breakfast, after I could no longer ignore the vibrations coming from the needy insulin pump in my pocket, I swapped out the cartridge on my t:slim.

I slowly drew insulin from my penfill cartridge into the syringe, filling it all the way up to its 3ml capacity. After tapping and priming the air bubbles from my syringe, I stuck the needle into my black t:slim cartridge and began to slowly inject the insulin in.

As I tried to continue pushing that last bit of insulin from my syringe into the cartridge, I was met with a little resistance. The cartridge must have been nearing full.

I knew I should have stopped then and there. Except that I didn’t.

After pushing a little more in, I pulled the syringe out and slid the cartridge into place on my pump. I was feeling a little hesitant, but figured I’d be able to pick up on anything weird soon enough.

I had lunch a little later on, and found myself at 10.6 when I checked my blood sugar afterwards. Which felt plausible, given that I had also eaten ice cream with my lunch. I can never seem to bolus for ice cream quite right.

After some correction insulin, a walk and nothing more than a coffee that afternoon, I was still lingering around the 10 mark.

After loads of corrections that evening, I don’t know why I didn’t just replace my insulin cartridge before I went to bed.

I guess a part of me was seeing the 200+ units of insulin in the pump, and didn’t want to be wasteful by throwing it away if there was actually nothing wrong.

After a full correction at bedtime that had little effect by the time I woke up at 5.30am this morning, I hauled myself out of bed and made a dash to the fridge. I swapped out my cartridge for a fresh one, this time only filling to around the 2ml mark on my syringe.

Yes, Frank was told to put less insulin into his cartridges when he got set up on his t:slim a few weeks ago. But Frank also didn’t like to be wasteful and wanted to get his money’s worth from the cartridges that he paid for with his hard earned money. Frank also doesn’t like not being able to reuse these cartridges like could with his Animas pump.

Anyhow, lesson learned.

Don’t overfill your t:slim cartridges. It just feels like your insulin isn’t working.