I love that every single time we get a new piece of technology I am on here that very night freaking out about something or other…today is no different!!!
My son got the t:slim for the first time today and his blood sugars have been steadily climbing throughout the day. He has been stressed, so I think that has something to do with it the high blood sugars but literally EVERYTHING the diabetes educator taught us at our training has gone out the freaking window. LOL I know that we need to make sure that his insulin is being delivered but I can’t exactly remember how to do that…
I remember her saying that after we checked all of the sites and that everything is screwed on we can pull the tube out and check to see if the insulin is actually coming out of the tube…right? How do we do that? How do we do that without his pump thinking that we have actually given him insulin or without him missing a precious dose???
Hi @lucyinthesky827 hey sorry about the rough start. It is unlikely there is no insulin. It is more likely the settings are very conservative and he’s not getting enough.
First of all anytime you have a major problem you can just go straight back to shots and start over.
When I started the “trainer” set me up with very low basal and very conservative carb ratios. It took a long time to dial those in.
Easy tell for the pump working is to do a correction for the amount he would take with a syringe. For example if his bs was 209 and he normally takes 3 units to correct for that, then you can give a manual bolus for that amount and watch the sugar over 4 hours. The pump is nothing more than a syringe and you can use it that way if you need to.
Get the trainers cell number or find a trainer or CDE willing to do extra care for the firs couple weeks.
Avoid stacking: that is correcting a high and then 2 hours correcting again. If he gets over 350 it’s time to get a syringe and do a correction manually, or like I said get the whole kit and go back to shots until you can get some support
The most likely failure is a bad infusion site. I never test or screw around if I think I got a bad one I rip it out and put a new one in a new place.
I will second @joe, who you may know is a very wise and experienced firing member. If you feel uncomfortable with the site, switch to a new one.
Keep in mind that starting on a pump involves some tweaking of settings (a term I use frequently). You’ll be working with your endo/office to see how his basal rate is working out, and you may have to set and adjust different ones throughout the day. See if your doctor’s office can share his pump data: mine sent me a link so they could log into my TCONNECT or Dexcom account and see how things are going (prior to that I had to print reports and send them in so this is a great thing).
I use TCONNECT so will speak to that one and leave explanations of Dexcom to those who use it, but attached is a screenshot from my pump - my doctor pulls up the same data when they log in. Based on trends over a number of days they will determine what if any adjustments to make - eventually you will be able to do this on your own but for now work with your team.
For now, call and let them know. They might want to hold off to see if the highs are related to the stress of going on the pump, and they might also want to do a basal rate check.
As Joe said, you may be tempted to stack insulin as you wait for a high to start coming down. As one who was famous for doing it I can tell you when it does all hit it is likely to cause a drop you will need to correct. Insulin simply takes time to do its job so you have to wait.
You had asked how to check if insulin is coming out the tube. Just addressing that specific question here: on the Tandem T-slim pump, one can disconnect the site at the little squeeze connector (as if you were getting ready to get in the bathtub). Then Options / then Load / then fill cannula / then start. Good lighting will help here — watch at the tip and you should see tiny drops. This small test just tells you then, that insulin is getting from the cartridge, through the tube, to the tip, external to the body.
Unfortunately this small test can’t tell you what happens underneath the skin. That is the assessment of sensors readings and / or blood tests , and as others have commented, sometimes you just have to tear out the whole site and start fresh.
Anecdotally, I will add that when I switched my son from one pump manufacturer to another, I had to steadily strengthen his correction factors and carb ratios. Maybe one manufacturer’s flow rates are not identically calibrated to another ? I just had to press on with the data in hand.
As others have noted, pls make good use of your doctor, trainer, and CDE. They are part of your team and there is no need to be bashful about asking for help.