Pump tubing problem

Technology & Management
1

Hello. I am Wyatt’s poppie. He is my 3 1/2 year old grandson and was diagnosed with Type 1 at 18 mos. He just recently went on a Medtronics minimed 650g. Initially the pump had worked flawlessly, he and his parents were just beginning to enjoy some of the freedoms that can come with it, when all of a sudden he started gating lows when he slept. Adjustments were made to the delivery rate which helped for a short time. Then he started going high with keytones. He is using Hemalog diluted with saline at a 5 to 1 ratio. The endocrinologist thinks the insulin is bad, the pharmacist says the solution is correctly prepared, Medtronics checked out the pump and it’s working right. An issue was found with the tubing in that it’s getting kinked. Some of it right out of the package. I am asking this forum if anyone has had issues with tubing, with any kind of pump and if so was it corrected and how?

My daughter and son in law are extremely stressed and looking for answers. My wife and I want to tell them to take him off it, we haven’t done that, because it is their decision and we have to respect that. My grandson is incredible. He is the calm in the center of the storm. On one day his infusion site was changed 5 times within 4 hours as his parents grappled with the problem. Aside from what any 3 year old would say being stuck by a needle so many times, he takes it in stride. I don’t think I could deal with it as he does.

And so I am asking for feedback from anyone. I must tell you that I am not diabetic and heart and respect goes out to all of you who live with this disease. And regardless if you can help or not, my profound thanks.

2

hi @Wyattspoppie,

I am joe and I have been using minimed pumps since 2005.

it is very likely that the physical pump - “the brick with the clip”, is fine.

most adverse reactions with pumps all center around the delivery system and all pumps have the same basic weaknesses. This delivery system is some combination of tubing (yes, even in a omnipod) and a local catheter that is supposed to deliver insulin at the “subcutaneous” level.

given your grandson needs 5:1 saline, he is very sensitive to insulin, which could always be an issue with lows. this typically changes as your grandson gets older.

the catheter he is using is very important, they can be straight, angled, teflon, or steel. Based on what I have heard, many people have problems with the straight-teflon “infusion” sets. most notably in children. If you work with minimed - you will find out they offer different infusion sets and if he is not on a “sure T”, in my opinion, he should try it.

given the sensitivity, he would still need diluted insulin with any injection strategy, such as a syringe or pen. in my opinion and experience, if you can figure out the delivery problem, the pump tends to be the most versatile and accurate.

with 30 plus years of experience, I get highs and lows. it’s not a failure of my pump, it’s just that perfect blood sugar is like a tiny target at 200 yards. in my pump’s “90 day history” my highest high was 290 and my lowest low was 39. If you think about the variability of activity, food, the inaccuracy of a home blood sugar meter, and the absorption of insulin, it’s a miracle if my bg is between 70 and 100 mg/dl.

good luck and please let us know how you are doing

3

I am only guessing based on the information you provided, but it sounds like your grandson is dealing with a bent canula (the part of the infusion set that goes under his skin), not the tubing of the pump itself. A kink in the tubing can be easily seen, but a bent canula usually isn’t detected until your blood sugars skyrocket and you pull the infusion set out. Assuming this is the case, a few things to try:

  1. Maybe a different type of infusion set would work better for him–Minimed offers many types and I am not sure which one he is currently using. If his parents call Minimed, they may be able to send them one or two infusion sets of different types just to try them out before they buy them–also try asking the sales rep that they worked with to get the pump in the first place to help with this. As a side note, you mention your grandson is only 3 years old I’m willing to bet he is relatively skinny. Sometimes those with less body fat need shorter canulas (and vice versa for those of us with more body fat).

  2. Are they sure they are inserting the infusion set properly? Bent canulas can happen with improper insertion techniques. For example, if a set that is supposed to be inserted at a 90 degree angle goes into the skin crooked, it can cause a bent canula.

Hoping they can get to the bottom of this problem. Pump therapy is so much more flexible than injections and is totally worth the occasional hassle it causes in my opinion. Good luck!

4

Hi Joe, Hi Katie

Thank you both for your advice. Here is what I know. Wyatt’s infusion set is straight and steel. If I remember one thing that was stressed during our training sessions, it was their emphasiS on inserting the set straight. I have seen the insertions a number of times and my daughter and son in law are both inserting it properly. They are also staying in close contact with both the endo and Medtronics. I will refer to the doctor, Medtronics rep, and the pharmacist as Wyatt’S team. The team is trying to approach the problem by process of elimination. It’S probably the only logical way to do it, but it scares the heck out of us. There is a new supply of infusion sets on its way. Those, of course, will be inspected closely . Today they are trying undiluted insulin. A temporary basal setting of 0.075 units is the setting. So now we wait and see. Thank you so much for your responses. I’ll let you know how it goes.