Infusion set comparative showdown

May 30, 2009

When I starter pumping a couple of weeks ago with my Medtronic Minimed 522, I was offered two choices for my infusion sets, including the Silhouette and The Quickset. I wasn’t particularly attracted to a manual insertion of the gigantic needle, so I settled for  the Quickset infusion sets.

Traditionally, Paradigm pump users have been limited to a small number of infusion sets due to the propietary nature of the Paradigm  connectors. Fortunately, a company has created a special reservoir that provides pumpers with the freedom to use most infusion set available in the market.

infusion-set-shipment

So I decided to challenge my initial decision and order a few different infusion sets to compare them and make a decision about which one I want to use permanently.

I decided that at least for now, I wanted to stay with infusion sets that offer automated insertion, preferably with an integrated inserter. To that effect, I have selected three infusion sets for my initial comparison. the Minimed Quicksets, Smith Medical Cleo 90 and Unomedical Inset II.

Over the next few weeks I will be trying each of these infusion sets in turn, and will post a review of each here. If you have any other sets you think I should consider, I would love to know about it.

Note: If you want to have a look at the outcome of this evaluation, visit the following articles:

Review: Thinset Reservoirs

Review: Inset II infusion set

Review: Cleo 90 infusion set

Review: Medtronic Minimed Quickset infusion set

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Basal testing

May 26, 2009

It’s been over a week since I have my pump and so far I couldn’t be happier. I’ve been able to stabilize my glucose levels pretty quickly and I’m enjoying all the flexibility that having a pump give me…. ah! and I’ve resisted the temptations and managed to keep my weight stable too.

Ever since I was on MDI I’ve found that my BGL go lower (and often hypo) just before lunch, and I always thought that was the onset of my evening Lantus causing the issue. After I started the pump I was surprise by seeing that the lunchtime hypos were still there, so my diabetes educator and I decided to do some small adjustments to both my basals and carb ratios to counter their effect.

This changes made the hypos less frequent, but I wasn’t too convinced this was the best it could get, so today I decided to skip breakfast and do a proper basal test. I tested every hour during the process and kept records of my results together with my current basal pattern.

Basal-testing

I found that the real cause of my lower MGL around lunch is that my basals don’t seem to be properly adjusted to my insulin needs around that time. It’s incredible to see how our bodies react to different things. I’m not any different at lunchtime than I am at 10:00am, but it’s obvious that my body is different then.

I will now proceed to create an adjusted basal pattern with my diabetes educator. Hopefully that way I will be able to deal with my lunchtime lows definitely.

Once again I find a reason to confirm that in my case, going to the pump was the best decision I could have made.

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My first set change

May 23, 2009

Today I changed my infusion site for the first time. Well, really the second time, but the first without the incredible assistance of my diabetes educator.

For most pumpers, changing infusion sites is a regular and simple process that does not attract a lot of attention. But for me, this particular change felt much more important and I was much more nervous than many of my fellow pumpers.

So I decided to follow the process exactly how I learned at my pump start, and took all my supplies and placed them in a table.

Pumpsupplies

In my case, supplies include a Paradigm reservoir for my Medtronic Minimed 522, a Quickset infusion set, automatic insertion device, vial of insulin (in my case Novorapid / Novolog) and an alcohol swab.

I proceeded to to load the reservoir with insulin and attached it to the infusion set. inserted the set into the rewinded pump and and loaded the set it into the Quickserter. I then cleaned a bit of my belly skin with the alcohol swab to eliminate some grease and kill any nasties. Finally placed the inserter against the spot and fired.

After all, the process was simple and completely painless. I’ve never complained too much about the (at least) 4 injections a day I used to have before the pump, but between shots and this, I’m much happier with this new routine.

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A stranger in my bed

May 20, 2009

Today I woke up for the first time with a stranger in my bed.  I don’t mean a person, but my newest friend for life, my pump.

Pump

Yesterday I finally got connected, to the Minimed Paradigm 522. After a day long training session I was finally sent home with an incredibly positive feeling. This “thing” attached to me feel a bit odd, but I was convinced great things were about to happen.

The training included all the basics of pumping, from loading the battery to changing your set. We started by calculating all our settings based on my total daily dose (TDD) and using some rules to estimate starting values. While these rules are amazing, it was also funny to see when the rules don;t quire work, like in my carb ratio, where the rule wanted me to almost double the ratio I used on MDI (no way that was going to work, so we manually adjusted to a more reasonable number) . We programmed a single flat basal rate, which is probably a good starting point, as well as single insulin sensitivity factor, and single carb ratio.

After setting up the rest of the menus, it was time to put some insulin in the pump, and more importantly, to put in my first infusion set. I must admit that I hate needles , and this part of the process was making me particularly nervous. In addition to that, I started using the Medtronic Quickset, which  uses the Quickserter, a spring loaded device that shoots the needle into you… really scary stuff…   To my surprise though, I didn’t feel a thing. The automatic insertion was so quick that by the time I looked it was all over. I’m very happy about the insertion process… it turned out to be not that scary after all.

quickeset

The next concern in my list was sleep. How do you sleep with this thing… I couldn’t imagine how it would be. For the first night, I decided to leave the pump on its holster, and just clip it to my boxers. I chose to put it in the front so at least I could move around and sleep on my back or either side. My body of course had other plans and I tossed and turned like usual. Again, to my surprise, the pump was like it wasn’t there. I even woke up for my 2am blood test and realized that I was sleeping over the pump and could not even feel it. Again, in my case, sleeping proved to be another misplaced apprehension that had no reason to be.

After a day I have virtually eliminated most of the concerns I had about going on the pump, and I can not wait to see the real benefits of this incredible technology.  Stay tuned…

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The Guy is sick

May 14, 2009

I spent the day in bed, fighting what seems to be a very strong cold or seasonal flu. But there is probably nothing notable in just being ill. What is notable though, is the effects my illness had on my blood sugars.

sick

The typical literature for sick day management with Diabetes alerts of higher blood sugar levels when ill. Well, for some reason, in my case the effects have been exactly the opposite. While I’ve been monitoring my condition pretty closely (including ketone testing and all) the reality is that I’ve been using about half the insulin that I normally would. In all fairness, I’m also eating a lot less, but even with semi accurate carb counting my insulin to carb ratios are very skewed compare to what’s normal for me.

I do have a number of theories, but the one that is gaining more strength in my mind is the one that says that sick2my body is still producing some insulin and because I’m suddenly very relaxed and eating less, this insulin may be enough to cover a bigger proportion of my daily needs. That said, is sort of useless to have a theory that has no effect on real life, so I’ll leave it at that.

I can only hope that this cold goes away soon enough, in time for my pump start next week. I would hate to see that being ill is a limiting factor on what could be the most important step in my diabetes management to date, but that is a story for a different day.

Stay tuned….

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Visit to the dietitian

May 13, 2009

On Wednesday I paid a visit to the dietitian. As part of the process to go on a pump, I needed to “learn” how to carb count. I’ve been counting my carbs for a while, but considering that this was a mandatory step in the process, I decided to embrace it and make the most of it.

dietitian

I had my appointment at lunchtime which was very convenient, as I didn’t have to take time off work (editors note: shouldn’t everyone providing services in this industry offer this?). We had a very nice chat about my diet for about 20 minutes, as she asked me to name absolutely everything that I eat regularly.

I didn’t see the point at the beginning, specially since after I was done she said that “we are not going to concentrate on whether your diet is good or bad”. She then said the the purpose of meeting me that day was to ensure that I understood the differences between the approached pre and post pump.

She helped me understand the subtleties of carb counting on the pump, and gave me a few pointers on how to find nutritional information for different food. I should probably point here that I didn’t get much value here, as I’m yet to see anything better than Calorie King. She also gave me a few tips and tricks that may come handy, in terms of GI and weighting foods.

Overall, the session was unexpectedly productive, and helped me realize that we can always refine our carb counting skills. I have another follow up session the day after my pump start, and I’m now looking forward to get as much from that one as I did this time.

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Welcome to D and the Guy

May 10, 2009

Welcome to my first attempt at the diabetes blogsphere. While I have been participating in a number of local and global diabetes communities, I feel that the more formal structure of a place like this will allow me to better share my learnings and experiences of living with D.

I was diagnosed as an adult and the story of my diagnosis is very similar to others. I had been presenting the usual symptoms for about 4 months, loosing weight, drinking litres of water at a time and going to the toilet a lot. Even with all that, for some reason I didn’t think there was anything wrong with me…  what an idiot!!!… Thanks god my wife pushed me enough to go to the doctor and BOOM!, there I was, a newly diagnosed type 1 diabetic.

I realize now that at the time I didn’t know anything about D, and that I probably behaved the same way to many of those whose attitudes I hate today. I didn’t know much, but thanks to the help of others who also live with D I am probably healthier know that I have ever been.

Hopefully this space will allow me to pay back some of the support that I’ve received over the last couple of years. I hope to help those who, like me, landed one day in the home of D without knowing what this whole new world was about.

Stay tuned, and feel free to keep in touch

Henry.-

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