# Cartridge low alarm - help please



## Pattidevans (Mar 5, 2014)

Hi

The pump (AccuChek combo) has just warned me that there's only 20u left.  I was going to change sets in the morning and there's plenty there to get me through the night as I only take just over 15u in a 24 hour period and I'm not planning on bolussing for anything before tomorrow.  Will the pump keep warning me through the night?  In which case I'd rather change sets now, but I needed a fresh vial this time and it was in the 'fridge which means I have to leave it to warm up and that would put the change right before bed and I know you aren't supposed to do that.  Can anyone advise please?


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## everydayupsanddowns (Mar 5, 2014)

I would leave it till the morning Patti. But the Veo wouldn't 'low res' alarm again for a long while


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## Sally71 (Mar 5, 2014)

Hi Patti, we have the Combo too.  It won't do anything else until the cartridge is completely empty so you are safe to wait until the morning.


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## Redkite (Mar 5, 2014)

Aaaaagh, hope it doesn't alarm in the night and disrupt your sleep.  I'm afraid I don't know about the combo, does it say anything about this in the manual?  If I were you I'd be tempted to change it now and fill from the cartridge in your insulin pen (assuming you have one?).  This is a bit fiddly since the reservoir doesn't fit squarely onto pen cartridges like it does on vials, but I have successfully done this a few times when I've forgotten to get the new vial out of the fridge in time.


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## Pattidevans (Mar 5, 2014)

Sally thanks.... ISTR a convo on another forum where someone said it only went off once so that's what I thought.

Redkite... the manual is very non-specific, just tells you how to silence the warning.  I've tried the online manual but it is hanging and won't load.  I have pen cartridges but they're in the fridge too, on the premise I used to inject straight from the fridge if necessary.  

I have rung Accu-Chek and someone is supposed to ring me back any minute.


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## Sally71 (Mar 5, 2014)

We have been down as low as 7 units with no further alarms so you can sleep peacefully!  The manual is rather frightening, isn't it!!


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## Redkite (Mar 5, 2014)

Pattidevans said:


> I have pen cartridges but they're in the fridge too, on the premise I used to inject straight from the fridge if necessary.



Oh!  That idea's a non-starter then. . I do try and remember to get a new vial out of the fridge on the day the old vial is used up (ie. 2 days before it will actually be needed), because otherwise I would never remember on the actual set-change day - and also by Sod's law if the vial was in the fridge we would probably have a cannula problem that day!


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## Pattidevans (Mar 6, 2014)

Accuchek rang me back (from the USA as the UK lot are in bed) and told me that the alarm won't go off again until the cartridge is empty, so I can safely go to bed and change sets in the morning.  Thanks to all who responded to me and particularly for responding so quickly 



> The manual is rather frightening, isn't it!!


It's big, that's for sure!  Odd that there's so little info on the subject in the "war and peace" manual, or the interactive DVD manual.


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## Pattidevans (Mar 6, 2014)

Redkite, I meant to get a new vial out when I changed the last set, but they last 6 days for me, so I thought it a little premature, then forgot it entirely!


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## Pattidevans (Mar 6, 2014)

All OK - I woke with 9u still in the cartridge


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## HOBIE (Mar 6, 2014)

Always take the vial straight out of the fridge & have never had any prob. I use Medtronic veo & cant comment on other pumps but if you are getting bubbles just flick with finger & push them out with syringe ?? Hope you got sorted


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## Sally71 (Mar 6, 2014)

I once forgot to get a vial out of the fridge in advance, and not knowing what else to do I just warmed it up in my hands for a few minutes.  Probably not what you are supposed to do, but it seemed to work OK - there was perhaps a little more air in the cartridge than I usually get, but not much and it came out easily enough when I primed the tube.  We didn't get any problems afterwards.

Patti - glad all is well and you were able to sleep soundly!


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## HOBIE (Mar 6, 2014)

Would NOT dream of warming insulin up !!!


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## Sally71 (Mar 6, 2014)

I didn't mean that I made it "warm", only that I took the fridge chill off it lol...
We got away with it that time but probably not something to make a habit of!  I do normally get a new cartridge out of the fridge a few hours in advance so that it can get up to room temperature slowly


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## HOBIE (Mar 6, 2014)

A vial normally takes 3/5 hits of being in & out of fridge.  If you are warming even with hands what is the point.  I will say again I have NEVER had problems with bubble that I cant just flick with finger & push ot with syringe.  I would Not warm & cause the insulin to be useless.  I would rather flick the bubble out.    What do they do in the hosp ????  Warm all the bottles ?????


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## Pumper_Sue (Mar 6, 2014)

HOBIE said:


> A vial normally takes 3/5 hits of being in & out of fridge.  If you are warming even with hands what is the point.  I will say again I have NEVER had problems with bubble that I cant just flick with finger & push ot with syringe.  I would Not warm & cause the insulin to be useless.  I would rather flick the bubble out.    What do they do in the hosp ????  Warm all the bottles ?????



Hobie, I think you are going a bit over the top 

It is standard practice to use room temperature insulin.
What Sally did was quite correct.
If you think about it the insulin in your pump is at room or body temperature after being in the pump for 20 mins or more  and I don't know how often you change your cartridge but mine is done every 6 days. I'm one of the many pumpers that *does not * carry a portable fridge around with me to keep my pump or insulin nice and cool


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## Sally71 (Mar 6, 2014)

Hi Hobie, I am sorry if I have upset you with that comment, I will try to explain.
At the time I was quite inexperienced and thought that you weren't supposed to put insulin in the pump straight from the fridge. I thought that holding it in my hands for a few minutes to take a bit of the chill off would not be too drastic. I was able to get all the bubbles out without difficulty as I have already said, and the insulin was not damaged as it worked perfectly and we had no problems afterwards.  As per my DSNs instructions I always keep the in use vial at room temperature anyway so did not put it back in the fridge afterwards, and we had no problems with the rest of the vial.

I have already said that I knew this is not the best idea, and perhaps I was lucky to get away with it; but I was inexperienced and at the time couldn't think of anything better to do.  That's all part of learning isn't it, mistakes will be made sometimes and you learn from them.  I thought I had made it clear that I normally allow new cartridges to get to room temperature slowly, I only did this once and even though it worked I don't intend to do it again.  I don't think I've suggested that it's a good idea that other people should try either, but if it reads that way then I'm sorry.

I hope that has explained where I'm coming from, I didn't mean to cause any offence.  But if we got everything right all the time then we wouldn't need this forum!


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## Pumper_Sue (Mar 6, 2014)

Sally, please rest assured you are not wrong. HOBIE is in the wrong.
What you did was correct.


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## Northerner (Mar 6, 2014)

Well, I don't know about pumps, but I always warm the cartridges in my hands after getting them out of the fridge and before using them. Body temperature isn't going to render the insulin spoiled and I've never had a problem


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## heasandford (Mar 6, 2014)

Unbelievably I had the exactly same thing last night for the first time, but didn't go on here  - should have done! But like you, plenty of insulin overnight and no more alarms.

I keep one vial out of the fridge all the time so it is always at room temperature to fill a cartridge. I work on the basis that I used to have all my pens at room temperature so why not? It lasts less than 30 days, I put a date on to check and it's a glass container. I then usually make up a cartridge the night before I change it, I know that adds half a day extra to its life but I assume there is plenty of safety life built in. I haven't ever felt that insulin-failure has been one of my problems - I have enough variation, but not due to that!


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## HOBIE (Mar 6, 2014)

I have NEVER noticed them do that in Hospital  After 47yrs. When you get a bottle of milk out of the fridge & pour it in a cup where is the bubbles ?


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## Sally71 (Mar 6, 2014)

Oh dear I seem to have opened a can of worms here, sorry folks!

Thank you for the kind words Sue 

Hobie I still don't understand why you seem quite so upset about it. Some people like their insulin at room temperature and that works for them.  You don't and it works for you.  Does it really matter?  Sometimes there is more than one way of doing something.


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## Hanmillmum (Mar 6, 2014)

I was just wondering if you could not change the low insulin alert on your pump Patti to something more applicable to you, 20 units would last us into another day and half, we have Medtronic though.
Re: insulin at room temp, I would never administer cold out of fridge and have been told not to by DSN, if I forget to get new vial out I pop down bra for a quick warm lol  Relax!! btw they do leave insulin out the fridge in hospital (or they have done on the wards I've previously worked on).


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## bev (Mar 6, 2014)

We always use room temperature insulin and make up a fresh vial each time we need itWe were told its better to use at room temperature - although I cant remember the reason for that now. To be fair to Hobie this is probably advice that was given a while ago when insulin maybe had a different shelf-life and was all kept in the fridgeBev


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## everydayupsanddowns (Mar 6, 2014)

HOBIE said:


> I have NEVER noticed them do that in Hospital  After 47yrs. When you get a bottle of milk out of the fridge & pour it in a cup where is the bubbles ?



Pour a glass of water from a tap and out it on a sunny window sill and you will see small bubbles of oxygen appear around the glass after a few hours as the water warms slightly. Oxygen is less soluble in warm or hot water. It's where the bubbles come from when you boil a pan of water. 

That's the reason why keeping 'in use' insulin out of the fridge is advised (less chance of bubbles appearing in the reservoir as the insulin is warmed by body heat) - though some people choose not to and that's fine if it gives them no problems/they prefer it.

For what it's worth Sally I'd have done exactly the same and have on more than one occasion


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## Redkite (Mar 6, 2014)

Sally71 said:


> Oh dear I seem to have opened a can of worms here, sorry folks!
> 
> Thank you for the kind words Sue
> 
> Hobie I still don't understand why you seem quite so upset about it. Some people like their insulin at room temperature and that works for them.  You don't and it works for you.  Does it really matter?  Sometimes there is more than one way of doing something.



Don't take it personally Sally 

This topic has come up before, and most of us do exactly what you do (ie. keep an in-use vial at room temp to avoid bubbles forming in the reservoir).  I have also observed (as have others) that I can start on day 1 with a bubble-free reservoir, and if left for 3 days, a few little bubbles will have appeared - these are dissolved air evaporating out because the insulin is warmer against his body.  Perfectly scientific explanation, and there are plenty of strategies to deal with it.  Hobie always seems to get cross when this topic comes up because apparently he personally doesn't get this effect! . No offence meant Hobie


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## Sally71 (Mar 6, 2014)

Thank you all for your replies - I didn't think my little comment would kick off such a debate, as you can tell I'm not used to posting on forums!  Well at least I know now that I'm not being a complete idiot if I ever again forget to get a vial out and have to warm it up by hand


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## Pattidevans (Mar 7, 2014)

> I was just wondering if you could not change the low insulin alert on your pump Patti to something more applicable to you, 20 units would last us into another day and half, we have Medtronic though.


No, that didn't come up as an option whilst I was searching the manuals.  Tomorrow I should have time to do more ferreting about looking for info as OH will be busy watching the 6 nations rubgy!

I was also told not to use insulin straight out of the fridge and that it would cause more bubbles when filling the cartridg.  DSN suggested sticking it in my bra to warm it up a bit if I had forgotten to get a vial out in time.  It actually fits quite nicely under my boob. I used to be able to pass the pencil test - no longer, now I can fit a whole vial there!


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## Phil65 (Mar 11, 2014)

On Sunday morning my Accuchek alarmed at the 20 unit level....we were busy at the time, skipped breakfast and I forgot completely, then went for a late pub roast lunch....went to bolus as food arrived and I had 2 units left!  oh well, ate it, drove home, changed cartridge and bolused, test 2 hours later ....5.4!  First time I've been out and about with an empty cartridge!


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## Pattidevans (Mar 12, 2014)

> On Sunday morning my Accuchek alarmed at the 20 unit level....we were busy at the time, skipped breakfast and I forgot completely, then went for a late pub roast lunch....went to bolus as food arrived and I had 2 units left! oh well, ate it, drove home, changed cartridge and bolused, test 2 hours later ....5.4! First time I've been out and about with an empty cartridge!


Arghhhh everyone's nightmare Phil.  I've not done it on the pump but a couple of times when I was on MDI I have found myself in a restaurant with food in front of me and either an empty cartridge in the pen or no needles.  On those occasions I've been mega surprised at how low I have been when I should have been high.  On one occasion I was questioning whether I'd had a miraculous cure!


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## Sally71 (Mar 12, 2014)

Sometimes it makes no sense, does it.  You try your hardest to keep your numbers as stable as possible, can't always succeed, and then when you expect a bad one you don't get it!

My daughter always removes her pump for a few minutes while getting dressed in th morning. One day she forgot to put it back on again, went to school and nobody noticed intil gone 11am. By the time I had found the pump and raced round to school to put it back on her it had been disconnected for nearly 4 hours   Trying not to make a big drama out of it I said "never mind, it's lunchtime in a few minutes, if your test comes out high at least we know why, pump will correct it when you do the lunch bolus.". Lunch blood test was...    6.5!!

The very next day we all made sure she remembered to put the pump back on in the morning, everything at school was normal, lunch time test that day came out at 13!!  Activity levels tend to be much more stable at school than out of school, so unless she had a sneaky snack that day that I don't know about, I can't work that out at all!


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## Annette (Mar 12, 2014)

I put my pump basal down to 40% when I am at the gym. Then I put it back up an hour after I finish. This means that I'm back on 100% by about 9pm. One day I forgot, and left it on 40% all night. When I noticed next morning, I thought I would be really high. My BS was...9.7. Higher than I would like, but not consistent with 60% less insulin for nearly 12 hours!


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