# Another question



## brett (Apr 12, 2013)

Just got a question on changing injection site.  Was told to change the needle bit every 2~3 days and the tubing from the pump every 6 days.  So when I change the needle thingy that is in me I can use the same tubing that had has already been primed.  However I'm sure I had to bolus 1 unit into the needle thingy to fill that up also.  is that correct and how do you bolus 1 unit in without it.thinking you have actually bolused 1 unit in you that could affect dose suggestions.


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## Hanmillmum (Apr 12, 2013)

We change the whole lot each time as that is what we have been told to do.

However your pump may have a " fill cannula" option in "reservoir and settings"?( not sure on your pump but something to that effect if not Medtronic). If you use that and put in the dose needed to fill the cannula it would not mess up your bolusing via pump accounting for the active insulin.


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## brett (Apr 12, 2013)

Hanmillmum said:


> We change the whole lot each time as that is what we have been told to do.
> 
> However your pump may have a " fill cannula" option in "reservoir and settings"?( not sure on your pump but something to that effect if not Medtronic). If you use that and put in the dose needed to fill the cannula it would not mess up your bolusing via pump accounting for the active insulin.



Thanks for the quick reply, using accu chek combo.  Can only see setting to prime the tubing, not an option to fill reservoir.


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## Adrienne (Apr 12, 2013)

Ok so Accu Chek are the only company who say you can use the same tubing for 6 days, all other pump company say every 2 to 3 days change the lot.   This is not a money spinner but because insulin and plastic do not mix very well and especially if only bolusing small amounts and/or small basals then the insulin starts to crystallise or whatever in the tubing.

This is always a long conversation on the CWD email lists as accu chek say something different.   Interestingly Medtronic used to sell just tubing years ago but now they sell the whole lot as they realised what was happening.

So just be aware if you start to see numbers rising towards the end of your 6 days of the same tubing this could be the issue - you may not see it but just be aware.

We have medtronic so wording different but priming would be right. You need to prime the canula (the bit inside you).    You need to prime enough so that if fills the new canula.   On the smaller length mio canulas (Medtronic) it is only 0.3 units but I have indeed heard others say 1 unit for the accu chek (no idea what set mind you).   Priming it through would be ok


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## brett (Apr 12, 2013)

Thanks for that info adrienne, think I will change the lot as I do only use small amounts, so won't risk any possible problems with the insulin sticking inside, I know where the setting is to prime it so will prime the lot before inserting the needle in me.


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## brett (Apr 13, 2013)

Anyone using accu chek combo, how do you fill flexlink cannula without having to bolus 1 unit ?


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## everydayupsanddowns (Apr 13, 2013)

We need another Combo user really. I'm sure there are quite a few. 

TW changes tubing and cannula separately as you describe so there must be a way!


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## brett (Apr 13, 2013)

everydayupsanddowns said:


> We need another Combo user really. I'm sure there are quite a few.
> 
> TW changes tubing and cannula separately as you describe so there must be a way!



Hi, its quite annoying, I know how to change them separately but both ways involve bolusing 1 unit to prime the cannula.  This would make the pump think you have bolused 1 unit.  First snag I've come across and very happy with the pump.  Do think they should of has an option to prime cannula and able to set dose for the various types of cannula.
Like the previous post, there seems to be this option on other pumps.


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## Hanmillmum (Apr 13, 2013)

Might be worth a phonecall to the company to see if there are any ways around it ?


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## everydayupsanddowns (Apr 13, 2013)

brett said:


> Hi, its quite annoying, I know how to change them separately but both ways involve bolusing 1 unit to prime the cannula.  This would make the pump think you have bolused 1 unit.  First snag I've come across and very happy with the pump.  Do think they should of has an option to prime cannula and able to set dose for the various types of cannula.
> Like the previous post, there seems to be this option on other pumps.



Medtronic has an option called 'Fill cannula' which would be must what you need!


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## brett (Apr 13, 2013)

everydayupsanddowns said:


> Medtronic has an option called 'Fill cannula' which would be must what you need!



Yep, thats the one, not got it lol


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## brett (Apr 13, 2013)

Seems like only option is to prime infusion set while connected to cannula.  it is an automatic 25 units but can be stopped any time .  So next time will do this and push stop at 24 units.  Should work, as long as I'm not distracted and end up priming 25 units into me lol


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## Adrienne (Apr 13, 2013)

Brett please explain in one straightforward paragraph what you mean (I know what you mean but in the language of the Accu chek pump as I don't understand that as we have medtronic).    I should be able to get you an answer tonight or tomorrow.  I would have to cut and paste your paragraph and show a few people, would that be ok.


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## brett (Apr 13, 2013)

Adrienne said:


> Brett please explain in one straightforward paragraph what you mean (I know what you mean but in the language of the Accu chek pump as I don't understand that as we have medtronic).    I should be able to get you an answer tonight or tomorrow.  I would have to cut and paste your paragraph and show a few people, would that be ok.



I will try lol, thats fine 

When changing infusion set first step is to stop pump and disconnect infusion set, remove cannula.  Insert new cannula, and connect new infusion set to pump.  Before connecting new infusion set to canula the infusion set needs to be primed.  Select option on pump to prime infusion set, at which point 25 units is primed from pump until insulin is coming out the end.  Connect Innfusion set to canula.  Now 1 unit needs to be bolused to fill new canula.  This is done by manually selecting to bolus 1 unit.  Problem is pump then thinks 1 unit hasbeen bolused into me and is showing on meter as ~1 unit I think it will affect future bolus advice by deducting that 1 unit should I enter.carbs being eaten.


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## Adrienne (Apr 14, 2013)

Hiya

I've copied and pasted but they may have gone to bed now (till test time ) but will get back to you once I have an answer  

Ooops gotta go Jessica is now beeping ....  She's high


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## brett (Apr 14, 2013)

Thanks adrienne x


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## Adrienne (Apr 14, 2013)

Actually I'm getting a few replies through now.  Us mums stay up late 

Just asking more questions that have come up from their answers.


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## brett (Apr 14, 2013)

Wow,.I'm impressed.  Also I mums do stay up late lol.  Think ill be up late too, 5.5 and a but anxious to go to sleep, although by the last couple of days that should be fine.  Just not used to going to sleep on such low numbers lol


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## Adrienne (Apr 14, 2013)

brett said:


> Wow,.I'm impressed.  Also I mums do stay up late lol.  Think ill be up late too, 5.5 and a but anxious to go to sleep, although by the last couple of days that should be fine.  Just not used to going to sleep on such low numbers lol



Yep I understand that.   Its funny but we are now reliant on sensors which I know are hard for adults (and now children) to get.   I'm happy to let Jessica to to sleep in the 4's and 5's but without a sensor I am more worried unless in the 6's yet nothing is different


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## Adrienne (Apr 14, 2013)

brett said:


> I will try lol, thats fine
> 
> When changing infusion set first step is to stop pump and disconnect infusion set, remove cannula.  Insert new cannula, and connect new infusion set to pump.  Before connecting new infusion set to canula the infusion set needs to be primed.  Select option on pump to prime infusion set, at which point 25 units is primed from pump until insulin is coming out the end.  Connect Innfusion set to canula.  Now 1 unit needs to be bolused to fill new canula.  This is done by manually selecting to bolus 1 unit.  Problem is pump then thinks 1 unit hasbeen bolused into me and is showing on meter as ~1 unit I think it will affect future bolus advice by deducting that 1 unit should I enter.carbs being eaten.



Ok you are right.  This is what I've been told by a few mums using Accu Chek with their kids.

There are 3 ways you can do this.    As you say doing it like you are the pump will think there is 1 unit active insulin or IOB (insulin on board) or BOB (bolus on board) - whatever you call it.  If you are then high or whatever it will take notice of that 1 unit which won't help you at all.

So you can:

1.  Work out how many carbs would equate to 1 unit for you and enter the carbs (this is what you said).

2.  You can use the prime, which is set at 25 as default and watch it count up or down (whatever it does) and get ready to press the stop button when its given one.   One of the mums does this which to me seems very hit and miss but she says its practice and is the quickest way.

3.  This is what I suggested and think I would do.   You can prime the 25 units through to fill the tubing, then reset the default prime from 25 to 1 unit.   Then connect the pump.  You can then prime safely knowing it will only give you 1 unit and you don't have to get ready to press that stop button.   It won't then count as IOB.   

One mum said but you would have to change it back to 25 units.   I disagree.   You wouldn't have to do that until it was time to do the next set change.   So you could keep it on 1 unit as default whilst wearing it.   Once you do your next set change, change it to 25 units and then back to 1 unit to prime the cannula and so on

Does any of that make sense and does it help?   No idea but hope it does a bit.   You were absolutely along the right lines.


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## brett (Apr 14, 2013)

Thanks adrienne, does make sense.  I didn't realise the infusion priming could be changed, as u suggest that way you know 1 unit is being bolused without the fear of hitting the stop button too late or early.  I will do that in future as I don't see.a problem in having to change it back on the next change and so on.

Massive thank you for your help.


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## Adrienne (Apr 14, 2013)

They are still chatting about this and what they are saying is that they do it as in number 2 (in my previous post) but don't tell their child they do that as potentially a disaster.  

One of them said that Accu Chek didn't plan for canula primes very well or at all, which is quite funny


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## Adrienne (Apr 14, 2013)

brett said:


> Thanks adrienne, does make sense.  I didn't realise the infusion priming could be changed, as u suggest that way you know 1 unit is being bolused without the fear of hitting the stop button too late or early.  I will do that in future as I don't see.a problem in having to change it back on the next change and so on.
> 
> Massive thank you for your help.



Hey any time, I know loads of people on all the pumps but most are children and its the parents I'm asking.    I would do that way as well as I know I would miss the stop button !


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## brett (Apr 14, 2013)

That is using the flexlink canula, but, someone else has said to me that the rapid d cannula which is a metal one can be primed before being inserted into the skin.  The flexlink one has to be primed whilst in the body.  Hasn't checked that.myself as I don't fancy a metal canula.


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## Adrienne (Apr 14, 2013)

No I wouldn't fancy a metal one either.   I believe from listening to other parents that the little little kids are on the metal ones and the older kiddies have the flexi jobbies.   Not sure why as not listened that hard as don't have that pump


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## brett (Apr 14, 2013)

Think because flexlink start at 6mm, and the metal ones go to 4mm which might suit the little ones without much meat on em


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## Twitchy (Apr 14, 2013)

Hello, bit late but I'm on the combo too...personally I wouldn't dream of just using the 25u prime & trying to stop in time, I'm far too easily distracted lol I just do 1 u & try & remember when I see that stray unit later in the record - not good I admit! 

I agree Accu chek don't seem to have thought this bit out well - I'd love some easy way of recording that I'd done a set change for this reason & so I could keep tabs of things better - I don't often seem to manage the full 3-4 days I was told a cannula should last but I don't know if that's because my sites are dodgy (mummy tummy plus lipoatrophy - guess my bikini days are well over lol!) ...or whether this tubing issue might be the reason?? Will have to try & check this out...

Sorry, rambling response, brain addled by tantruming kid!


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## m1dnc (Apr 14, 2013)

I'm using a combo and I was taught to do it by using the bolus advice option with a "phantom" carb amount. I.e. tell the pump that you are eating sufficient carb to bolus 1 unit. Thus, in my case with a morning carb ratio of 1:8 I tell it I'm eating 8g of carb and it then boluses 1 unit to fill the new cannula. In practice I usually try to change the cannula around a mealtime and then just add extra carb to the bolus advice to add an extra unit. According to my rep this is the best way of doing it, but I agree that this is one area where Roche have missed a trick.


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## brett (Apr 14, 2013)

good suggestion M1dnc.  didn't think of that, that way the extra 1 unit is accounted for and won't affect any advice


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