# Lesson learned, or just more questions.



## Pattidevans (Dec 17, 2013)

This morning I was due a full infusion set replacement.  So I decided to refill the reservoir before unhooking the pump and starting the cartridge change procedure on the pump.  Thank heavens I did!

I started to fill the reservoir, only to find that there was insufficient insulin in the vial from which I was filling it (question, can you do a fill out of 2 different vials?).  Squirted all the insulin back out again,  went downstairs to the fridge and got a fresh vial which I put in a patch of sunlight in the bathroom and got into the shower.  Instead of taking the old reservoir out of the pump I'd only detached the cannula, taken it out & left the pump on "stop" (of course it drives you mental alarming every minute).

I then did all the necessary teeth cleaning etc etc, got dressed, then estimated that the vial had been out of the fridge for 20 minutes, plus it felt like room temp, so I filled the reservoir and realised I had a veritable froth of bubbles at the top of the reservoir.  The more I tapped it the more bubbles I got.  So I got another reservoir out and started again... same thing.  I was getting a bit panicky by then because I'd had the pump disconnected for about 40 mins by this time.  I rang my DSN who said ditch the lot - get another vial out of the fridge and another reservoir and wait 20 minutes.  To cut a long story short, I was on my 5th reservoir and in a blind panic before I remembered I hadn't taken the reservoir out of the pump and there was still insulin in it.  So I put a new cannula in and re-connected.  Blow me down there was a huge bubble in the reservoir in the pump - definitely hadn't been there when I'd originally changed it 4 days ago.  I just kept my fingers crossed, went away and tried to calm down.  Luckily I hadn't discarded the last two reservoirs because I remembered that other people re-use them sometimes.


3 hours later I have just been back, refilled one of the reservoirs from one of the vials I'd opened and everything has gone fine... phew.

Lessons learned :  Don't be in too much of a hurry if you get a new vial out of the fridge and leave yourself plenty of time to change the infusion set in future. 

Questions:  Can you fill a reservoir from 2 different vials? 
Is it OK to keep and refill the other reservoir I had opened, filled, empties and not used?


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## Pumper_Sue (Dec 17, 2013)

Hi Patti,
There is no reason on earth not to use 2 vials to fill your cartridge.
To save blind panic at change time just fill the cartridge 1st before you do anything else


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## AlisonF (Dec 17, 2013)

I do as sue suggests - fill the cartridge first (from however many vials are needed. I also only remove the old cannula once the new one is up and running. That way there's little panic if I need to stop mid change.

I also never stop the pump when I disconnect for a shower etc. I leave it running and just make sure its not on the bed otherwise the bedding ends up stinking of insulin.


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## Redkite (Dec 17, 2013)

Everything is less stressful if you're not in a rush, cannula changes included!  You can have the pump detached for 60mins quite safely though.

A tip for the future - assuming you keep a backup insulin pen at ambient temperature, you can take the cartridge out of that and fill your pump reservoir from the pen cartridge.  It's slightly more fiddly as the connector doesn't fit snugly and you have to hold the two parts in line, but it's exactly the same insulin.  This has saved us a few times now when I've used up a vial and forgotten to get a new one out of the fridge in time.


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## Pattidevans (Dec 17, 2013)

Pumper_Sue said:


> Hi Patti,
> There is no reason on earth not to use 2 vials to fill your cartridge.
> To save blind panic at change time just fill the cartridge 1st before you do anything else


Sorry I wasn't too clear.  I take your advice on board to fill the reservoir before doing anything else and I was actually filling it before I did anything else, but once I realised I needed another vial out of the 'fridge I decided that I'd get it and let it warm up whilst I was showering etc.  So I disconnected the pump and took the cannula out to shower.  The thing I was really unsure about was whether or not I could fill the reservoir from 2 different cartridges - don't forget I've only had to do it half a dozen times so far.  I still have my "L" plates on LOL! Taught me a lesson about using cold insulin tho'

Alison - how much insulin leaks out whilst you shower?  It's a thought putting it somewhere other than on the bed.  I had put it on the bed because if you switch it off and put it on a hard surface it also vibrates as well as squeaks and that makes SUCH a noise.  I'd followed the instructions to turn it off.  That's why it's so great to talk to other pump users because you get the real life "how to" rather than the instructions.

Redkite - I never realised you could be detached for up to an hour!  I do have a pen at ambient temp, though it's now probably been out over 30 days.  Will remember that tip!

Thanks everyone


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## everydayupsanddowns (Dec 17, 2013)

Yup I'll fill from multiple vials if need be, few issues, though a bit more bubble-tapping sometimes. 

I've also been told 1hr disconnected is fine - I always disconnect and just leave running too. Often I loop the cannula round Artoo and tuck it in on itself and leave it in the gym locker. 45-60mins of basal is usually only a micro-dribble for me


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## ingrid (Dec 18, 2013)

Hi Patti, it never occurred to me not to fill from more than one vial when using the last dregs from one, they should both be pretty sterile, can't see any harm in mixing. Only thing is you can't put air in the new one before withdrawing insulin (well, spose you could before withdrawing ANY insulin at all), but as someone who regularly reuses reservoirs, and who therefore can't put air in first on the refills, I don't think that's a problem. As everydayupsanddowns has said, it can even help towards minimising air bubbles. (When I next use a fresh reservoir I do put some extra compensatory air in so the pressure doesn't become too unequal in the vial). 

It's interesting the differences between the pumps, or perhaps the advice given. Before your experiences starting pumping, I'd not ever come across anyone turning off their pump when disconnecting for any reason, including any set changes. I was told and had read it was ok to disconnect for showers/(un)dressing/sport etc. up to an hour but no mention ever made of turning pumpy off. So, although you can 'suspend' delivery on Vibes, I've never done it when disconnecting. I can see it makes sense to be reminded by the alarm to 'resume' so that you don't forget to reconnect, but personally I hate all the alarms and would rather not have them bleeping or vibrating at me. When I want to cut basal delivery for e.g. rapidly dropping BGs, I turn the basal down by -100% for X mins instead of suspending delivery. It's good to have the choice though. 

The connector on the reservoir was a new one to me too! The Animas reservoirs (they call them cartridges) just look like an ordinary syringe and you stick the needle into the top of the vial (or pen cartridge) without any guidance. Funny how you assume all companies' pumps and consumables are pretty much the same and then discover they're not! 

"Is it OK to keep and refill the other reservoir I had opened, filled, empties and not used?" - I would, can't see why not as for you it's only 4 days between changes. Will it get contaminated in 4 days? Will the dribbles of insulin still in the reservoir react with the plastic/lube? Maybe put it back in its sterile packaging & keep in the fridge til next change? If you're worried about any of that then don't use it, but I would have no qualms about it but that's me. I wonder why you got all those bubbles from the new vial??!! How frustrating!


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## AlisonF (Dec 18, 2013)

Patti, its the tiniest amount of insulin that drips out while im not connected, normally less that a unit. But I find if I leave it on the duvet, even with that tiny amount I can smell it when I go to bed. And I hate sleeping with the whiff of insulin under my nose!


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## Pattidevans (Dec 18, 2013)

Hi Ingrid


> it never occurred to me not to fill from more than one vial when using the last dregs from one, they should both be pretty sterile, can't see any harm in mixing. Only thing is you can't put air in the new one before withdrawing insulin (well, spose you could before withdrawing ANY insulin at all), but as someone who regularly reuses reservoirs, and who therefore can't put air in first on the refills, I don't think that's a problem. As everydayupsanddowns has said, it can even help towards minimising air bubbles. (When I next use a fresh reservoir I do put some extra compensatory air in so the pressure doesn't become too unequal in the vial).


I thought Mike was saying there were more bubbles?
Definitely the Roche pump has gadgets for everything.  As well as the connector there's a battery "Key" that you need to undo the battery compartment.  This is a gadget about 1" in diameter made of clear transparent plastic with a sort of rounded edge with a knob on.  This morning the meter was alarming like mad and when I fished it from my pocket it said the battery was low.  So off I went to find the key.  When I was doing my training morning lots of things were chucked more or less willy nilly into various boxes (The Roche rep saying "Oh have a few more of this/that").  Now I had tidied it all up and I knew I'd seen the key amongst stuff but could I find it this morning?  Searched 9 boxes twice and meantime tried opening the battery compartment with a coin which didn't work.  Finally found a 10th box and there it was with the belt and a couple of horrible skins!  Phew!  I'm looking forward to the day I take all this for granted and don't have to have a treasure hunt every time I need to change something!

Turning the insulin down by -100 for so many minutes sounds like a plan.

Alison, I can't smell insulin any more.  Apparently hubby can, so best kept off the bedding


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## ingrid (Dec 19, 2013)

"Hi Ingrid
I thought Mike was saying there were more bubbles?"

Oops, that was in another post somewhere, about putting in less air than insulin you'll be withdrawing - creates a sucking back pressure which results in fewer bubbles coming out with the insulin. 

"Definitely the Roche pump has gadgets for everything.  As well as the connector there's a battery "Key" that you need to undo the battery compartment.  This is a gadget about 1" in diameter made of clear transparent plastic with a sort of rounded edge with a knob on."

I was given a key for Vibey's battery compartment but luckily a coin works just as well since I've no idea where the key is. Yes, lots of gadgets ===> more to lose! Though I suspect we all love gadgetry (I do). Do you get a 'getting low' battery warning first, which still gives you some days/weeks breathing space? I tend to ignore these and wait until it is about to conk out with its final warning, but I think even then you have some hours during which the pump still functions. Must admit the best 'gadget' I acquired was from Roche rep : a furry little pump replica  normally reserved for erm young pumpers (like kids)...but I fell in love with him when I spotted him on rep's keyring and offered to rehome him


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## Pumper_Sue (Dec 19, 2013)

The only gadget! I received with my pump was a belt clip. Instruction manual says use a coin to undo the battery cap. Unfortunately they didn't provide a gold sovereign for the task  Oh forgot the skin they sent as well which compromises the alarm sound.


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## Pattidevans (Dec 20, 2013)

> I was given a key for Vibey's battery compartment but luckily a coin works just as well since I've no idea where the key is. Yes, lots of gadgets ===> more to lose! Though I suspect we all love gadgetry (I do). Do you get a 'getting low' battery warning first, which still gives you some days/weeks breathing space? I tend to ignore these and wait until it is about to conk out with its final warning, but I think even then you have some hours during which the pump still functions. Must admit the best 'gadget' I acquired was from Roche rep : a furry little pump replica normally reserved for erm young pumpers (like kids)...but I fell in love with him when I spotted him on rep's keyring and offered to rehome him


I did get a low battery warning.  I wasn't sure if it meant "Low, I am going to turn myself off any second now" or "I'm giving you a week's notice that you will need to change the battery a week tomorrow and meantime I shall continue to remind you at unearthly times of the morning when you are fast asleep".

Unfortunately I couldn't open the battery compartment with a coin.  In 10 mins I had only managed a quarter turn & the coin was shearing off the plastic on the sides of the slot.

Your little fluffy pumpy sounds cute!

Sue - shame about the gold sovereign!  What a silly skin design if it compromises the alarm!


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## Maryanne29 (Dec 20, 2013)

Can you set up a 'cartridge low' warning on the Accu-Chek Combi? I've been thru the manual and now have info overload! If anyone knows the answer and how to do it, I'll be very happy.


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## ingrid (Dec 20, 2013)

Pattidevans said:


> I did get a low battery warning.  I wasn't sure if it meant "Low, I am going to turn myself off any second now" or "I'm giving you a week's notice that you will need to change the battery a week tomorrow and meantime I shall continue to remind you at unearthly times of the morning when you are fast asleep".
> 
> Hi Patti, I imagine it'll be different for each pump - any Combo-istas out there know about this? I found thru' trials on Vibey that when the battery logo thingy goes down from 3 to 2 bars (rep said to change at this point), there's still at least a couple of weeks' grace before the Low Battery Warning. With LBW you then get a minimum of 30 mins' use still but manual sez in 'Changing the Battery' section "You can remove the pump battery for up to 12 hours..." - I assume this means it will still function reliably and normally for the 12 hours but been too scared to try this bit out myself! Once battery level goes down to 2 bars I just make sure I'm carrying a spare or 2 batteries around with me, but don't always wait until the LBW to change if it's going to be very inconvenient. I wonder if Combo has a similar set up? I wouldn't like to suddenly get the LBW with only about 30 mins left, with no prior warning it was getting low.
> 
> ...


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## ingrid (Dec 20, 2013)

Sorry can't work this mutli-Quote thing out! Hope my message above is clear enough...


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## AlisonF (Dec 20, 2013)

Ingrid, to answer your question, I've only ever used a coin to open the Veo's battery compartment. I'm not actually sure what else im meant to use!


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## everydayupsanddowns (Dec 20, 2013)

Will be good for you to compare notes with Trophywench Patti - I'm sure she would know if there are alternatives to the Combo battery widget. 

I always wait until the pump low battery warns, though once I've been on '1 bar' for a few weeks I might carry a battery in my pocket to be on the safe side (though AAAs are easy enough to find)


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## Redkite (Dec 20, 2013)

everydayupsanddowns said:


> I always wait until the pump low battery warns, though once I've been on '1 bar' for a few weeks I might carry a battery in my pocket to be on the safe side (though AAAs are easy enough to find)



Do you mean to say your pump carries on for weeks with just one pip on the battery?!!  A new battery only lasts 4-6 weeks for us!  And once it goes down to one pip, I err on the side of caution and change it.  Once he was in school and the pump alarmed low battery and shut itself down (possibly he had ignored a previous alarm!) - lesson learned and repeat of situation to be avoided!  I do use the backlight a couple of times each night, which will use more battery power, and when he wears a sensor it definitely drains the battery quicker, but sadly sensors are in short supply.  So I'm surprised how much life you get out of yours


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## Pattidevans (Dec 21, 2013)

Goodness what an interesting subject, partic for Redkite.  

Well Trophy would be a good advisor, but methinks she's a bit offline for a few days.


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## Pumper_Sue (Dec 21, 2013)

My pump battery lasts about 12 weeks and then pump goes into overdrives with alarms and you must change it within 30 mins or you have a dead pump 
Once you change the battery you have no IOB showing as it's all wiped out. (you can still check when last bolus given though) Oh and then you have to do a complete rewind and prime of the pump  Which is the dumbest thing ever.


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## AJLang (Dec 21, 2013)

With regard to the plastic key with the Combi I order "service packs" which contain the plastic twister, batteries, a battery cap and the cap where the reservoir goes in. My pump nurse said that the caps and plastic key should be changed on each third pump battery change to prevent damage to the caps. To begin with I ordered a service pack for each month that the cannula order was due to last. I then keep one set in my purse and one with my other supplies so that I've always got them with me - I learnt to do this after panicking the first two or three times that the batteries needed changing


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## AJLang (Dec 21, 2013)

Maryanne29 said:


> Can you set up a 'cartridge low' warning on the Accu-Chek Combi? I've been thru the manual and now have info overload! If anyone knows the answer and how to do it, I'll be very happy.


I've tried to do this but haven't found anything to set. It automatically alarms when there is 20 units of insulin left  when you need to acknowledge the alarm. I think the next alarm is 0 units.  Depending upon what I am doing I will change the reservoir between 5 and 20 units - but my basal is quite high at 1 unit per hour


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## Pumper_Sue (Dec 21, 2013)

AJLang said:


> With regard to the plastic key with the Combi I order "service packs" which contain the plastic twister, batteries, a battery cap and the cap where the reservoir goes in. My pump nurse said that the caps and plastic key should be changed on each third pump battery change to prevent damage to the caps. To begin with I ordered a service pack for each month that the cannula order was due to last. I then keep one set in my purse and one with my other supplies so that I've always got them with me - I learnt to do this after panicking the first two or three times that the batteries needed changing



When I self funded I looked into the roache sp* pump and was shocked at the price for this so called service pack. (?40),
I was told to change the battery cap and cartridge cap every 6 months with both of my previous pumps.


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## AJLang (Dec 21, 2013)

Interesting Sue because my pump nurse really emphasised changing them on every third battery change because she had seen caps badly damaged when this hadn't been done. I'm going to follow her advice because I don't want to take any chances


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## Redkite (Dec 21, 2013)

The Veo's battery cap doesn't require changing in the pump's lifetime (you can undo it with a coin).  The reservoir comes with its own cap attached to the tubing.  You don't have to rewind and prime when you change the battery.  And you don't lose any data when you change the battery (unless you take too long, in which case everything is wiped and you have to completely reprogram).  I'm surprised other models aren't the same - reps don't talk about these sort of features!


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## ingrid (Dec 22, 2013)

Pumper_Sue said:


> My pump battery lasts about 12 weeks and then pump goes into overdrives with alarms and you must change it within 30 mins or you have a dead pump
> Once you change the battery you have no IOB showing as it's all wiped out. (you can still check when last bolus given though) Oh and then you have to do a complete rewind and prime of the pump... Which is the dumbest thing ever.



Hi Sue, wow wish I could get 12 weeks out of a battery, especially since we have to buy our own now! (Animas used to provide 'em as part of consumables orders until some EU directive came into force about sending dangerous objects (potentially explosive?) through the post from Europe, and as Animas send theirs from Belgium it applied; other pump co.s send theirs from UK I believe so don't encounter this silly problem). Do you use Eveready Ultimate Lithium? I've just bought a load 2 days' ago and re-read what Animas say in the manual & on the website - it seems any old lithium batteries won't do, has to be these Eveready ones? I get 4-6 weeks out of one battery. I've now just accidentally bought 3 years' supply  

It also says in the manual that you can take the battery out for up to 12 hours but I've been too scared to try this! Because of this, I don't get the impression pump would die after the 30 mins. I'm waiting for someone else to test this out though  

I agree the full rewind & prime is a right royal pain in the backside


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## Pumper_Sue (Dec 22, 2013)

Hi Ingrid, I use the energizer ultimate lithium battery. Slightly over the top in my saying the pump dies after 30 mins. What I should have said was the pump stops working as in delivering insulin. From what I can gather the settings are intact for 12 hours.
I received batteries on my last order   Hope you asked for the VAT back as the batteries are needed to power a medical device.


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## ingrid (Dec 23, 2013)

Pumper_Sue said:


> Hi Ingrid, I use the energizer ultimate lithium battery. Slightly over the top in my saying the pump dies after 30 mins. What I should have said was the pump stops working as in delivering insulin. From what I can gather the settings are intact for 12 hours.
> I received batteries on my last order   Hope you asked for the VAT back as the batteries are needed to power a medical device.



Ahhhh thanks, that makes sense that it stops delivering insulin but keeps the settings for 12 hours...glad I never tested that out! That could be clearer in the manual.

Maybe Animas have found a way to post the batteries directly from UK now,  which I'm pleased to hear  (my last lot from them a few months' back, they told me I'd have to buy them from now on) I had a brainstorm in the shop thinking the pump uses 4 at a time, and the packs were 6 for the price of 4...so I bought 4 'bargain' packs to cover me 6-8 months, except Vibe takes just 1 battery which is why I now have enough to last 2-3 years. Stoopid me. Oh well, they're very well dated hehe. Forgot about the VAT exemption


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## everydayupsanddowns (Dec 23, 2013)

Redkite said:


> Do you mean to say your pump carries on for weeks with just one pip on the battery?!!  A new battery only lasts 4-6 weeks for us!  And once it goes down to one pip, I err on the side of caution and change it.  Once he was in school and the pump alarmed low battery and shut itself down (possibly he had ignored a previous alarm!) - lesson learned and repeat of situation to be avoided!  I do use the backlight a couple of times each night, which will use more battery power, and when he wears a sensor it definitely drains the battery quicker, but sadly sensors are in short supply.  So I'm surprised how much life you get out of yours



Makes a lot of sense for batteries to wear out fast with a sensor, but yes... I do get several days on one battery bar. My current battery is showing 1 bar, and already it has gone back up to 2 bars for half a day before settling back to 1 bar. I use the backlight probably once or twice a day myself too... Though I always turn it on and off manually rather than waiting for it to 'timeout'. 

I think the last time I changed battery was mid-October, I'm not sure if this one will make it into January so I'm carrying batteries with me over the Christmas period.


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## Redkite (Dec 23, 2013)

Hmm, I think different user styles might make a difference too.  For example, my son will do multiple boluses in a typical day, taking insulin for each item of food as he's about to eat it, rather than deciding in advance what he's going to eat.  So instead of 3 meal boluses in a day, there will probably be about 15, including snacks.  Maybe that uses more battery power too, never thought about it before.


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