# Day four...



## Freddie99 (Apr 15, 2010)

In the pumping zone now! Just done my first set change and reservoir fill and change without the team there. Went like clock work. Nice and easy. I'm just a little irritated that so far it seems that I can't get the reservoir to take in it's whole one hundred and eighty unit capacity, I'm falling short by twenty units each time roughly. Any hints?

Tom


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## Red Pumper (Apr 15, 2010)

Hi Tom,

glad your set change went OK. I remember being just a tiny bit apprehensive about doing my first one. They will soon become second nature.

I'm not sure that I can help with the reservoir filling problem as i am on a different pump to you. Do you have to draw the insulin into the reservoir in the same way that you would fill a syringe?


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## Red Pumper (Apr 15, 2010)

Hi Tom,

just done a quick google and the Veo reservoir looks very similar to the Accu-Chek cartridge. It looks like you have to fill it from an insulin via using the plunger - very smilar to a syringe. Is that correct?

If so, you could try putting more air into the vial before drawing out the insulin, that should allow you to pull the plunger further down. The other thing to try is to draw up more than the full amoiunt and then push the excess back into the vial once you have got rid of any bubbles.

The Accu-Check Spirt cartridges take 315 units but by the time I have filled and then primed, there is usually about 290 units left.


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## tracey w (Apr 15, 2010)

Hi tom, well done on your first set change, i remember being so nervous my hands were shaking! 

Different pump i know, but i draw up more than the 315 units to begin with, then once ive got out air bubbles and primed im there or there abouts.


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## Alzibiff (Apr 15, 2010)

TomH said:


> ... I can't get the reservoir to take in it's whole one hundred and eighty unit capacity, I'm falling short by twenty units each time roughly. Any hints?
> 
> Tom



Don't worry about it Tom - unless you cannot draw up enough for three days anyway. It's all about drawing up from the vial and how much you pull down the reservoir plunger - too far and you start to come past the rubber seals and air leaks in.

What is the most important - for me anyway - is that you get enough for three days worth of insulin. So... if you have a total daily dose of 40units for example, you need 120units in the reservoir plus a bit more for contingency - say a total of 140units. (Gives you a bit of leeway in terms of infusion set change time and how much food you are going to eat).

Alan


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## Sugarbum (Apr 15, 2010)

Hi Tom,

Sounds like you are going great guns!

Try not to worry too much about getting the full 1.8mls in the syringe....its something you will no doubt perfect as time goes on. You will also notice that even if you do fill they syringe, you will always end up disguarding (rather annoyingly) the insulin in the top triangular part of the syring where it is connected to the giving set. It is rare for me to go to the final dregs of the syringe, so I'm not bothered about too much about getting the 1.8 in, but I know what you mean...

Are you apprehensive that the 1.8 isnt going to last you very long? I was like that when I got pumping, it took me a couple of weeks to relax- 1.8 is plenty! It will last me 3 to 4 days no problem.

*Drawing up the syringe*
As redpumper advises, before you draw out, push the full 1.8ml of air into the vial and then turn upside down. Let the plunger move itselfs as it fills and just assist it at the bottom by pulling gently. Dont force it out into the syringe- the more you try and pull out more than the size of that needle you are forcing small air particles through into your syringe. They are small to see, but then in a days time you see they have collected together to make a nice juicy air bubble in the line. *Degassing* is another technique to help avoid air bubbles....there is a youtube video on degassing. Shelley degasses and could no doubt give you some tips. I didnt find it easy, but that may be hindered by using a smaller medtornic syringe (which I also find at times to be a little flimsey).

Dont worry about mucking up and getting through a few extra syringes or sets etc- Medtronic have never given any hint to me on the phone of being annoyed at the amount of supplies you might get through initially (phew!).

Sounds like you are going great guns anyway. I was inspired after hearing your stories about scatching your pump to put a protective cover on the screen of mine! I had a new mobile and had some fo that cut to size stuff!

Well done Tom- its a lot to do and take on board and constantly think about and deal with- especially when you have other big life things going on right now. You sound like you are doing a sterling job.

Lou


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## Cate (Apr 15, 2010)

Don't forget that some of the insulin you draw up gets used to fill the set tubing, so (I think) wouldn't show in the "units remaining" screen - at least that's what I was told, on my first pump with a 1.8ml reservoir I used to get about 155-160 units of insulin to use.


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## Freddie99 (Apr 15, 2010)

Cate said:


> Don't forget that some of the insulin you draw up gets used to fill the set tubing, so (I think) wouldn't show in the "units remaining" screen - at least that's what I was told, on my first pump with a 1.8ml reservoir I used to get about 155-160 units of insulin to use.



Ah thanks, it seems today's change wasn't that good. I managed to get about a hundred and forty units, I've used a fair chunk of that today. Need to maximise the capabilities of the smaller reservoir I feel. I may well just change it out when I do a set change in a few days time.

Tom


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## Red Pumper (Apr 16, 2010)

Hi Tom,

the Accu-Chek pump that I have holds 300units which lasts me just over six days. That means that I change the reservoir every second cannula change.

Unless your insulin needs become very small, I doubt that your 180 unit reservoir will give you the same coverage. I think your best policy (once your basal and bolus rates have been sorted) will be to fill the reservoir with enough insulin to last three days (plus a bit extra just in case) and change everything every three days.


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## randomange (Apr 16, 2010)

My reservoir holds 200 units, but by the time I've got rid of the air bubbles and primed, I lose about 20 units as well.

At the moment I'm using bucket loads of insulin (thank you stress... ), so I'm going through a reservoir roughly every two days.  What I've been doing is just changing the sets and the reservoirs at different times, which is a bit inconvenient, but nothing too bad.  Is that an option for you if your insulin requirements are going to stay the same?


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## Shelb1uk (Apr 16, 2010)

degassing rules..here is the you tube vid tom http://www.youtube.com/watch?v=OwbelFCNGz4 it's helped me tons as air bubbles r a right pain!!!!

S x


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## Freddie99 (Apr 17, 2010)

Thanks for the tip Shelley, I just tried it but I didn't have much success. However, it does help a little to do it the other way. I've managed to get a hundred and sixty units into my reservoir and prime it with only six units!

Had a minor drama when doing a cannula change yesterday. I tried to put it around my back but unknown to me I was about to put it through a blood vessel! First thing I knew was that the tubing and set were filling with blood! It got about three quarters of the way up the tubing. I can't exactly repeat some of what I said when I saw that happening! All I did was just put another one in another place and stop the bleeding. I've got a nice little bruise where the not so good one was.

Tom


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## tracey w (Apr 17, 2010)

TomH said:


> Thanks for the tip Shelley, I just tried it but I didn't have much success. However, it does help a little to do it the other way. I've managed to get a hundred and sixty units into my reservoir and prime it with only six units!
> 
> Had a minor drama when doing a cannula change yesterday. I tried to put it around my back but unknown to me I was about to put it through a blood vessel! First thing I knew was that the tubing and set were filling with blood! It got about three quarters of the way up the tubing. I can't exactly repeat some of what I said when I saw that happening! All I did was just put another one in another place and stop the bleeding. I've got a nice little bruise where the not so good one was.
> 
> Tom



Ouch, poor you, that doesnt sound good, but you are so brave for trying to put the cannula there I dont think id have the nerve even now! I like to be able to see whats going on! 

I use the degassing method and it seems to work for me, i do get the occasional bubble but nothing much.


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