There are exceptions, of course, but in all probability, the doctor who prescribed your insulin pump or continuous glucose monitor (CGM) doesn’t wear one. That doesn’t mean they can’t support your use of this gear. It does mean that the doctor’s office isn’t always the best place to turn for solutions to the many common — but unexpected — day-to-day problems that users encounter.
Instead, when it comes to in-the-trenches, real-life everyday problems with these diabetes devices, the best solutions often come from veteran people with diabetes (PWDs).
Today, we’re dishing out a serving of street smarts culled from the collective wisdom of fellow PWDs to help you cope with four of the most common problems reported with both insulin pumps and CGMs.
I have trouble detecting whether my pump has an occlusion problem. An “occlusion” is any blockage of the thin plastic cannula that serves as the entry port into your body for insulin. Sometimes cannulas get bent on insertion, reducing or cutting off the flow of insulin. Other times the body “fouls” the cannula over time. Pumps are supposed to detect occlusions
- Fix-It: If your sugar starts rising in the first 2 hours after a site change, suspect an occlusion. Any other time that a high doesn’t respond well to an insulin correction, especially if your glucose keeps rising after the correction, suspect an occlusion. Don’t wait for an alarm in either case; remove and replace the body portion of the site. Don’t worry about wasting supplies. Occlusions are dangerous and can lead to DKA. On a conventional pump, you don’t need to replace the entire set: The old tubing and the insulin cartridge are unaffected. If you use an Ominipod, tubeless pump, you can use the fill syringe to recover the insulin from the bad pod and transfer it to the replacement. Remember that lightning does strike in the same place twice with diabetes it seems, so always carry two spare sets or pods with you — even if you just put on a fresh set.
The @%$#&! pump tubing gets caught on every doorknob. There’s an odd magnetic attraction between doorknobs and infusion set tubing, it seems. Many users feel like they can’t walk by any door without getting “snagged.” Sometimes stove knobs show the same tendency.
- Fix-It: Tuck your excess hosing under the waistband of your pants or skirt, tuck the tubing into your underwear, or coil it up and slide it into your pocket. A product designed specifically to tame tubing called TubeGuard from Unomedical seems to have been discontinued, but there are still a bunch of pump-wear products out there that can help: Check out Hid-In, Clever Travel Companion, and Anna PS, to name a few. Also, users are continually coming up with their own DIY fixes to keep pump tubing safe, from the clever use of scarfs and belts to employing a velcro strap.
I’m worried about the insulin I “lose” when I disconnect. In the shower. Getting a CAT scan. Swimming. Intimate moments. These are times when you want — or need — to take the darn thing off. The problem is that as a pumper, you have no long-acting insulin in your body, so if you’re separated from your constant drip of fast-acting for too long, your blood sugar will spike, perhaps dangerously so.
- Fix-It: Set a smartphone stopwatch timer (or other timers) when you disconnect. When you’re ready to hook up again, check the sans-insulin time and multiply it by your average basal rate during the time you were disconnected, then take that amount as a manual “makeup” bolus.
My site reminder won’t let me choose anything longer than 3 days. Yeah. We get it. Times are tough. You gotta stretch every dollar spent on outrageously expensive insulin, and that might mean stretching your infusion sets an extra day. Or two. Of course, your diabetes educator told you never to do this, but in fact, many of us do. And so long as your skin isn’t having a bad reaction to the set, and you’re not experiencing elevated blood sugars on the extra days — suggesting absorption problems with extended wear — there’s no harm in it. But the pump companies don’t have your back this time. You can’t set a 4- or 5-day site change reminder. What to do?
- Fix-It: One option is to use external tech, such as a smartphone alarm, to remind you. Another trick is to use the pump volume alert as a proxy for a site change reminder. Gary Scheiner, renowned Diabetes Care and Education Specialist at Integrated Diabetes Services in Pennsylvania and type 1 PWD himself says to simply turn off the reminder feature of the pump, and “Instead, put just enough insulin into the pump to last the intended number of days.” For example, he says if you use an average of 40 units per day and want to use a set for 5 days, load 200 units (plus 10 to 15 for priming). When the “low insulin” alert occurs, you should be approaching the time for your set change. He cautions, however, that stretching site wear may not be the best way to save money, as most people start suffering absorption problems after 2 to 3 days. He’s clear that this advice is ONLY for those who find their bodies are still able to absorb insulin in the usual manner with extended wear.
Now, let’s move on to fixes for common problems with CGM systems.
My system keeps losing the wireless signal. Data gaps. Lost alarms. Sometimes it seems like your CGM transmitter and monitor (or smartphone app) are headed for a divorce, as they just won’t talk to each other for any length of time.
- Fix-It: Always wearing the monitor, pump, or phone (depending on the system you are using) on the same side of your body as the CGM transmitter. Yeah, we know this can be inconvenient, but it will solve the problem. It often seems crazy that the CGM thing will connect from halfway across your house, but the signal can’t manage to find its way from one side of your body to the other — but that appears to be the case. Many users have reported significantly fewer dropped signal problems when they keep the CGM monitor or smartphone on a belt or in a pocket on the same side of the body where the sensor is placed.
My sensor always falls off before it expires! Especially in hot weather, many PWDs find that the sensor doesn’t want to stay on for the entire session.
- Fix-It: Think about when you attach a sensor. Kamil Armacki of NERDabetic YouTube fame says, “One thing I have found helpful is applying the sensor when my skin is dry and cold, so not within 4 hours of taking a bath or shower.” If that doesn’t work, many PWDs cover the sensor with an over bandage, either from the very start or once the edges of the adhesive pad on the sensor start peeling loose. Don’t use duct tape or Band-Aids! Dexcom offers free over patches for its users. For something more artistic, Pump Peelz offers a wide range of creative over bandages. Or for the active crowd, Skin Grip offers a 4-way stretch hypoallergenic fabric patch in a wide range of both skin and primary colors. What also helps is using an adhesive wipe on the skin before insertion. See Problem No. 3 below.
I get a nasty, itching, red rash under the sensor toward the end of its run. Let’s be honest: Human skin did not evolve to have glue stuck to it, and CGM sensors are being designed for longer and longer wear times. For many people, especially in warm weather, the skin under the sensor adhesive goes into major protest mode after 4 or 5 days.
- Fix-It: To prevent irritation, try using a medical “barrier” wipe before putting the sensor on. These wipes create a layer of skin-friendly film between your epidermis and the more aggressive glue of the sensor adhesive. Caution: Be sure to let the wipe’s liquid fully dry before slapping on the new sensor. Read our comparative review of skin wipes for diabetes devices. Once the damage is done, you can treat irritated skin with anti-itch cream, lotion such as calamine lotion, or cream with at least 1 percent hydrocortisone. Experts also suggest taking an antihistamine like Benadryl to reduce itching, keeping the area moisturized, avoiding scratching the rash, and using a cool compress on the area, as well.
I’m out of sensors because a couple of them “died” early. Sometimes sensors just crap out early. When this happens, you slap a new one on and continue plowing through life until one day, suddenly, your diabetes closet is bare and new supplies won’t be coming for another week. Now what?
- Fix-It: Rat out a lazy sensor immediately. Any time a sensor fails to reach its official life expectancy, take the time to call the manufacturer for a replacement — even if you still have a closet full of spares. Your health insurance company will only pay for exactly what you need, and the CGM makers know this. So it’s worth taking time out of your day to get the replacements you need and deserve. The manufacturer will quickly replace a sensor that doesn’t last as long as it should, but ya gotta call to make that happen.