# Here's a good article for today
**URL:** https://forum.fudiabetes.org/t/heres-a-good-article-for-today/15646
**Category:** Tips, Tech & Gear
**Created:** [December 5, 2025, 2:28pm UTC](https://forum.fudiabetes.org/t/heres-a-good-article-for-today/15646 "2025-12-05T14:28:48Z")
**Posts on this page:** 19
**Page:** 1
### Author:  [@mohe0001](https://forum.fudiabetes.org/u/mohe0001)
#### Post date: [December 5, 2025, 2:28pm UTC](https://forum.fudiabetes.org/t/heres-a-good-article-for-today/15646/1 "2025-12-05T14:28:48Z")
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# **Trusted – Until It Stops: Real‑World Failures in Diabetes Technology**
**[](https://www.linkedin.com/in/derekbrandt/)**
## **[Derek Brandt](https://www.linkedin.com/in/derekbrandt/)**
Per Aspera ad Astra - Auf rauen Wegen zu den Sternen
December 5, 2025
### **An example what can happen, if there is a pump malfunction:**
A vivid example is a teenager with type 1 diabetes who developed recurrent diabetic ketoacidosis (DKA) because an insulin pump silently stopped delivering insulin, and nobody initially recognized that the device itself had failed. The story illustrates how quickly pump malfunctions can escalate when people trust the device but miss subtle warning signs.
**The clinical course**
A 14‑year‑old girl on pump therapy was admitted with severe DKA and treated successfully with intravenous insulin and fluids; the initial assumption was “human error” (diet, insulin handling) rather than hardware failure. When she improved, subcutaneous pump therapy was restarted, but the pump later malfunctioned, insulin delivery again dropped off, and biochemical markers showed a relapse of DKA that required another prolonged course of IV insulin before a replacement pump was arranged.
**What went wrong technically**
Retrospective review concluded that the pump had a mechanical failure that intermittently stopped insulin despite appearing to function, so neither she nor the team immediately suspected the device. This kind of “silent interruption” is particularly dangerous in pump users because there is no long‑acting insulin in the background, so relative insulin deficiency can develop within hours and evolve into absolute deficiency and full DKA within a very short time window.
**Lessons for people with diabetes**
The case underlines the need to treat any unexplained, rapid rise in glucose and ketones on pump therapy as potential pump or infusion‑set failure until proven otherwise, not just as a behavioral issue. It also shows why education on troubleshooting (checking the line, changing set and site, considering a temporary switch to injected insulin) and on advocating for device evaluation in hospital is as critical as the pump technology itself.
Here are some further information about the case: **[https://pmc.ncbi.nlm.nih.gov/articles/PMC2769395/pdf/1757-1626-0002-0000008012.pdf](https://pmc.ncbi.nlm.nih.gov/articles/PMC2769395/pdf/1757-1626-0002-0000008012.pdf)**
## **Diabetes Technology malfunctions**
Common malfunctions in diabetes technology devices cluster around failures in insulin delivery (hardware and consumables), sensor accuracy and connectivity, and skin/adhesive problems, often amplified by environmental and human‑factor issues. These malfunctions can be “silent” (e.g., insulin under‑delivery without alarm) or very visible (e.g., device shutdown, sensor fall‑off), but in both cases they drive glycemic excursions and loss of trust.
### **Insulin pumps: device failures**
Insulin pump malfunctions include failure to power on, generic “pump error” or malfunction alarms, unresponsive touchscreens or buttons, and speaker‑related defects that break communication with CGM or alarms. Physical damage (cracks, water ingress), mechanical or software faults, and reservoir/cartridge defects are frequent root causes in adverse‑event narratives. These issues can result in inappropriate insulin delivery and are associated with both hypo‑ and hyperglycemia in observational analyses of MAUDE data.
It is really interesting to search the MAUDE database: **[https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/search.cfm](https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/search.cfm)**
### **Infusion sets and catheters**
A large proportion of insulin pump problems trace back to the infusion set: kinked cannulas, occlusions, catheter knots or bending, accidental traction, and leakage at the insertion site. These failures may present clinically as “unexplained” hyperglycemia and failed correction boluses, sometimes without an occlusion alarm being triggered. Adhesive detachment of the cannula patch, bleeding, local inflammation, and skin problems (itching, pain) are also common and often lead to premature set changes and variable insulin absorption.
### **CGM sensors: accuracy, signal, and wear**
For CGM systems, the dominant malfunctions are inaccurate readings, premature sensor failure, communication errors between sensor and transmitter/receiver, and generic error codes. Environmental factors such as heat, humidity, and physical activity contribute to adhesive failure, sensor lift‑off, and intermittent signal loss, which in turn produce missing data and unreliable trend information. Insertion problems (bleeding, partial insertion, incorrect placement) and repeated use of the same site can destabilize sensor performance and shorten effective wear time.
### **Adhesive and skin complications**
Across both CGM and infusion sets, adhesive‑related issues are central: sensors or cannula patches falling off, accidental pull‑offs, and transmitter–sensor uncoupling. Many users develop contact dermatitis or other skin reactions to adhesives, plastics, or metals, ranging from mild irritation to severe rashes and blistering that limit long‑term device use. Site overuse can lead to scarring and altered tissue characteristics, which further degrades both insulin absorption and sensor signal quality over time.
### **Human factors and system behavior**
Human‑factor and algorithmic issues intertwine with hardware malfunctions: errors in set insertion, inadequate training, ignoring or misinterpreting alarms, and suboptimal site rotation are all implicated in adverse events. In AID systems, mismatches between CGM input and real glucose, or algorithm behaviors such as unexpected suspensions or aggressive corrections, can compound hardware issues and contribute to severe hypo‑ or hyperglycemia. Overall, analyses emphasize that many serious events occur without clear device alarms, underscoring the need for robust failure detection, better user education, and more resilient hardware–software co‑design.
## **Conclusion**
Diabetes technology needs to become radically more user‑led: safer, simpler, and truly designed around everyday life, not just regulatory checklists and glossy trial data. The only way to get there is to treat real‑world user feedback as hard evidence, not soft “anecdotes.”
### **What needs to improve**
- Reliability first: Fewer silent pump and CGM failures, better detection of interrupted insulin delivery, and clearer, smarter alarms that actually point to the root cause instead of generic error codes.
- Human‑factor design: Interfaces, workflows, and training that match how people really live, including sickness, travel, burnout, shift work, and low digital literacy—not just idealized “perfect user” scenarios.
- Interoperability and data integration: Devices and apps that talk to each other seamlessly so PwD can see one coherent picture of glucose, insulin, food, sleep, and activity instead of juggling islands of data.
- Equity and access: Designs, interfaces, and support models that work for older adults, people with low income, different languages, and varying tech skills, or technology will widen, not close, the diabetes gap.
### **Why real user feedback must lead**
Today, most safety and usability signals come filtered through under‑reported adverse‑event systems and short research studies, which systematically miss frustration, workarounds, and “near misses” that never reach a journal or database. In contrast, continuous, structured feedback from PwD—user panels, in‑app surveys, co‑design workshops, real‑world N‑of‑1 data—captures what truly matters: when people stop using a device, which alarms they mute, which features they never touch, and which small fixes would change adherence and outcomes.
If diabetes technology companies and regulators start treating this lived experience as a primary design input—weighted at least as highly as HbA1c curves and time‑in‑range graphs—the next generation of systems can be not only more advanced, but meaningfully safer, fairer, and less exhausting for the people who rely on them every single day.
## **For me it is clear: Nothing about us without us: diabetes tech must be built with real users at the table.**
**Here are some links, if you want to read more about device malfunction:**
**[https://pmc.ncbi.nlm.nih.gov/articles/PMC12436335/](https://pmc.ncbi.nlm.nih.gov/articles/PMC12436335/)**
**[https://pmc.ncbi.nlm.nih.gov/articles/PMC8875056/](https://pmc.ncbi.nlm.nih.gov/articles/PMC8875056/)**
**[https://pmc.ncbi.nlm.nih.gov/articles/PMC4764227/](https://pmc.ncbi.nlm.nih.gov/articles/PMC4764227/)**
**[https://pmc.ncbi.nlm.nih.gov/articles/PMC10716844/](https://pmc.ncbi.nlm.nih.gov/articles/PMC10716844/)**
**[https://diabetesjournals.org/care/article/38/4/716/37581/Insulin-Pump-Risks-and-Benefits-A-Clinical](https://diabetesjournals.org/care/article/38/4/716/37581/Insulin-Pump-Risks-and-Benefits-A-Clinical)**
**[https://journals.sagepub.com/doi/10.1089/dia.2015.0434?icid=int.sj-abstract.similar-articles.5](https://journals.sagepub.com/doi/10.1089/dia.2015.0434?icid=int.sj-abstract.similar-articles.5)**
**[https://www.liebertpub.com/doi/10.1089/dia.2022.0498](https://www.liebertpub.com/doi/10.1089/dia.2022.0498)**
**[https://cardiovascularbusiness.com/topics/clinical/heart-health/insulin-pump-error-linked-700-adverse-events](https://cardiovascularbusiness.com/topics/clinical/heart-health/insulin-pump-error-linked-700-adverse-events)**
**[https://blog.profil.com/blog/insulin-infusion-system-failure](https://blog.profil.com/blog/insulin-infusion-system-failure)**
**[https://www.liebertpub.com/doi/full/10.1089/dia.2021.0540](https://www.liebertpub.com/doi/full/10.1089/dia.2021.0540)**
**[https://pmc.ncbi.nlm.nih.gov/articles/PMC5478030/](https://pmc.ncbi.nlm.nih.gov/articles/PMC5478030/)**
**[https://journals.sagepub.com/doi/10.1177/19322968221093362](https://journals.sagepub.com/doi/10.1177/19322968221093362)**
**[https://cdn.clinicaltrials.gov/large-docs/94/NCT04113694/Prot\_000.pdf](https://cdn.clinicaltrials.gov/large-docs/94/NCT04113694/Prot_000.pdf)**
**[https://www.chuwi.com/uploads/healthy/the-most-common-mistakes-people-make-when-they-first-get-a-cgm-dQrBcx.html](https://www.chuwi.com/uploads/healthy/the-most-common-mistakes-people-make-when-they-first-get-a-cgm-dQrBcx.html)**
**[https://www.snaq.ai/blog/7-factors-that-affect-your-cgm-accuracy-sensor-placement-medications-and-more](https://www.snaq.ai/blog/7-factors-that-affect-your-cgm-accuracy-sensor-placement-medications-and-more)**
**[https://journals.sagepub.com/doi/10.1177/19322968241267774](https://journals.sagepub.com/doi/10.1177/19322968241267774)**
**[https://gluroo.com/blog/diabetes-101/replace-cgm-guide/](https://gluroo.com/blog/diabetes-101/replace-cgm-guide/)**
**[https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/detail.cfm?mdrfoi\_\_id=23437933&pc=QFG](https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/detail.cfm?mdrfoi__id=23437933&pc=QFG)**
**[https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/detail.cfm?mdrfoi\_\_id=10534902&pc=MDS&device\_sequence\_no=5](https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/detail.cfm?mdrfoi__id=10534902&pc=MDS&device_sequence_no=5)**
**[https://www.diabetesaustralia.com.au/news/warning-about-insulin-pump-failure/](https://www.diabetesaustralia.com.au/news/warning-about-insulin-pump-failure/)**
---
### Author:  [@CarlosLuis](https://forum.fudiabetes.org/u/CarlosLuis)
#### Post date: [December 5, 2025, 2:58pm UTC](https://forum.fudiabetes.org/t/heres-a-good-article-for-today/15646/2 "2025-12-05T14:58:58Z")
From my years of testing electronic circuitry, there’s always the possibility that the testing device is faulty. For this reason after getting a CGM and later a pump paired to it I always have backup insulin delivery and glucose meter at hand.
Stuff breaks and often without warning. We all need to be aware of how we feel and if that doesn’t correlate to CGM readings TEST, and act accordingly.
It amazes me at how well CGMs work but there’s too many areas they can fail- mechanically, biologically, chemically or electronically. Even so I want my diabetes tech. My life is better with it than without.
Because I don’t have unwavering faith in CGMs I am wary of any pump more automated than Tandem C-IQ. That’s too much authority given to a brain without the ability to discern problems.
It would be nice to have tech make all decisions, but not when my health is in the pot.
---
### Author:  [@RachelMaraii](https://forum.fudiabetes.org/u/RachelMaraii)
#### Post date: [December 5, 2025, 5:53pm UTC](https://forum.fudiabetes.org/t/heres-a-good-article-for-today/15646/3 "2025-12-05T17:53:10Z")
> [@mohe0001](#):
>
> Interoperability and data integration: Devices and apps that talk to each other seamlessly so PwD can see one coherent picture of glucose, insulin, food, sleep, and activity instead of juggling islands of data.
I’ve left app reviews for Sugarmate in particular hoping they’ll integrate t:slim data with the app, since Tandem owns both companies. It would mean so much less labor to track information in the same place!
---
### Author:  [@John58](https://forum.fudiabetes.org/u/John58)
#### Post date: [December 5, 2025, 8:07pm UTC](https://forum.fudiabetes.org/t/heres-a-good-article-for-today/15646/4 "2025-12-05T20:07:52Z")
> [@mohe0001](#):
>
> A large proportion of insulin pump problems trace back to the infusion set: kinked cannulas, occlusions, catheter knots or bending, accidental traction, and leakage at the insertion site. These failures may present clinically as “unexplained” hyperglycemia and failed correction boluses, sometimes without an occlusion alarm being triggered.
That has been my experience using Omnipod. My theory is that the shallow angled cannula is prone to infusion disruptions from getting jiggled, knocked or skin stretched at the site, etc., which sometimes means a totally ineffective bolus and basal and other times means partially effective bolus and basal. Usually the infusion disruption is accompanied by pain at the site but not always. I can’t remember a single time the Omnipod software alerted me to an infusion disruption such as described above, other than an occasional occlusion.
These failures definitely present as “_unexplained” hyperglycemia and failed correction boluses_". They are hard to diagnose, often taking maybe a half day to decide to abandon a pod and start a new one. This insulin that is pumped out but not absorbed throws off the Auto mode algorithm on Omnipod 5. That is why I have gone back to manual bolus and basal.
I’ve never used a tubed pump…I am curious if other infusion sets used for Tandem, Medtronic or Sequel Twiist are overall more reliable day to day than Omnipod.
---
### Author:  [@bkh](https://forum.fudiabetes.org/u/bkh)
#### Post date: [December 5, 2025, 9:12pm UTC](https://forum.fudiabetes.org/t/heres-a-good-article-for-today/15646/5 "2025-12-05T21:12:38Z")
> [@John58](#):
>
> I’ve never used a tubed pump…I am curious if other infusion sets used for Tandem, Medtronic or Sequel Twiist are overall more reliable day to day than Omnipod.
I definitely found the Medtronic Quickset infusion set much more reliable than the Omnipod Dash. I never had leaking around the cannula with the Quickset.
---
### Author:  [@Terry](https://forum.fudiabetes.org/u/Terry)
#### Post date: [December 5, 2025, 9:24pm UTC](https://forum.fudiabetes.org/t/heres-a-good-article-for-today/15646/6 "2025-12-05T21:24:03Z")
> [@John58](#):
>
> I’ve never used a tubed pump…I am curious if other infusion sets used for Tandem, Medtronic or Sequel Twiist are overall more reliable day to day than Omnipod.
Many years ago, before I started on my current Loop DIY system, I tried the Omnipod system for about 5 months. I found, over time, that I developed a trend of unexplained third day glucose rises along with unexplained glucose rises in the time following a pod change. These two trends led me to dropping the Omnipod.
I concluded that my case was in the minority and that my long history of pump use perhaps wore out my dermis. I knew that there were thousands of many happy users of Omnipods and I accepted that I was the exception. Yet I continued to read about accounts that reminded me of my poor experience of the Omnipod system.
I switched back to a tubed pump (Animas Ping combined with another angled infusion set) and the absorption problems totally resolved. Now I think that the fixed Omnipod cannula depth was just at a bad layer of tissue for me. I’ve had sustained (9 years now) success, however, with MM Silhouette infusion sets, surprisingly another angled infusion set.
The experience I had with Omnipod taught me to be quicker in my decision to change an infusion site even if it is newer. I’ve also experimented with the “untethered” regimen where I combined a pump with a daily long-acting basal insulin. I remember it as a dependable system but it did come at the cost of adding another daily injection. I used Tresiba and found that forgetting a shot for up to 12 hours made little difference in my glucose levels
---
### Author:  [@jbowler](https://forum.fudiabetes.org/u/jbowler)
#### Post date: [December 6, 2025, 12:16am UTC](https://forum.fudiabetes.org/t/heres-a-good-article-for-today/15646/7 "2025-12-06T00:16:37Z")
> [@CarlosLuis](#):
>
> It amazes me at how well CGMs work but there’s too many areas they can fail- mechanically, biologically, chemically or electronically.
Indeed. They do what they do and it is amazing. It is hardly surprising that they fail.
---
### Author:  [@elver](https://forum.fudiabetes.org/u/elver)
#### Post date: [December 6, 2025, 6:27am UTC](https://forum.fudiabetes.org/t/heres-a-good-article-for-today/15646/8 "2025-12-06T06:27:17Z")
Thanks for the article @mohe0001 , very informative and a good place to start chasing possible errors!
---
### Author:  [@bostrav59](https://forum.fudiabetes.org/u/bostrav59)
#### Post date: [December 6, 2025, 6:26pm UTC](https://forum.fudiabetes.org/t/heres-a-good-article-for-today/15646/9 "2025-12-06T18:26:49Z")
Thanks from me too. Very interesting. I also believe as the article states
> [@mohe0001](#):
>
> safer, simpler, and truly designed around everyday life, n
In a different thread around travel prep we discussed making sure that you had a backup (and sometimes a backup for that backup) would be important.
These days, from what we are learning about people giving up their intelligence to machines, I’d add that diabetes management solutions which keep the user involved are important.
Of course, what does this say about artificial pancreas technologies? Should the goal be a fully automatic technology or one that is more semi-automatic, requiring periodic user awareness?
in the example provided here of pump failure, wouldn’t the existence of a CGM address this problem well before KA?
---
### Author:  [@LWithrow](https://forum.fudiabetes.org/u/LWithrow)
#### Post date: [December 7, 2025, 12:44am UTC](https://forum.fudiabetes.org/t/heres-a-good-article-for-today/15646/10 "2025-12-07T00:44:46Z")
> [@bkh](#):
>
> I definitely found the Medtronic Quickset infusion set much more reliable than the Omnipod Dash. I never had leaking around the cannula with the Quickset.
It’s funny that you mention this today! Yesterday, my Medtronic Quickset got yanked out so I replaced the cannula with a leftover Tandem XC because they are interchangeable and my site is now doing exactly what it did for years…._itch_. I had forgotten about the itching with the Tandem cannulas. I just dealt with it until the site went bad and started leaking and then I’d change it out. I had to jump through all kinds of hoops with Tandem to get extra infusion sets. In the end, they wanted me to try the steel infusion set, but by that time I had already been looking into switching to Medtronic, so I never did use the steel set. – I’ve been on the Medtronic Quickset which is a seven-day set with no itching since February. – Just goes to show that not all hardware is created equal.
---
### Author:  [@jbowler](https://forum.fudiabetes.org/u/jbowler)
#### Post date: [December 7, 2025, 11:27pm UTC](https://forum.fudiabetes.org/t/heres-a-good-article-for-today/15646/11 "2025-12-07T23:27:28Z")
> [@bostrav59](#):
>
> Of course, what does this say about artificial pancreas technologies? Should the goal be a fully automatic technology or one that is more semi-automatic, requiring periodic user awareness?
Speaking from a purely capitalist viewpoint there are many market segments and some of us want something we can ignore whereas others want something we can control. I don’t see why one market segment should be ignored?
I guess modern cheapskate capitalists just want one size that fits Al. As Larson observed, I’ve got the book somewhere; IRC it’s the one with the “Enormous Shoe Sale” in it.
---
### Author:  [@elver](https://forum.fudiabetes.org/u/elver)
#### Post date: [December 9, 2025, 5:48am UTC](https://forum.fudiabetes.org/t/heres-a-good-article-for-today/15646/12 "2025-12-09T05:48:13Z")
@bkh I wonder if Medtronic is using a different adhesive formulation than the Tandem sets are. I was under the impression they were both made by Unomedical.
---
### Author:  [@bkh](https://forum.fudiabetes.org/u/bkh)
#### Post date: [December 9, 2025, 2:10pm UTC](https://forum.fudiabetes.org/t/heres-a-good-article-for-today/15646/13 "2025-12-09T14:10:13Z")
I don’t know if they use a variety of adhesives for different infusion sets. I don’t even know if the Medtronic Quickset today uses the same adhesive as it did back when I used them. But I can say that the permanent inserter used with the Quickset (especially the old one with the blue handle, more than the newer green one) was significantly better for me than the built-in coiled up plastic spring disposable inserter used in the Tandem sets that I tried.
---
### Author:  [@CarlosLuis](https://forum.fudiabetes.org/u/CarlosLuis)
#### Post date: [December 9, 2025, 2:22pm UTC](https://forum.fudiabetes.org/t/heres-a-good-article-for-today/15646/14 "2025-12-09T14:22:29Z")
> [@elver](#):
>
> I was under the impression they were both made by Unomedical.
While infusion sets may be made by Unomedical for different companies they may not be identical, but made to the specifications of the ordering company.
---
### Author:  [@elver](https://forum.fudiabetes.org/u/elver)
#### Post date: [December 10, 2025, 5:17am UTC](https://forum.fudiabetes.org/t/heres-a-good-article-for-today/15646/15 "2025-12-10T05:17:45Z")
> [@CarlosLuis](#):
>
> but made to the specifications of the ordering company.
That would make perfect sense @CarlosLuis. Trade secrets and stuff/proprietary whatchamacallits. In all seriousness, having different adhesives for different contracted clients does make perfect sense.
---
### Author:  [@LWithrow](https://forum.fudiabetes.org/u/LWithrow)
#### Post date: [December 11, 2025, 10:20pm UTC](https://forum.fudiabetes.org/t/heres-a-good-article-for-today/15646/16 "2025-12-11T22:20:36Z")
> [@bkh](#):
>
> But I can say that the permanent inserter used with the Quickset (especially the old one with the blue handle, more than the newer green one) was significantly better for me than the built-in coiled up plastic spring disposable inserter used in the Tandem sets that I tried.
Same. – I actually think it is the cannula tubing _under my skin_ that I’m allergic to; whatever that’s made of irritates my insertion area.
---
### Author:  [@CarlosLuis](https://forum.fudiabetes.org/u/CarlosLuis)
#### Post date: [December 11, 2025, 10:53pm UTC](https://forum.fudiabetes.org/t/heres-a-good-article-for-today/15646/17 "2025-12-11T22:53:34Z")
> [@LWithrow](#):
>
> Same. – I actually think it is the cannula tubing _under my skin_ that I’m allergic to; whatever that’s made of irritates my insertion area.
Try Trusteel sets. If those don’t caued the problem then it would be the flexible canula.
---
### Author:  [@LWithrow](https://forum.fudiabetes.org/u/LWithrow)
#### Post date: [December 12, 2025, 12:05am UTC](https://forum.fudiabetes.org/t/heres-a-good-article-for-today/15646/18 "2025-12-12T00:05:49Z")
It’s only for the Tandem XC sets. The Medtronic extended wear ones (blue) I have not had a problem with. Thank goodness!!
---
### Author:  [@Russ](https://forum.fudiabetes.org/u/Russ)
#### Post date: [January 13, 2026, 7:32pm UTC](https://forum.fudiabetes.org/t/heres-a-good-article-for-today/15646/19 "2026-01-13T19:32:16Z")
Hi Terry, I’m trying to start a medical device company that addresses just this problem. This is common especially for younger users who use less insulin. Could you tell me more about your control deterioration on the third day? I’m particularly interested in how much insulin you used per day when this occurred. Would you be willing to have a 15 minute conversation with me?
Thanks,
Russ