So this has developed over the last 4-6 months to the point of being chronic and it’s driving me nuts.
Synopsis: I switched to T-Slim approaching 4 years ago from my old Medtronic Paradigm dumb-pump (hated their AID systems). I was using Fiasp, which I was very happy with but is off-label for T-slim. Read some complaints about Fiasp causing occlusions but mostly people said it was ok, including my trainer, who was a Fiasp user herself. For three-odd years I’ve had no problems other than the usual bad insertion or whatnot. I could often get 4 days on an infusion set/reservoir with no difficulties whatsoever.
But over the last months that has ceased to be the case. I can’t even get the statutory 72 hrs. Everything’s fine day one and most of day two but after 48 hrs the insulin potency noticeably drops off and then I start getting No Delivery alerts. Can’t dial up a bolus–just stops after a unit or not even anything. No choice but to swap everything out and start a new session.
- Inset condition: usually fine but sometimes the last millimeter of the cannula is slightly bent.
- The latter led to the suggestion to try switching to 6mm cannulas vs the 9mm I’ve always used. I’ve lost about 25 lbs over the last year and Clinical Support suggested that could be an issue. Tried two but nope, same problem. Day 3 occlusion nightmare.
- I’ve done the standard occlusion test: disconnect from “pigtail” and deliver 5 units; if that checks out, reconnect pigtail and do the same at the inset end. Must have done this half a dozen times or more now. On one occasion I got insulin from the pigtail end but NOT from the inset clip. 5 units dialed up, nothing came out. But most of the time both check out.
- The above result, along with the “insulin fade” issue after48 hrs seemed to indicate maybe Fiasp clumping was an issue, though why now after 3+ years is a mystery.
- Scar tissue? I rotate religiously between abdomen out to the love handles and upper thighs. Been at this long enough that yeah, there’s a lot of marks everywhere. But the problem is constant no matter the location and I’ve tried some newer areas farther up on my abdomen with no luck.
I read up on Lyumjev and the info says it’s as fast or a little faster acting than Fiasp, yay, plus it IS on-label for T-slim (uses a different molecule for the rapidity effect). So I got my endo to prescribe it and I started on it yesterday. So far it’s been great. Definitely faster (I got into a little trouble yesterday when it came on sooner than I was ready for), and it seems like the efficacy is all I could want. I’ve been fasting today other than a.m. coffee (splenda and light cream) and I’ve been running right at 100 ± 4 all day.
BUT
This is only day one (about 27 hrs from the change as I write this). So it’s a little premature–I won’t know for at least another 24 hrs if this was the fix. I’ll report back. But meanwhile would love to hear from anyone else with experience around this because it has been baffling, frustrating and not a little depressing. Stuff I’d love a response on:
- If it does turn out Fiasp was the problem, why is it only cropping up now after all this time?
- If god forbid the Lyumjev craps out sometime around tomorrow night (per the rule that says persistent occlusion alarms must always occur between midnight and 4am), what the heck do I try next. Please don’t say Truesteel because I tried them a long while back and… shudder. But if I gotta I gotta.
- It doesn’t seem like the pressure sensor or something in the pump itself is the issue but should I rule that out? It’s actually a replacement for my original one that bricked sometime last spring. Not sure if that means it’s a reconditioned one or brand new. There’s a lag between when I got the replacement pump and when I started to notice this issue but it was occasional at first before it became constant, so I might not have noticed if it’s some kind of slow-developing fault in the machine. Anyone experienced a pressure sensor going off and does any of this fit the pattern?
And sorry to have been absent from these precincts for a while. Just had other focuses and matters T1 have been pretty stable before this cropped up. Always do enjoy my time here.
