Roll Over Beethoven

I heard it from across the crowded room. The unmistakable melody. A terrible electronic version of 'Fur Elise' was coming from my daughter's insulin pump. What, I often wonder, would Beethoven think?

Eye contact confirmed that this wasn't a simple 'Bolus cancelled by user button push' or 'Unable to communicate with pump' Animas Ping alarm. My kid looked both concerned and irritated. I made my way through a few conversation groups.

'I forgot to do a site change before we came. I'm out of insulin. It gave all it was supposed to give to cover what's on my plate but now I'm out.'

We were really enjoying this party. I was reveling in the opportunity to hold an adorable baby whose mom needed a civilized plate of food and adult conversation. My daughter was enjoying helping the little ones at the cookie decorating table. We were having great conversations with friends both new and old. To add atmosphere, it had just begun to snow. This particular festive gathering was exactly what we needed after a whirlwind weekend of holiday shopping and preparations.

We were not, I decided, going to let diabetes win the afternoon. My daughter ate a little less than she'd bolused for, to provide a cushion. We kept an eye on her numbers. She held steady for almost an hour, then her blood sugar started to creep up very slowly. We considered leaving then, but I had to return the baby, and then on the way to get our coats we found other people we wanted to talk to. The rise became more significant about twenty minutes later, and we started our round of goodbyes. But considering the homework that still needed to be done and the football that needed to be watched we wouldn't have stayed much longer no matter the diabetes circumstances.

We got home, replaced the insulin and the site, and bolused for an hour and a half worth of missed basal insulin in addition to the suggested correction for her blood sugar at the time (about 220...not bad at all). The rest of the night was uneventful blood sugar wise.

There were few minor downsides: I needed to heat up some leftovers since she had stopped eating anything but raw vegetables once she ran out of insulin. She missed out on a great spice cake. And the electronic Beethoven theme repeated itself every few minutes- but I'm guessing it probably wasn't audible to anyone but us over the music and conversation.

Looking back, I'm glad we didn't panic. There was no need to. She disconnects her pump at the pool for an hour at a time all summer. At the beach it's often longer. We do the same thing we did last night: make up the insulin once she's hooked back up to the pump. Ideal? No. Medical advice? Absolutely not. But sometimes it's more important not to let diabetes ruin a good time.

A Cautionary Tale

It was Saturday evening at 5:30. My daughter had, as is her custom, waited until the last minute to do a site change.  In less than half an hour she would be leaving to go out to dinner with friends: a gathering to commemorate the end of summer.  Just a quick site change and she would be off.

Supplies were gathered.  The cartridge was filled.  Wipes were applied.  The pump was picked up and buttons were pressed to 'rewind' the area that holds the insulin in order to accommodate the new, full, cartridge.  The motor started to buzz and then...

'BEEP boop BEEP boop.'  It sounded like a very tiny ambulance.  The message on the pump screen read: 'ALARM  CALL SERVICE  No delivery.' There was a code number.

It was then that our lives passed before our eyes.  Diabetes-wise anyway.

Where were the syringes? When was the last time I'd given her an injection?  She had never had to give herself an injection. Would she be able to figure it out in time to go out to dinner? When was the last time I'd written down all of the basal rates, insulin to carb ratios and correction factors?  Probably a year ago.  And where exactly were they anyway?

Without that information we would be challenged to figure out how much lantus to give her if the pump was actually dead.  Then, how would we figure out how much novalog to give for dinner and for meals and corrections to come?  I'd have to call our diabetes clinic and get help.  On Saturday night of a holiday weekend.  And what if a replacement pump couldn't come until Tuesday- after Labor Day?  What if she had to go through her first day of high school on Lantus and Novalog shots? 

My hands were shaking as I dialed the number on the back of the pump.  'For 24 hour technical assistance with your insulin pump system, press 1.'  I pressed 1 and was connected to a new menu including: 'For 24 hour technical assistance with your insulin pump system, press 1.'  I pressed 1 again and was connected to yet another new menu including: 'For 24 hour technical assistance with your insulin pump system, press 1.'  Really? Maybe if I press harder?  The third time was the charm.

The representative I spoke with did not seem panicked or pessimistic.  This was encouraging.  "Have you tried rebooting the pump by removing the battery?"  I had not.  "Let's try that."  My daughter fetched a quarter.  It took longer than usual, with my shaky hands, to use the quarter to unscrew the battery cap, but I did it.  We removed the battery, waited a few seconds, put it back in.  The alarm screen was gone.  I was told to attempt to rewind again, and if that was successful to continue with the whole insulin replacement process while still on the phone with the representative. 

As it began to become clear that things weren't as bad as I had imagined they might be, I said to the representative, "It sounds like this isn't as big a deal as I thought it might be...is this a common call you get?"  She explained that when the pump rewinds it does a series of self-checks and that if it detects a possible abnormality this alarm screen comes up.  Rebooting the pump and rewinding it again causes it to recheck itself and most of the time it does not alarm a second time, meaning (apparently) that the first one was a false alarm.  She did say to call if it happens again, so that they can document it, and that if becomes a regular occurrence they would need to replace the pump. 

In the end, we loaded up the new cartridge and primed the pump with no further problem.  While my daughter finished getting herself ready to go out, I jotted down total daily doses from the pump's history, her basal rates and ratios, and every other number I could think of.  And I set a reminder in my phone to do it again after the next endocrinologist appointment. 

 

So please, pump users, take this as a cautionary tale.  Please (today) make sure you have all your info jotted down or electronically stored somewhere other than your pump, and that you have the equipment and knowledge you need to activate your back-up plan.  Hopefully, like us, you won't need it.  With any luck you won't even be late for dinner.

Two-fer

Over the past month or so, my daughter's pump screen has been getting progressively dimmer.  At first, I thought I was experiencing yet another symptom of being 40-something.  But soon my daughter was complaining about it too.  Procrastinator that I am, I figured I'd find the time to call eventually.  The final straw was when the screen got to the point where we barely see it outdoors.  I called Animas on a Friday afternoon.

"We'll overnight you a new pump," the technical support person told me after a couple of her suggested quick-fix tricks were unsuccessful.

The pump arrived by 9:30 on Saturday morning.  I carefully transferred all of the settings from the old pump to the new one, double and triple checking my work like my third grade math teacher always insisted.  The last step was to pair our current meter remote with the new pump. I successfully paired the two up, with their screens showing each other's serial numbers, seemingly as a mark of true love.

Fast forward to lunch.  "What's going on?  Why won't this work???" my daughter grumbled as I washed the grapes.  "When I put the strip in, I get the timer thing-y and then the screen turns black and then the thing just turns off."

We took the batteries out and put them back in again, and tried a different vial of test strips.  We could power it on to check the history but once a test strip was put in, it shut down.

After lunch (don't fret- we have an extra meter or two kicking around- she was perfectly safe), I called and explained the situation to a person at Animas with the title, "meter specialist."  The meter remote would have to be replaced too. "Will not accept the test strip," was the specialist's official diagnosis.  I think it was broken-hearted at the disappearance of it's old pump partner myself, but the guy at Animas is the expert of course.  Meters being apparently less important than pumps, I was told the replacement meter was to come on Tuesday, signature required.  I tried to negotiate this detail since the (significantly more important and expensive) pump did not require my signature, but it seemed there was no choice.

"Put a black x on the back of the meter before you return it," the meter specialist requested.
Should we have held some sort of service of remembrance while we did so?

Tuesday came and we were more excited than we expected to be.  We missed the remote features, particularly at night if a correction was needed.  Rolling a sleeping 14 year old over in bed to find her insulin pump was no easy task.  Noon came and went- no meter.  My daughter came home from school at 3:15.  "Did the meter come?"  Nope.  At 5:30, I called Animas.

"It shipped and my tracking number shows it's out for delivery.  Let me give you the number too.  It should come tonight."

My husband came home, we ate dinner, and soon it was 8:15.  No meter. He called UPS with the tracking number.

"I'm showing it's on a truck and the truck is still out. Our days are already running long because of holiday shopping."

"I understand that," my husband said, "but this is a medical device for a child who is eventually going to bed...I'd like it to be here before that happens."  The UPS customer service person could offer nothing more than sympathy.

My daughter climbed into bed around 9:30 with her book.  At 9:45 (AT NIGHT.  PM.) the doorbell rang and my husband signed for the meter I'd been at home waiting for since 8 a.m. and which, according to the UPS tracking system had been on the truck since 4:30 a.m.  We set up the meter and paired it with the pump. They've gotten along splendidly ever since.

I hope, at least, that the previous pump and meter were reunited and that they will be laid to rest together.

Panic

As I rolled out of bed this morning, I grabbed Dexi for a peek.

Turns out the signal had been lost for about half an hour, which happens from time to time. It's usually not longer than that, and usually not a big deal.  Per the graph, blood sugars had been been skirting the 80 line for an hour or two before communication was lost.

I wonder if this is physiologically possible?

I got up, and as I walked past my daughter's door, Dexi regained contact. Bzzzzt, bzzzt, bzzzt, bzzzt. Four is not good.  Four bzzzts means under 50. My usual routine of starting the coffee before hauling the 13 year old out of bed was aborted.

I was relieved to easily wake her with a gentle rub on the back and a 'good morning.'

Meter in hand, I wasted no time checking her blood as she began to rouse herself.

113.

Good news, if a bit unexpected.

I fed Dexi the number and followed up with another as she requested (which was close to the first) .

As my daughter put her toast in the toaster, a mere 10 minutes later, more alarms:  bzzzt, bzzzt.

High.

Impossible, I decided.  Clearly, Dexi's in some sort of panic mode at this point and making wild guesses.

"Just let her settle down," I advised.  My daughter actually gave the Dexcom a little pat and told it not to freak out.

By the time we'd finished breakfast, Dexi was reading in the low 100's and her imaginary crisis was over.