Monday, April 7, 2014

The t:slim Air Bubble Dilemma.

Editor's note: as always, nothing on this site should be taken as medical advice. I am sharing some troubleshooting I've done with my insulin pump and if you'd like to recreate anything you see or learn in this post, please know that you are doing so at your own risk. If you're unsure, contact your insulin pump manufacturer to make sure you aren't going to void your insulin pump warranty with whatever you're wanting to try. I cannot be held liable if you accidentally turn your functioning medical device into a really expensive paperweight. 

I've been noticing a pretty consistent bummer of an issue lately when it comes to pumping with the t:slim:

My pump likes to err when it comes to air.


Little buggers!


It seems that air bubbles (which, according to Tandem's safety information, can compromise insulin delivery) like to gather in the connector area where the "pigtail" - at the end of the couple inches of tubing that comes directly out of the cartridge - and the luer lock of my tubing meet. I've also noticed a bunch of tiny air bubbles (a Tandem rep I spoke with referred to them as "champagne bubbles") that accompany the insulin I'm priming through the tubing with each new cartridge change.

Here's a better look at the "connector bubble" I'm talking about:




Yeeeeah, that can't be good.

I'm not alone, either: a Google search for "tslim air bubbles" pulled up around 7.6 million results, many of them discussions between patients and caregivers about what they've tried and how one might "beat" the air bubble quandary. (Some of the threads on TuDiabetes and within the Facebook t:slim group are notable.)

That Google search also led me to a YouTube video from a fellow pumper named Scott who has some fairly unique ideas on how one might combat air bubbles. I've tried a variation of his method a couple of times and while I'm still getting the hang of it, it does seem promising to me so far. Actually, it's kind of brilliant (and more work than it seems like you should have to do, but if it works...). Scott told me he's relatively new to pumping - he started using his first pump, the t:slim, last November after years of MDI - and applied some of the same principles he knew from multiple daily injections to his t:slim cartridge changes. He's also an engineer by trade, so yeah, that probably helps.

I'm going to reiterate that this video isn't medical advice and isn't the official way to fill a cartridge as recommended by Tandem Diabetes (but for what it's worth, everyone I've talked to at Tandem seems to be open to the possibilities of other ways of doing things, as long as they don't harm the pump). If you're going to try this, do so at your own risk. (And thank you again, Scott, for letting me share your video!)




I realize that having to bang the side of an insulin cartridge with a Swiss Army knife (is that what he uses?) isn't an ideal solution, but sometimes you have to improvise. (I actually use the old cartridge as my "hammer" of choice, but you do you.) The two key things here for me are the angle at which you're holding the cartridge when pulling the air bubbles out, and the whole in-out-in thing you're doing with the syringe.

At the same time that I started trying out some of these techniques, I also reached out to Tandem Diabetes (makers of the t:slim) to see what their take is. They said they're aware of the air bubble that tends to appear at the connector - the rep even commented that she sees them too, in her demo pump. We ran through all of the normal troubleshooting bullet points - is the insulin room temperature when you're filling with it, are you keeping the pump pigtail-side up when filling and priming, are you making sure there are no air bubbles in the filled syringe (for the record, I don't think I've ever been able to get every air bubble out of a filled syringe - it's just the nature of the beast - but I am usually able to flick the side of the upside-down syringe enough that they all collect towards the plunger, and I stop just short when filling the cartridge so that these bubbles stay in the syringe) are you making sure the luer lock is tightened all the way, etc.

One idea that a Tandem rep gave me and I've tried with success is: when priming the tubing, don't connect the tubing to the pigtail before the fill starts. The pump requires you to prime a minimum of 10 units each time, so what you can do is prime most of your air bubbles out before you attach the tubing. (The thinking here is that a 3 inch piece of tubing is a lot less space for air bubbles to escape through, than through 20 inches or more.) Once you've hit the 10u mark - or if you're feeling especially dexterous, you can just do this part once you see insulin at the top of the pigtail and all of the bubbles have escaped, and the pump is still priming - attach your tubing and continue to prime.

It seems like some combination of these processes might work best for me, and I plan to keep experimenting. If you're using a t:slim - what have you tried? Are you getting the same air bubbles I am, and if so, what are you doing to avoid them?

51 comments:

  1. Yes. This is 1 of 2 critical flaws with this pump that make me loathe it.
    (1 - air bubbles, 2- can't get absorption with this pump at alt sides)

    I've been using the "pull air-out with syringe" + "tapping" + "prime without connecting" technique and it helps.

    In all honesty, I used the tapping (banging) technique on my Medtronic pumps too. The pump would eventually get hairline cracks near the top of the pump. However, with the Medtronic pump, you could see when you got the bubbles out of the reservoir. On the T:Slim its literally blind faith.

    ReplyDelete
    Replies
    1. It makes me wish the housing of the cartridges was clear - at least I could see what's going on that way!

      Delete
    2. Of course pre-filled cartridges with the insulin of your choice would ideal.

      Delete
    3. Absolutely. I love that about the Snap pump.

      Delete
  2. I will give this technique a try and see what happens, otherwise I just kind of ignore the bubble after other t:slim users told me not to worry about it. Thanks for sharing Scott's video.

    ReplyDelete
  3. I ignore those bubbles and have never had a problem. As long as they don't end up in the main tubing, I don't even consider them bubbles.

    ReplyDelete
  4. As someone looking at getting a Tslim, this sounds like a lot of extra work and a long process. Is it really worth it?

    ReplyDelete
    Replies
    1. I'm not sure if you're asking me specifically, or other commentors, but: I do not regret choosing t:slim. Each pump has its quirks; this is one for the t:slim!

      Delete
  5. This is one of the big factors that influenced my final decision not to buy a t:slim. No matter what I tried, I couldn't get rid of all the air bubbles. Even when it seemed like I had, there were times when I experienced unexplained Highs -- the kind that Tandem liked to tell me was "user error," but ones that I've NEVER experienced in any of the many other pump types I've used in my 13 years of insulin pumping. Ultimately, what seemed like an inconvenience at first turned into a fundamental distrust that I wasn't getting all of the basal or boluses that the t:slim said I was and some off-label experimenting of my own determined that was pretty much true. I've heard others comment that they don't think the t:slim has enough power/force, thanks to the micro-pumping mechanism, to force all of the air bubbles out like other pumps do in their more traditional reservoirs. I have no idea whether that's the case or not, but it makes sense to me. And in the end, I'm glad I didn't buy one and decided to wait and see what the next gen t:slims bring us. In the meantime, glad there's posts like this that bring the issue to light and highlight these tricks like Scott mention in the video. I do hope Tandem addresses this.

    ReplyDelete
  6. Hi Kim,
    Thanks for the air-bubbles post! As Mike is saying, it's really important to bring these issues to light. I've been on the t:slim for about 3 months, and it's my first pump, so I never know what quirks are specific to the t:slim or to pumping in general. I also get the air-bubbles in the pigtail, every time I change the cartridge. After talking to a Tandem rep, my method for getting rid of them is:
    1) After filling the cartridge, tapping it, to move the air to the top (similar to how Scott shows it in the video, even though I don't remove the cartridge from the pump).
    2) While priming, I tap the connector (right where the air bubble collects) to losen the air bubble and get it into the main tubing, so I can prime it out. This is unelegant, but it usually works pretty well. It wastes a few units of insulin (between 2 and 5 I would say, depending on how much air is in there and how fast I can get it all to dislodge), but I think it's worth while.
    Even though I find this (and a few other things) annoying, I still like the t:slim a lot, and don't regret my decision for it. I guess, as you said, that every pump probably has its own issues.
    Also, I've been reading your blog for at least 2 years and I love it! This is my first comment, so that had to be said.

    ReplyDelete
    Replies
    1. So glad to hear from you, Eva! It's both reassuring and troubling to me that I'm not the only one with these air bubble issues.

      Delete
  7. Ok, I feel a little bit famous because you linked to my TuD posting. That's gonna carry me through the day.

    In the interest of disclosure, I have to admit that I'm off my tslim. I never did really beat the bubbles - that stupid big one always shows up and reappears in my pigtail. It won't leave me alone. Like Mike, I also had more than few unexplained highs that (in my mind, with no testing other than righteous indignation) I attribute to inconsistent basal delivery. I will say, I can't remember a time that the big bubble moved itself into the main tubing; I always had to flick it out.

    I think the quirks of the tslim became too much for me and I went to the other end of the spectrum - the Asante Snap. 1980's user interface, 30 second cartridge change out. I still really want to love my tslim, and I'm in this ongoing chat with customer service to solve some of the cartridge errors and phantom occlusions that made me tear the thing off last time. So, every few months I through in a cartridge and hook myself up...and hope.

    ReplyDelete
  8. Hi Kim,

    The air bubbles became a deal braker for me. T:Slim was my second pump so I was lucky enough to start using my ping again. Unfortunately, as we are all finding out, Tandem doesn't really admit that this issue is important enough to warrant a return or refund to my insurance company. So T:Slim sits in my dresser drawer and I'm hoping this Ping will last until the T:Slim warranty expires. Soctt (above) summed up my feelings "it became a fundamental distrust", something I didn't have room for in my daily life with diabetes. Thanks for bringing this to light. Jason in Orlando

    ReplyDelete
  9. That tubing connector thing is BIG! That's weird!

    In looking at this T-Slim pump at the ADA show in Chicago, I noticed all the tubing was short... its because none of them had this connector thingy. How- and where does one hide that?!?

    ReplyDelete
  10. I'm very grateful you described this problem and let us know about it. Thank you for posting, and thanks to all the commenters too. My solid and reliable Cozmo is over two years out of warranty and I'm far from ready to give it up. I had considered trying the T-slim, but doubt about insulin arriving in my body is the number one deal breaker for me when it comes to pumps and infusion sets. I'd rather take shots.

    ReplyDelete
  11. "when priming the tubing, don't connect the tubing to the pigtail before the fill starts. The pump requires you to prime a minimum of 10 units each time, so what you can do is prime most of your air bubbles out before you attach the tubing" <---BRILLIANT! Psyched to try.

    I kind of hate this. I didn't know that I hate learning new things.

    ReplyDelete
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    Amazon Prime Video is the official app for this popular service from Amazon that lets you stream dozens of movies and TV shows completely legally. To be clear, amazon.com/mytv Amazon Prime works quite similarly to Netflix and HBO GO.The Amazon My TV Code program requires the customer to have an Amazon account and a streaming device or TV. Amazon Prime Video is available on almost all streaming devices like Roku, Amazon Fire TV, Chromecast. amazon.com/mytv For this you just have to go to Amazon and activate amazon with the help of amazon activation code. You can visit our website amazon.com/mytv for details of the entire process.

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  36. Amazon Prime Video is one of the best platforms to watch movies and TV shows continuously on the internet. amazon.com/mytv You can now watch your favorite shows not only on your laptop or computer but also on your Smart TV and streaming sticks. It is also available on a few selected set-top boxes at a cheaper cost.amazon.com/mytv is the most ideal website to activate the Amazon Prime Video subscription on users’ Smart TVs. Once the registration is done successfully, people can select their TV cable service provider, amazon.com/mytv log in to their user account and enjoy their favorite Amazon Prime videos on the devices.

    Switch on your Smart TV. Now, on the homepage, go to your Amazon Prime App, or, if you don’t have it then download it from your app store or play store. amazon.com/mytv Now, open the app and go to the sign-in option. You will receive an amazon code, visit amazon.com/mytv and enter amazon activation code on your smartphone or laptop.Search your Smart TV’s app store or the Amazon Prime app. Download and add it to the channel. amazon.com/mytv Open the app and click on amazon my tv the ‘Register on the Amazon website’ link.

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  37. Amazon is a video streaming service available for Amazon Prime members. amazon.com/mytv With an eligible Amazon Prime membership, you have access to thousands of Prime Video titles at no additional cost.One of the most popular platform for video streaming now a days is amazon prime video competiting directly with Netflix and many others. amazon.com/mytv While there is no doubt that prime video is increasing its daily subscribers day by day, amazon.com/mytv We have also noticed people facing issues activiating their primevideo services using primevideo mytv.

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  38. Enter the link Amazon mytv enter code on your browser. Input your login details to log in to your Amazon Prime video account. A new screen will open which will ask for the “ Amazon Prime Verification Code . Amazon.com/mytventercode Amazon Prime is a subscription service that caters to the media needs of people through the platform. Notifies visitors about topics such as Register TV, Amazon Prime TV, and MyTV code. To register your device on the Amazon website you go to our website and enter the given code. The program requires the customer to have an Amazon account and a streaming device or TV. amazon mytv Amazon Prime Video is available on almost all streaming devices like Roku, Amazon Fire TV, Chromecast. For this, you just have to go to Amazon with the help of the amazon activation code. You can visit our website for details of the entire process. You can do this by installing the Video application on your smart TV, or the digital media player or video game console connected to your TV by visiting the link provided by us in the de cription.

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  39. Start now and set up Amazon Prime Video on your devices. Register your Smart TV, streaming media player, or any other device to watch now thousands of movies and videos in HD quality. amazon mytv activate Amazon Mytv Enter Code For Tv Registration now offers you several coupons to save money. amazon mytv enter code for tv If you want to take full advantage of your Amazon Prime account please link it to your TV and thank us later. Simply head on over to amazon mytv activate visit here.

    Amazon Prime Video administration on your Smart TV or gushing gadget ought to be effective. This gives you boundless access to huge amounts of films and TV appears, both for yourself and your friends and family. the actuation procedure is so basic and clear that everybody can enact Amazon Prime Video on amazon.com/mytv and amazon.com/mytv is the best site to initiate the Amazon Prime Video membership on clients' Smart TVs. When the enrollment is done effectively, individuals can choose their TV link specialist organization, sign in to their client account and make the most amazon.com/mytv of their preferred Amazon Prime recordings on the gadgets.

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  40. Amazon prime video is accessible on practically all spilling gadgets like Roku, Amazon Fire TV, Chromecast, and some more. You need to just actuate your amazon prime video by visiting Amazon.com/mytv and Amazon Prime is a membership administration furnished by the amazon with boundless amusement with loads of different advantages. No one at any point envisioned a membership administration with Amazon.com/mytv these advantages.Amazon Prime through Amazon.com/mytv is available to proprietors of gushing stages and gadgets like Chromecast, Fire TV, Amazon TV, and Roku, among others.

    Amazon Prime through Amazon.com/mytv is accessible to owners of streaming platforms and devices like Chromecast, Fire TV, Amazon TV, and Roku, among others. Amazon.com/mytv Amazon Prime Video service on your Smart TV or streaming device should be successful. this Amazon.com/mytv gives you unlimited access to tons of movies and TV shows, both for yourself and your loved ones. the activation process is so simple and straightforward that everyone can activate Amazon Prime Video on Amazon.com/mytv You can visit our website for more information.

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  41. Open the Amazon app on your TV. Amazon.com/mytv Sign in with your newly created Amazon Prime account. Amazon.com/mytv There will be a 6 letter code on your TV screen. Enter the code shown on the TV screen in the activation window on your PC.Amazon.com/mytv visit the amazon mytv website Amazon.com/mytv and enter the 6 digit code displayed on your tv, sign in to amazon prime account to register device.

    To download Norton Security Online, you will need your Xfinity User ID and password. xfinity norton download Simply download Norton Security Online and enter your Xfinity User ID and password when asked. xfinity norton You will then also be prompted to create a Norton Account. Please enter in your information when prompted during Norton Security Online’s installation.Xfinity locates offline financial deals for authorized Internet, video and mobile services. You can activate Xfinity Authorized by visiting the website xfinity norton And with xfinity you can get the service you need offline. You can visit our website xfinity.com/authorize for more information.

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  42. Proceed to amazon.com/mytv and create your own Amazon accounts, in the event you currently have a free account then sign into your account. Amazon.com/mytv Now enter the activation or verification code within the next screen that's front of you. Amazon.com/mytv You're now ready to delight in a great deal of fantastic and great movies and exhibits onto your own intelligent TV.Amazon.com/mytv is a registration portal of Amazon Prime from which members can watch thousands of videos and shows for free from their apparatus some features expect a superior subscription. Amazon.com/MY TV The instantaneous video company can just be viewed after enrolling your machine with a easy subscription code.
    www.amazon.com/mytv |
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  43. Proceed into mcafee.com/activate. Click on the'grid' icon at the top correct. Click Publish your Re-Tail Card. Click Input Product Crucial. Variety your activation code at the Input your code niche. Form your current email address at the Input your electronic mail section. Simply click Next. Adhere to the prompts to get into your McAfee program.
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  44. That's Great & Giving so much information after reading your blog. For RentaPC Laptop on Rent
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  45. Streaming online video content is trending nowadays because people are switching to modern ways of getting entertained. They subscribe to different streaming services such as Netflix, Hulu, and more. One such streaming service among many others is Amazon Prime. This service not only gives you the eligibility to stream different videos but also lets you use many other features that come along with it. And, all of this can be done by getting and redeeming amazon.com/mytv

    amazon.com/mytv
    Amazon Activation Code
    amazon.com/mytv enter code

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  46. You just need to open the application and get your excellent Amazon Activation code. It will be given to you when you endeavor to activate an alternate device for review. For instance, getting an Amazon Prime Video Trial notwithstanding contraption Amazon Activation code. At the point when you get the Amazon Activation code, enter it at amazon.com/mytv

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