My Pump Almost Killed Me... Twice

Katherine Marple -Author of Wretched

| Jul 31, 2012

One of the greatest technological advancements in diabetes care has been the insulin pump.  For one, it gives you the illusion of being "normal" because you no longer have to inject insulin throughout the day. Instead, you "bolus" by pushing a button on the pump itself or using a remote control. It allows better glucose management because you can adjust your basal rate (the "background" insulin dose) by increments of one thousandth of a unit every hour.  Especially when you're moving from the peaks and valleys of NPH or the restraints and hazards of Lantus, the freedom of living with an insulin pump is incredible.  But pumps do not come without their kinks.

Most people in the diabetes community know what a pump is, but for those who don't, I'll give a quick overview.  A Medtronic MiniMed insulin pump, for example, carries about 200 units of fast-acting insulin in a machine about the size of an early pager.  The insulin moves from the pump via a tube that is connected to your skin through a cannula.  The cannula is inserted into your subcutaneous layer via a two-inch needle.  After insertion, the needle is removed and the plastic tube remains under the skin, held in place with sterile medical tape.  The pump pushes insulin through the tube into your body in increments as small as .05 units per hour.  Pumps like the OmniPod don't even have a tube; they're connected directly to your skin after being pre-programmed with your insulin requirements.  When you're using a pump, you no longer require insulin injections via syringe and you no longer use basal insulin (NPH, Lantus, or Levemir).

I have learned many lessons while on the insulin pump. For example, I learned how my body reacts to the Dawn Phenomenon, that early morning rise in glucose levels that occurs when the liver dumps glucose into the bloodstream to prepare the body to awaken.  I found that my body begins this process as early as 4:00 AM, so I need approximately two extra units of Apidra (the fast-acting insulin that I have relied on for the past six years) per hour to keep my glucose from shooting outside my target zone.  At 7:00 AM, my basal needs are adjusted back down to my normal "daytime" rate.  

I have also learned that to avoid insulin shock in the middle of the night, I need to lower my basal rates by a half-unit per hour from midnight to 3:00 AM.  With these kinds of needs, you just can't maintain a consistent glucose level throughout the night using injections and a basal insulin such as Levemir (my personal trusted basal insulin) without waking in the middle of the night to test and correct.

I used the Medtronic MiniMed insulin pump (as well as many samples of the OmniPod) for almost three years.  During that time, I learned incredible things about how my body reacts to foods and how intricate an insulin regimen I require to keep a balanced A1C.  Using the insulin pumps helped me to find my unique treatment path.
 
However, I also came upon the harsh reality that I cannot depend on anything  but myself to survive this mean beast of a disease.  The main issue I have with the insulin pump is that it uses only fast-acting insulin.  With multiple daily injections, if you inject into a poor injection site, at least you have the background basal insulin that is injected once or twice per day to get you through until you can inject another bolus shot.  The basal insulins act as a buffer to make sure that your glucose levels never get too far out of control.
 
Fast-acting insulins, such as Humulin R, Apidra, and Humalog, stay in the bloodstream for a maximum of only four hours.  Let's say you have a pump malfunction and you don't receive any insulin.  After four hours with a malfunctioning pump, you no longer have any insulin whatsoever coursing through your veins.  This, of course, leads to the extremely painful, scary, A1C-shattering, and life-threatening condition of ketoacidosis.

Once I was fast asleep when my Medtronic pump malfunctioned and stopped delivering insulin. It also failed to sound an alarm to let me know that it had stopped working.  When I woke five hours later, I was already in full blown ketoacidosis and was rushed to the ER. I ended up staying in the ICU for three days while my levels were re-adjusted.  I notified Medtronic of the malfunction, and they promptly sent me a replacement pump.

A few months later, now using the new Medtronic, I was working at my office desk when my pump malfunctioned again.  Once again, it didn't sound an alarm that it wasn't delivering insulin.  This time, however, I could feel my glucose levels rising.  Because I was awake, I was able to test my glucose on my meter and notice the steady increase as time went by.
 
After the first hour, I simply input a few units of bolus, hoping to bring down my level that way.  I didn't realize that my pump was not delivering insulin because no alarm had sounded. At the second hour, still not realizing that the pump wasn't pushing any insulin through, I used my back-up syringe to dose a small bolus of Apidra.  By the third hour, however, my glucose was still rising.

Finally guessing that the pump wasn't working properly, I discarded my cannula set and changed out the reservoir.  I primed the pump and re-inserted a new cannula under my skin.  By this time, however, more than three hours had passed without insulin delivery and I was already in the throes of another episode of ketoacidosis.  I was driven to the ER and enjoyed another three-day stay in the ICU.

I haven't been back on the pump since then.  I later learned that my difficulties with the pump may have been because I am allergic to the cannula that is inserted under the skin.  My endocrinologist believes that I have an allergy because although it has been six years since I've used an insulin pump, I still have snakeskin-like bumps across both sides of my stomach where I used to do the majority of pump insertions.
 
I never had a set in place for more than three days at a time, usually changing it every two days.  I tried using my abs, my lower stomach, my thighs, my hips, the upper flesh of my butt, and my lower back (even trying the back of my arm with the tubeless pumps).  Every site had failed absorption rates, sometimes infecting within just one day and sending blood back up into the tube that was connected to the pump.  In the end, the two threats to my life in a few short months, not to mention my steadily rising A1C and the endless frustration and pain, were just too much.  I haven't been able to trust my life to a computer since.
 
At least when I'm injecting via syringe, I know that the insulin is delivered because the syringe comes back empty.  If I inject into a bad site that has low absorption, then I still have Levemir in the background to save me from ketoacidosis, and I can inject another dose via syringe in the next hour in a new site.  To battle the Dawn Phenomenon, I wake in the middle of the night and check and correct.  
It's inconvenient, but so was having failed pump sites, infected cannula scars, and ICU stays due to a failed pump signal.  Having insulin-dependent diabetes is inconvenient, in general.  I just can't bring myself to trust anyone but me to manage my diabetes. That includes a machine, no matter how many other people swear by its design.

The lessons I learned about myself and my body while using an insulin pump are priceless.  I doubt that I would have the stellar control that I have today, six years after discontinuing the pump, without first trying to use one.  While I don't blame the pump manufacturers for my disappointing experiences, I have made my decision to steer clear of machines that deliver the insulin I require to keep breathing.  Although the insulin pump is an incredible advancement in diabetes care, it is still just a computer attached to your body.  In my 14 years with type 1, I've tried just about everything available on the market.  While the insulin pump is a huge help for some, it is a cure for none.  I'm still asking and waiting for more.

Click Here To View Or Post Comments

Categories: A1C, Apidra, Basal Rates, Diabetes, Diabetes Health, Diabetic, Glucose, Insulin Pump, Insulin Shock, Insulindependence, Ketoacidosis, Medtronic


Take the Diabetes Health Pump Survey
See What's Inside
Read this FREE issue now
For healthcare professionals only
  • What's on the Horizon with Diabetes Research and Therapy
See the entire table of contents here!

You can view the current or previous issues of Diabetes Health online, in their entirety, anytime you want.
Click Here To View

See if you qualify for our free healthcare professional magazines. Click here to start your application for Pre-Diabetes Health, Diabetes Health Pharmacist and Diabetes Health Professional.

Learn More About the Professional Subscription

Free Diabetes Health e-Newsletter

Latest
Popular
Top Rated
Print | Email | Share | Comments (13)

You May Also Be Interested In...


Comments

Posted by Anonymous on 2 August 2012

pH is inversely porportional to glucose and the electrodes are far cheaper. Why don't we make pH meter pumps and save the diabetes clients a huge amount of money and use a CGMS with the glucose sensors. A low pH will have a higher blood glucose and this can be converted to show what your glucose is. All you need is a medical engineer to make up the pump which one told me would be cheap. People with diabetes in Canada do not have the insurances the US people do so need this to happen so these pump companies will have competition and won't charge people more than they can afford.

Posted by shosty on 3 August 2012

The CGM has far more problems than the pump (my daughter loves her pump after 15 years on it), and should only be used to check trends, not actual blood sugars. And yet the artificial pancreas is constantly touted as a coming miracle. Absolute algorithms will always be dangerous anyway, and I believe human intuition will always be needed to make judgments about insulin and carbs, since blood sugar behavior is hardly rational or consistent for many.

I have stopped supporting diabetes organizations until they start supporting the implantable pump, a much better direction for advocacy and research. As for a cure: well, well, I have for one have given up. No money in that.

Posted by Rick on 3 August 2012

i'm glad the young lady survived this so scary experience. obviously the insulin pump isn't for everyone. i have had a minimed for seven years and it mostly works wonderfully for me. i have to tweak the settings occasionally so you have to know how to operate it and be very careful. as far as night time lows. i set mine so i'm in the 150 range in the morning. my a1cs' are right around 7% and my endo is happy with that. too many type 1s pass in their sleep due to insulin shock. not me.

Posted by Anonymous on 3 August 2012

I HAVE HAD DIABETES, T1, FOR 59 YEARS. I USED GLASS SYRINGES, CLINITEST TABLETS WITH AN EYE DROPPER TO TEST MY URINE RE SUGAR LEVEL,ETC. THE ENTIRE PATH...

WE ARE SO VERY LUCKY TODAY TO HAVE THE ADVANCEMENTS THAT ARE AVAILABLE TO US. FROM THE INSULIN PUMP TO THE AIC, TO THE CGM INSTANT CONSTANT BS READING. LUCKY. LUCKY. LUCKY.

AFTER ALL OF THESE YEARS, I AM STILL HERE, WITH ALL OF MY BODY PARTS WORKING.I AM STILL TRYING HARD TO CONTROL MY DIABETES WITH EVERYTHING AVAILABLE TO ME. I TOOK MANY CLASSES RE CARB COUNTING, I WATCH WHAT I EAT CAREFULLY, AND YOU WOULD NOT FIND ME HAVING A BIG LUSH SUGARED DESSERT.

I AM CURRENTLY ON THE OMNIPOD PUMP, ( ABOUT 6 YEARS, NOVOLOG INSULIN,
AND THE DEXCOM CGM.)( I WAS ON THE MINIMED FOR 4 YEARS, BUT I TOO WAS ALLERGIC TO THEIR CANULA, AND SWITCHED TO OMNIPOD. )I CHANGE THE SET EVERY TWO DAYS.YOU STILL HAVE TO BE THE ONE TO HAVE CONTROL OVER THE PUMP, ( YOU HAVE THE FINAL WORD AS TO DOSAGE, ETC.), I HAVE NEVER FOUND THERE TO BE A MAJOR PROBLEM WITH THE OMNIPOD PUMP. WHEN I WAS CONCERNED ABOUT SOMETHING, THEY OVERNIGHTED A NEW PUMP. I HAD NO PROBLEM IN TAKING INSULIN BY SYRINGE FOR A DAY. IF I AM NOT FEELING WELL, ASIDE FROM MY REGULAR TEST TIMES OF BEFORE EACH MEAL, AND BEFORE BEDTIME, I TEST... ANYTIME I AM NOT FEELING WELL, WHICH GIVES ME A CLUE AS TO WHAT TO DO RE INSULIN.) (TAKE, REDUCE DOSAGE, ADD, ETC.)

THE CURRENT PUMPS ARE BETTER THAN THEY WERE 6 YEARS AGO.THE LAST TIME ONE DIABETIC COMMENTER ABOVE SAID THAT SHE HAD USED THE PUMP AND RETURNED TO ONLY SYRINGES. IN ADDITION, THE OMNIPOD DOES NOT HAVE A CORD, BUT USE A WIRELESS SYSTEM, WHICH IS VERY MUCH IMPROVED OVER THE CORDED UNIT OF MINIMED.

THESE IS ALSO THE TWO KINDS OF DELIVERY- BASAL AND BOLUS. SYRINGES ALONE CANNOT GIVE YOU THAT.

I STRONLY RECOMMEND THAT THE ABOVE COMMENTER SHOULD LOOK INTO THE NEW PUMPS. WORK WITH A TRAINED DIABETIC EDUCATOR.

I WISH YOU ALL A LONG ,HEALTHY, DIABETIC LIFE...

Posted by Anonymous on 7 August 2012

Great article! Very informative! We often think that once a product has been approved put on the market, esp. one we rely on to live, would have alarms when it malfunctions. Maybe the companies producing them, should consider "stepping up" on making sure this problem gets resolved promptly!

Posted by Anonymous on 10 April 2013

Katherine, I had a similar experience with the insulin pump stopping its delivery without notification alarms. After repeated problems, and having tried three different brands of pumps, I have taken matters into my own hand and returned to using my pens.

Posted by Anonymous on 23 May 2013

Please consider using ports over pumps. I use an I port. It is manufactured by KK Patton Pharmaceuticals. You change them every three days. If you put numbing cream on before insertion, you hardly feel it. Then you don't have to feel another needle for three days. It is spectacular! I Ports can't accidentally kill you.

Posted by Anonymous on 31 May 2013

Katherine,

have you ever considered the Medtronic Sure-T infusion set? It does not have a plastic cannula. Instead the needle stays in the skin. My son never tried it, so I can't comment how comfortable it is, but it might have worked for you.

Posted by Anonymous on 14 July 2013

I just wanted to say after researching on forums and things like that, it seems like apidra just fare as well in a pump as humalog or novolog. Instead of doing away with it altogether, why not just try a different insulin?

Posted by Anonymous on 8 July 2014

 I use a Medtronic pump and have done so for more than ten years and if there is a malfunction with the pump itself it does alarm, EVERY time. But if the issue is with the user(whether user error or, in this case, allergic issues) three is no way for the pump to know something went wrong. The issue is the same whether you are on the pump or not. 

Posted by Anonymous on 18 July 2014

I have been a Type 1 diabetic for 21 years this June 2014. I have been on a Medtronic pump for over ten years. I never had any problems until the last 6 six weeks my pump has been malfunctioning also. I will get a "No Delivery" alarm but who knows how long I was receiving NO insulin before the alarm sounded. I have been waking up in the high 300s, chronically feeling like I have the flu. Medtronic did send me a new pump but this one is doing it also. You can't tell me that after being on the pump for over 10 years that I suddenly don't know how to fill the reservoir, harpoon myself with the infusion set, etc. I'm with you, Katherine, I just went to the pharmacy and loaded up on some more syringes and Lantus to go with my Humalog. I am tired of feeling crappy. Shots are a inconvenience, I totally agree, but I'm ready to feel better NOW!

Posted by Anonymous on 3 September 2014

I am also having problems with my cannula sights, they are red and lumpy when I remove my cannulas and they are tender to the touch after a couple of days of being inserted. I have also had to problem with blood shooting up my cannula and into the tube. I also feel pretty uncomfortable being attached to a device 24/7, and although I realise I am insulin dependent, I feel more dependent, kind of like I have a deformity or something, with my pump constantly attached. As a female I am also body conscious and feel I cannot hide my pump properly. I have waited for this for 2 years and I thought it was going to change my life for the better, but instead I am finding that my blood glucose is more out of control and I have also had an episode of my pump switching to stop mode in the middle of the night, with no explanation and also a case of my cannula ripping out in the middle of the night, both of which cause me to feel really ill. I know nobody that is even diabetic, never mind on a pump so I am looking for advice. Am I giving up too easily after only 3 months or should I go with my gut and go back to regular injections?

Posted by Anonymous on 11 September 2014

To the recent anonymous commenter: in my opinion you should meet with an endocrinologist and figure out if there is a different infusion set or even a different pump that you can try. I managed my type 1 diabetes for about 20 years with multiple daily injections and after using a minimed pump for the last 10 years I don't see ever going back. As inconvenient as diabetes can be the pump gives me freedoms I never could have with injections. It's not a problem if you sleep in one day or decide at the last second to eat desert after a meal once you have your pump "dialed in". It can be uncomfortable at times but I found with a little trial and error I figured out where the best infusion sites on my body are and easy ways to conceal the pump if needed (oftentimes I wear it on my belt in a holster or I poke a tiny hole in the pocket of my pants and thread the tube through so I can just keep it in my pocket.)

As far as the complaints in the article I feel as though her issues were as a result of her allergy and not a problem with the pump. It sounds as though the pump didn't malfunction but rather the insulin wasn't absorbed properly. In the couple of rare instances I've had it not delivering there is always an alarm that you can set to audible or vibrate on the medtronic pump. I know we're all different and I guess I should consider myself fortunate because even if I went a few hours without basal insulin I would wake up or feel the effects well before ketoacidosis. Scary that she ended up in the hospital for days but I think for most pump users, even with a severe malfunction, it can be corrected with a syringe before life threatening sickness kicked in. These are clearly just my rambling opinions but for me the insulin pump has been a very positive life-changing device.


Add your comments about this article below. You can add comments as a registered user or anonymously. If you choose to post anonymously your comments will be sent to our moderator for approval before they appear on this page. If you choose to post as a registered user your comments will appear instantly.

When voicing your views via the comment feature, please respect the Diabetes Health community by refraining from comments that could be considered offensive to other people. Diabetes Health reserves the right to remove comments when necessary to maintain the cordial voice of the diabetes community.

For your privacy and protection, we ask that you do not include personal details such as address or telephone number in any comments posted.

Don't have your Diabetes Health Username? Register now and add your comments to all our content.

Have Your Say...


Username: Password:
Comment:
©1991-2014 Diabetes Health | Home | Privacy | Press | Advertising | Help | Contact Us | Donate | Sitemap

Diabetes Health Medical Disclaimer

The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained on or available through this website is for general information purposes only. Opinions expressed here are the opinions of writers, contributors, and commentators, and are not necessarily those of Diabetes Health. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this website.