Monthly Archives: July 2018

Tandem Occlusion Alarms: Crying Uncle

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Last week I published a blogpost addressing my annoyance with false occlusion alarms on my Tandem X2 insulin pump. Periodically Tandem techs have advised me that using a case might eliminate the alarms and that has actually been my experience. But I hate the case which makes the pump heavy and bulky instead of slim and sleek. Thinking that maybe adding something to the pump to protect the vent holes might mimic the case, I experimented with attaching a black plastic ring to the back of the pump. 

A few hours after publishing the blogpost, I added an update:

7/26 Late Morning: Unfortunately my science experiment is already a FAILURE with an occlusion alarm during basal delivery this morning. I totally jinxed myself by publishing this blogpost. In defeat I have already taken off the black washer. I spent 45 minutes on the phone with Tandem and the pump passed all of the tests. Of course it would because the pump works fine most of the time. I even changed my cartridges every 3 days for the last week and a half and got 4 alarms within the last 8 days. The issue has been sent to the local rep and I guess I can try to work with him to get a replacement pump. But I am not convinced that a replacement pump will matter. Why do I get these alarms and so many people don’t???😩😩😩

In my typical stubborn fashion, I put the case-less and clip-less pump back in my pocket. Fast forward to Saturday where I had another occlusion alarm—the 5th alarm in 9 days. (Please note that these alarms stop insulin delivery so they are a serious problem.) Not only did the blogpost jinx me, one of my Facebook friends who never gets occlusions got an alarm on her X2. Then another friend got an occlusion on his Medtronic pump. Occlusions are spreading like wildfire through the diabetes pumping community!

Maybe the wildfire remark is an overreach, but I cried uncle and put my pump in a t:case vowing to wear it clipped to my waistband. Unfortunately I had previously broken my black case  and was stuck using the pink case which I don’t like. Boy, do I sound like someone with a severe case of #1stWorldPrivilege! In my defense, Amy Tenderich of Diabetes Mine figured out a long time ago that design is important for diabetes devices and her 2007 “Open Letter to Steve Jobs” went viral.

The 24 hours that I wore the pink case reinforced now much I hate it. Both the shade of pink and the amount of black showing through the cutouts bug me. I decided to purchase a new case and was disappointed that black is out of stock in the Tandem Online Store and at Amazon. So it was back to the drawing board. I devised a minor engineering solution to secure the Tandem clip to the broken case by using Velcro in place of the missing plastic anchor strip. So far it is working and my fingers are crossed that the fix will be durable. The Velcro does double duty by adding “grab” to help prevent the pump from sliding off my waistband, an unfortunate common t:case problem. 

So it has been another-day another-adjustment to diabetes tech. If I continue to get occlusion alarms on this pump, I will now be totally justified in battling for a replacement pump. If a case solves the alarm problem, I should be happy. But I will still be frustrated. Frustrated that Tandem promotes the small size of the X2 with photos of the case-less pump. Frustrated that many people use the t:slim successfully without a case and I can’t. And maybe most importantly, frustrated that I still don’t understand why.

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7/30/18 Afternoon: I need to stop publishing blogposts because once again my fix that was successful for two days FAILED. The clip slipped out of place and the pump fell off my waist mid-morning. Ugh! My latest solution to prevent going back to the pink case is to attach a Nite Ize clip to the back of the case using strong outdoor adhesive tape. There are various pieces of Velcro on the inside of the clip to make sure the pump stays put. Although I do not miss my Animas pumps in many ways, I do miss the clip that easily attached to the pump and held it tightly on my waist.

Tandem Occlusion Alarms: An Engineering Experiment

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I began using the Tandem t:slim X2 insulin pump in December 2016. Since then I don’t think that I have written a blogpost about the pump without mentioning false occlusion alarms. In my first review of the pump, I wrote:

“I have used the Tandem t:slim X2 for almost 10 weeks. In that time I have had 9 occlusion alarms resulting in an immediate stoppage of insulin delivery. The first couple of times I panicked at the shrieking pump alarm fearing that something was actually wrong. Nope. Not once has there been a problem that did not disappear by working my way through the menu screens and pressing “Resume Insulin.” The vast majority of these alarms have been while delivering meal boluses, but not all.”

Periodically I have thought that I have solved the problem and interestingly I have had completely different experiences with my three X2 pumps. Pump #1 got weekly occlusion alarms during the first four months of use. I eliminated the alarms by either using a case or wearing the pump on my waistband with a Nite Ize Clip. But I hated those solutions and eventually went back to carrying my case-less and clip-less pump in my pocket. For no discernible reason the occlusion problem didn’t reoccur and I only had two or three occlusion alarms in the next 11 months. In February 2018 Pump #1 was replaced due to a battery failure. I only used Pump #2 for a month due to a defective T-button. But in that time I did not have a single occlusion alarm.   

Then I got Pump #3 and immediately returned to weekly occlusion alarms and sometimes two or three a week. I figured these alarms were the price of refusing to use a case or clip and I just lived with them. Then a couple of 2-alarm days convinced me that enough is enough. I dug the case out of my supply box. The pump became heavy and large with the case and would no longer would easily fit into the waistband pockets of my workout pants and pajamas. Total PITA. But I didn’t get occlusion alarms. Hating the case, I went back to the Nite Ize clip with the pump on my waistband. And ugh, I started getting occlusion alarms again.

So now my question became: Why does the case eliminate false occlusion alarms? A Tandem tech rep once told me that the case eliminated temperature fluctuations that occurred when I took the pump out of my pocket to enter a bolus. Seemed kind of far-fetched and if that was the case, why doesn’t everyone who carries the pump in their pocket get occlusion alarms? And when I was wearing the pump on my waistband with a clip, why did I get occlusion alarms because there was no temperature change?

My current hope is that the case works because the cut-out over the pump vent holes stops the vents from being blocked during insulin delivery. How could I replicate that without using a case? On Tuesday I went to the nearby Ace Hardware and wandered down the aisle with screws, washers, nuts, springs, etc. I bought a couple of gizmos including black plastic rings with a hole large enough to protect the 6 vent holes on the back of the pump. (It should be mentioned here that there are constant discussions on Facebook about the purpose of these tiny holes and some people swear that they are only for sound. A Tandem tech rep recently told me that the holes are dual-purpose and function both as vents and speaker holes. So that’s what I am choosing to believe.) I also bought 2-sided adhesive strips. 

Working in my kitchen laboratory, I used a hole puncher to cut a perfect-sized hole in the adhesive and then used scissors for the outer circle. Carefully I attached the ring to the pump. Voila! (It wasn’t quite that simple so if my experiment is a success, I will share more detailed instructions.)

It will take a week or two to see if this MacGyver fix works. I started a new cartridge yesterday and I rarely get occlusion alarms until the cartridge measure 80-120 units. If I make it a week without an occlusion alarm, I will have to see what happens with my next cartridge. And then another. 

Diabetes. A science experiment that sometimes requires engineering solutions.

7/26 Late Morning: Unfortunately my science experiment is already a FAILURE with an occlusion alarm during basal delivery this morning. I totally jinxed myself by publishing this blogpost. In defeat I have already taken off the black washer. I spent 45 minutes on the phone with Tandem and the pump passed all of the tests. Of course it would because the pump works fine most of the time. I even changed my cartridges every 3 days for the last week and a half and got 4 alarms within the last 8 days. The issue has been sent to the local rep and I guess I can try to work with him to get a replacement pump. But I am not convinced that a replacement pump will matter. Why do I get these alarms and so many people don’t??? 😩😩😩

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Other Comments: I truly believe that false occlusion alarms are related to a design flaw in Tandem pumps. I have so many questions. What percentage of Tandem pumpers experience these alarms? It is hard to tell because social media only attracts those having the problem. Are there common characteristics for those of us getting the alarms such as low TDD of insulin and small boluses? Or is it that certain pumps have overly sensitive occlusion sensors? I could go on and on with questions.

At the same time I want Tandem to succeed. I like almost everything about my t:slim X2 and I appreciate the innovation and good customer service that comes from this company.  There are few pump choices these days and my being on Medicare reduces that number even farther. My primary D-tech loyalty is to Dexcom as my CGM and I am unlikely to return to Medtronic although I was previously happy with my Medtronic pumps. At this time Omnipods are not a good financial option for many of us on Medicare and I have always been fine with a tubed pump. I am intrigued by Bigfoot Biomedical using the Freestyle Libre and keep my fingers crossed that it will be a future option for me. 

I do not follow all of the Tandem rules. Because of my low TDD of insulin, I refuse to change my cartridge every 3 days and throw away more insulin than I use. I change it about once a week while replacing my infusion sets every two days. This was how I operated on Medtronic and Animas and it works for me. With my first X2 I tried changing the cartridge every 3 days a few times and still got occlusion alarms.

I have always had superb customer service from Tandem. Although I am continually frustrated by false occlusion alarms, I do not regret my choice of the Tandem t:slim X2. If I had to choose a new pump today, I would probably choose the X2 again.

But false occlusion alarms are a problem.

*****   Relevant Links   *****

A Review of the Tandem t:slim X2

A 5-month Review of the Tandem t:slim X2

Tandem t:slim X2 and Dexcom G5: It Takes Flexibility

Joining the YMCA: Celebrating Seniors 

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A while back I wrote about how arthritis was messing with my life. I complained about sore feet and sore hands. If I had written the post at 2:00AM I might have described sore feet, sore hands, sore back, sore hips, and a sore soul. Despite all of that, I feel okay most of the time. But I am not stupid and know that I need to make lifestyle changes to help reduce joint pain. 

As someone who has lived with Type 1 diabetes for 41 years, I have gotten used to the idea that more than doctors and pills, I am the one in charge of my health. I make the conscious decision to monitor my blood sugar, eat reasonably well, and optimize my insulin regimen. But as I look at the last 4 decades, I strongly believe that I am healthy today because of exercise: tennis, golf, hiking, dog walking, step classes. Unfortunately I am finding that arthritis demands that I no longer hike 12 miles in the Arizona mountains or walk 6 miles on my hilly Minnesota golf course. Weight lifting benefits my biceps but my hands suffer. Planks and push-ups strengthen my core, but my elbows and shoulders rebel. Almost everything bothers my feet.

One of the benefits of my Medicare supplement plan is Silver & Fit where I can join a health club for free. In 2017 I selected the nearby Lifetime Fitness and enjoyed cardio, strength, and cycling classes. Unfortunately this spring I began to realize that despite trying to modify exercises to my capabilities, these classes were too taxing on my joints.

Thanks to a local diabetes friend, I was persuaded to check out the Southdale YMCA. She has belonged there for years and calls it her “home away from home.” She mailed me a copy of the long list of fitness and pool classes, some designed for seniors and others targeted for exercisers of various ages and fitness levels. After being faced with the possibility of both foot and hand surgery, I determined that it was time to check out the Y.

I stopped by one rainy morning in May and was immediately welcomed and taken on a tour. With little hesitation I joined on the spot. Fate determined that my free orientation session was with a trainer who happens to have a sister with Type 1 diabetes! We talked about exercise and low blood sugar and she showed me the stash of glucose tabs in the file cabinet at the fitness desk.

The senior exercise classes are organized under an umbrella of ForeverWell. There are three activity tiers: Just Getting Started, Already Active, and Exercising Regularly. Aging, illness, and surgery can shift you from one category to another and the boundaries are fluid. I am a good fit for “Exercising Regularly” classes and faithfully attend ForeverWell Yoga and occasionally ForeverWell Strength. I also participate in several cycling classes each week.

ForeverWell Yoga:  Imagine a studio filled with 75 people over the age of “don’t ask-don’t tell” and many well into their 70’s and maybe 80’s. You need to arrive early to get a spot although no one is ever turned away. The instructor uses kindergarten teacher skills to quiet the noisy group to get started at 8:15 on Tuesdays and Thursdays and reminds us to take care of injuries and sore joints. A long warm-up is followed by instruction in poses that increase strength, flexibility, balance, and mental health. There is something really inspiring about seeing a roomful of seniors in child’s pose or warrior two. I plan my life around never missing this class and I always leave feeling better than when I arrived.

ForeverWell Strength:  This class is mostly attended by women with an occasional guy hanging out in the back row. The formula is a step warm-up, strength work with weights and an elastic band, various exercises with a small ball, and then a cool down. None of it is hugely difficult, but the always-moving and always-smiling instructor keeps us on the go and I get a good workout. When I attend this class, it means that Abby the Black Lab misses her morning walk with friends at the dog park. My health versus the dog’s happiness. It’s a tough choice except on rainy days.

Studio Cycle:  Studio cycling gives me an intense cardio workout without the pounding of running, hiking, and step classes. The bikes are a tech wonder where I enter data about myself and get a personal fitness number to measure whether I am in the target zone of white (take a nap), blue, green, yellow, or red (Ferrari). Each of the many different instructors has pushed me to test my limits while pedaling and sweating to great music playlists.

Other Classes:  The Y class schedule is amazing with 12 to 30+ classes offered daily and I am in no danger of running out of things to try. Although I lack motivation for individual workouts, many people lift weights, use fitness machines, swim laps and do all sorts of things apart from organized classes.

Of course the YMCA is not only for seniors. I enjoy the age, race, and fitness diversity of the membership and have been happy to see kids everywhere this summer. I see lots of uber-fit young adults and fondly remember those days.

But the magic of the Southdale Y for me is that it embraces seniors. It is a social club with coffee and newspapers in the lobby. The prequel to yoga class is a noisy affair where new and old friends chat and laugh. The fitness area revolves around one longtime Y member who spends his mornings on a rowing machine and attracts a steady stream of chitchatting visitors. The friendliness is contagious and on my second visit to a noontime water aerobics class, I was invited to join the group that goes out to lunch once a month. The ForeverWell Newsletter mentions things like bingo, hearing screenings, and balance classes—things that you expect to see at a senior center. But it also offers an Al and Alma’s Lake Minnetonka Cruise, a trip to Winona, and an invitation to help landscape the exterior of the building.

This talk of senior fitness and community is a bit schmalzy but I know that my mother’s senior years were lonely. She would have been happier and healthier with daily interactions with other people. I remember when my in-laws moved into an assisted living facility and my father-in-law felt alienated because the residents looked so old. Of course they were no older than he was, but he didn’t see that he was “them.” What I love about the YMCA is that I look at “them” and am comfortable being “them.” I am in the early years of being a senior, but I see respect for every person of every age and every level of health and fitness. I don’t see condescension towards older people or actually towards any people. Everyone is welcomed and appreciated at the Southdale YMCA and I am glad to be part of the Y community.

*******   Links   *******

https://testguessandgo.com/2018/05/14/diabetes-arthritis-and-the-dog/

https://www.silverandfit.com

https://www.ymcamn.org/locations/southdale_ymca