Replies to This Discussion

Permalink Reply by Sophie on January 11, 2010 at 1:01pm

Hey Dan, Have you seen the discussion in the comments section of the "Minimed Paradigm Insulin Pump Users group" from early and mid September?

I am copy and pasting a comment from Elizabeth from September 13, 2009 that might be relevant to your issue: "Hey guys, here's the way it shook out: after a high pressure test and a second conversation with a techie at Medtronic, we all came to the conclusion that the reservoirs were the problem - the seal between the reservoir and the plunger wasn't perfect and would slowly leak air. So they sent me new reservoirs and we tried again after the holiday weekend, and lo & behold, NO BUBBLES. So it appears that particular lot of reservoirs is defective. I'm sending them back and will get more from Medtronic."

Maybe you've gotten a bad batch of reservoirs? Additionally, one question: is this issue with the uneven rhythm while priming a new problem, or one that has existed SINCE you got the reconditioned pump from medtronic?

Whether it's a reservoir or pump problem, you should probably give medtronic a call (I know, probably the LAST THING you want to do) - maybe they'll recognize the uneven rhythm thing immediately, or maybe they'll send you some replacement reservoirs to test. GOOD LUCK.

(also, I see you live in Providence, RI -- I'm a Brown student!)

Permalink Reply by Dan W. on January 11, 2010 at 2:41pm

Hi Sophie -

Thanks for the info - that would make perfect sense, as it did seem like certain reservoirs were very sensitive to the seal/gasket angle. I plan to call Medtronics right away! And that is funny you are at Brown - I run a letterpress print shop here in Providence, and have been teaching letterpress at RISD just down the hill. It must have been quite an adjustment to be negotiating your diagnoses while finishing school - but i guess it is an adjustment no matter the circumstance!

Thanks for your help, I'll up date the post with any relevant news. Anyone else with bubble problems from that time?

Permalink Reply by Julie on January 11, 2010 at 5:00pm

I have been noticing more air bubbles with the new funny looking reservoir caps too...tiny kind of champagne bubbles. If I do a lot of tapping and let it sit for 15 minutes it helps...but I don't always have the time.

Permalink Reply by Dan W. on January 15, 2010 at 7:02pm

Well, just an update - I did call Medtronics, and after a friendly but long conversation, they first offered to send out a trainer (!), and then within 2 seconds, said they were sending anew pump - strange logic, BUT since the new pump arrived it has been like night and day - no problems (or atleast unexplainable ones!). One issue that might have contributed is that when I rewind the pump, I used to leave the old reservoir in until it rewound or atleast cleared the reservoir - they emphasized that was a huge no no, and that may have damaged the plunger-thing... so now it is get rid of the old reservoir before any rewinding!

Permalink Reply by Elizabeth on May 30, 2010 at 3:21am

Gee, I wish someone had told me this - I've been doing the same thing right along. I haven't had any major problems with bubbles since the initial issue that Sophie quoted, but since I really don't want to damage Eric's pump, I'll change my habits. Sure wish these pumps came with a "Don't Do This!" list.

Permalink Reply by Dan W. on January 20, 2010 at 9:23pm

To update the status - despite the new pump, similar problems keep reoccuring. I spoke to Medtronics again today (and am on hold with the help line at the moment...) and they say they do NOT have a known reservoir problem at the moment.

However the reason I am calling them back, is that I had another odd high sugar, corrected, and then just before bed (11:30 here on the east coast still high, at 255. Just corrected with the needle, as I did see one large (1/4 inch) bublle at the end (site-side) of the tubing. removed the connector from the silhouette, primed it out, and then sitting there, the bubble reappeared. It is like the tubing/reservoir is not holding its pressure, and letting the tubing suck air in from the needle end...

Long talk with 24 hour medtronics help people, they are sending a "tubing clamp" for me to test the tubing the next time it hapen, but keep leaning towards a problem with my prep. it seems to me the tubing should not be pulling in air that way, but maybe I am misreading it somehow. New set, try again...

Permalink Reply by Dan W. on January 29, 2010 at 5:55am

Thanks, Rita -

I was somewhat shocked when the rep put me on hold, and then came back and said "my supervisor wants to know whatyou want - a new pump?" or something along those lines! Either way, things have been much better, I junked those reservoirs (they did send a few new ones, but I had older boxes which seem fine. I also am doing a fixed prime every time I disconnect before reconnecting to an exisiting site...

Some of the customer service reps are great, and knowledgeable, others are clearly just following the flow chart. Thanks for your thoughts - its all mickey mouse on some level...

Permalink Reply by Tina10 on April 21, 2010 at 6:33pm

Hi Dan,

We seem to be having the same problem with my son's minimed 522. He is 7 and has worn a pump for almost 5 years, so we feel we have a pretty good handle on set changes. Since at least 12/09, when we change his set, a few hours later a large bubble appears in the resevoir near the seals, which eventually makes its way down the tubing. In 1/10, Medtronics also gave us a new pump after sending us a tubing clamp to test our old pump for pressurization issues, though they didn't find any problems. Since then, on at least 3 occassions we have noticed after priming the silhouette and leaving it sit, we watched as either insulin was either being sucked back up the tubing or air was getting sucked in through the needle end. (we've never seen this problem with the Quik-set which we occassionally use) We've made endless calls to Medtronics and have not gotten anywhere with either problems. (bubbles in reservoir/tubing and bubble created at end of needle end)

I often wonder how many times after changing his set and priming it, if a much smaller bubble appears in the needle end that we can't even see. On several occasion after changing his set and not seeing any visible bubbles at the needle end, his numbers will rise significantly (150+pts). We have weeks where his numbers are great, then a week where we change his set on a daily basis and really restrict his carbs and still have him spiking up to 300+ and then have trouble with getting him down. I just feel there has to be some sort of defect with the supplies. Same feeling I had before they announced the recall of the Quik-sets this summer.

Have you had any luck finding a solution to these problems? We would appreciate any info Medtronics may have passed along to you. Thanks

Tina

Permalink Reply by TS on April 22, 2010 at 11:18am

Try hanging the pump upside down, if air bubbles are being introduced due to normal setup, etc, then they will rise to the top of the reservoir and not get into the tubing coming out of the bottom.

Permalink Reply by Dan W. on April 22, 2010 at 4:28pm

Hi Tina -

I have not had the same issue with the air bubbles coming from the reservoir end, but have a working solution as far as the air bubbles coming from the silhouette side, which is basically to prime before reconnecting, even if only "unplugged" for a minute or two. This is still so strange as I do not recall this happening at all on previous pumps, but priming before reconnecting seems to solve the problem - I usually give about .6 units, depending on the length of the bubble.

The MEdtronics rep finally confirmed it is not a "closed loop" system, as the pump is not continuosly adding pressure, only every minute and a half or whatever it is, so that air can be sucked back if open to the atmosphere and not in the site. Good luck!

Permalink Reply by Debbie on May 20, 2010 at 8:34pm

Hi, I've noticed the same problems as described in all of these situations. It's so frustrating I don't even call Minimed because I already know what they'll say and I don't want to deal with the endlessness of those questions/testing of the pump. There is clearly something wrong with this system/equipment.

I'm a little lost about what to do though, change pump companies, change reservoirs? People (doctors/DNEs) look at me like I'm crazy when I mention this. This group is a life saver if only in the fact to know that others have the same problems.

Related to this, does anyone notice how the insulin is less affective as it gets closer to the "low reservoir" message? I upped mine from 20 to 25 but I still am noticing this happening.

I've been trying to do basal testing and have been unable to do it with all of these other pump issues!

Permalink Reply by Sharon on May 28, 2010 at 7:04pm

The subject of bubble troubles came up about 18 months ago. We put a LOT of information (probably more than anybody wants to know) in a blog:
http://regressionsrus.blogspot.com/

Eighteen months in, we still don't know what causes the bubbles to develop in the reservoirs; that is, why (apparently) an imperfect seal between the plunger and the reservoir results in air leaking into the reservoir. Even though the reservoir isn't under constant positive pressure from the pump plunger, it doesn't seem reasonable there could be a significant "negative pressure" in the reservoir which would be required to cause air, in effect, to be sucked into the reservoir. And we don't know why some people get bubbles, but lots of other people don't. We do know that it isn't "patient error;" for people who are prone to getting bubbles, bubbles develop over 24-72 hours no matter how careful you are to make sure there are no bubbles at the beginning of use of the infusion set.

Medtronic blames "patient error," and says it's rare for bubbles to be a problem. Their phone representatives try to be courteous and helpful, but they have to toe the company line. Almost all physicians say, "This is new to me."

But whatever the source of the problem, and even if Medtronic is avoiding finding the solution (probably with the possibility facing them of negative publicity, another multi-million dollar recall and retooling, and a hit to their market share and stock price), we do know the solution:

If you have trouble with bubbles (more than about 1/4" in the tubing), then
1. Check your tubing 2-3 times a day for bubbles.
2. Prime out the bubbles before they get to your body.
See the blog for details.

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