Grandpa: Now, remember the plan, boy. If you run out of air, tug on the rope…
Bart: 64 times, no more, no less. Got it.
Grandpa: No no! 63 times if you’re out of air; 64 is if you found the treasure!
Grandpa: 61… 62… 63… Oh no! 63! He’s out of air! I’ve sent my only grandson to a watery gra… 64! He’s found the treasure! I’m rich!
-from The Simpsons 1996 episode “The Curse of the Flying Hellfish”
Remember that one? (I wish I could find a video to embed. Some help, please?)
Using my insulin pump is kind of like that sometimes. As I think I’ve mentioned in the past, I keep my pump on vibrate mode. I tried the beeping-mode, but many times (like when I’m in noisy places) I can’t hear it, and other times (in quiet places) everyone can. But I can always feel the pump vibrate when clipped to my belt, so I go with that.
(Word on the street is that the next generation of alert, the can’t-be-missed design that sends an electric shock through the tubing to the infusion set, is stuck in FDA purgatory.)
But one of the problems with vibrate-mode is that it’s monotonous. Literally. While the beep-mode uses different pitch tones for different alerts, vibrate-mode does not. It requires a certain level of concentration, like interpreting Morse Code, to understand the message. Actually, it’s worse than Morse. Morse Code has two “symbols”, dots and dashes. Medtronic Code has one — just dots (or just dashes. Pick your poison).
When you add CGM alerts to the pump alerts (since they’re the same device), it’s tough to keep them all straight. Again, beep-mode is easier: three ascending tones (do–re–mi) means the BG is rising. Three descending tones (mi–re–do) means it’s falling. But three identical vibrating tones — three dots — could mean either. Or it could mean the reservoir is low, or that a bolus was not completed, or that temporary basal is in effect.
A dot–dot–dot is actually a common occurrence, one that doesn’t freak me out that much. Sometimes I dismiss it without looking (thinking it’s a low reservoir) when I shouldn’t (it defaulted to square-wave, meaning I didn’t bolus for lunch), but it’s not catastrophic.
Beyond three, there’s trouble.
Dot–dot–dot–dot: In Medtronic Code, four vibrates means insulin delivery has stopped. Occlusion, motor error, whatever. That fourth dot really freaks me out. I get nervous and mentally prepare for a bolus-by-syringe, a set-change, and possibly a phone call.
But sometimes it continues.
….dot–dot: Six vibrates means my CGM is due for a calibration.
But when it’s followed by a fifth dot and then a sixth, the feeling of relief is immense.
Kind of like how Grandpa Simpson felt when he got the 64th tug on the rope.