One to grow on

Image via Wikimedia Commons user Fir0002, used under Creative Commons license

Image via Wikimedia Commons user Fir0002, used under Creative Commons license

Pump supplies and CGM sensors should be like candles on a birthday cake.

There should always be one extra, looking towards the future.

For my ninety-day pump trial (disclosure), I was given exactly three boxes (total 15) of Enlite sensors and three boxes (15) of Mio infusion sets. The infusion sets last three days, the sensors last six.

At least that’s how they see it.

Understand that the they I refer to isn’t Medtronic and the trial sponsors — they’re offering these supplies for free and I won’t look a gift horse in the mouth. It’s the whole healthcare “system” at large. The one that thinks straight math solves everything, and the “what-if” contingencies only take effect if we make allowances for them.

(To Mrs. Hartman, my favorite all-time English teacher whose class I sat in from 1987-88, I apologize for consecutively using the words “that the they” in the previous paragraph. I know it must be driving you crazy — if you’re reading.)

But infusion sets don’t always last three days. So far in the last three weeks, I’ve had to replace two sets prematurely. Luckily, I’ve had a stash of personal reserves in which to dip. (The endo who started me on the pump wrote my prescription to change sets every two days, since the manufacturer’s guidance at the time was two-to-three days and he wanted to make sure I was prepared; hence the stash. I’m lucky. Not everyone is.)

Had I not had reserves, I would’ve run out of infusion sets before the 90-days was up and would have to end my trial early. Or, in the real world, I’d have to stretch the life of a different infusion set beyond the allowable time. While stretching the life during a trial is forbidden, doing so in “the real” world is frowned upon, but permitted.

In fact, I think it’s secretly (and off-the-record) encouraged. How else are we supposed to handle an unexplained  high? Wait it out and hope it fixes itself? (We often do that, and regret it later).

Let’s not even speak of the insulin inside the reservoir.  Or in an even more dramatic case, the Pod.

* * *

Because of the timing of my 530G training, my first Enlite sensor was inserted at about 6pm on a Monday. That means that, after the two hour “warm-up”, the six-day clock started that night at 8pm (with a second calibration due by 2am). That sensor expired the following Sunday at 8pm. I found time to replace it about 45 minutes later, starting the six-day clock at 10:45.

(Hint: timing your first sensor calibration in the middle of an after-dinner BG spike is not a good idea. But if you want to adjust your sensor-changing-schedule to a time that’s more convenient, you can only wait – unprotected – and do it later; you can’t change the sensor early or you’ll run out in the end).

* * *

That’s kind of what happened to me last night (I am writing this on Saturday morning). My sensor was due for a replacement at around 11:30pm and I was dead-tired by 9:30 (that’s what happens when you turn 40!). I was also in the midst of a steady BG ascent (due to the apparent overcorrection of an earlier low) and wasn’t prepared to fly blind for the next two hours. So I figured I’d let it run its course, quit at 11:30, and change the sensor in the morning.

Dateline Saturday, 1:10 am. My sensor is expired, my mouth is dry, my stomach is churning, and my BG is in the 280s. I’m wondering if it’s a problem with my not-even-two-day-old infusion set or a result of the food I’ve eaten earlier (switching to a Kosher-for-Passover diet since last Monday night has most definitely not been friendly for my diabetes). Ketones are negative, so I take a correction, via pump, and go downstairs to putz around on the computer for 45 minutes. Then, when I re-test and see that I’m in the 300s, I take 5 units of Novolog by syringe, rip out my fallen Mio (no irritation or tenderness at the site, whatsoever), and set myself up with a stockpiled Sure-T, using the same reservoir. I also remove my expired Enlite Sensor and slip my transmitter into the charger, covering it with my pump holster so the flashing green light doesn’t drive me batty as I try to go back to sleep.

(Aside: I selected the Sure-T because it’s what I’m most comfortable with on my back. It gives me some time to heal the limited real-estate market on my front before I put in a new sensor in the morning).

I set my alarm clock to wake me in 90 minutes to test. Ninety minutes later, I’m confronted with a mouth that’s no longer dry but eyes that don’t want to open, so I turn off the alarm and go back to sleep.

* * *

The moral of the story is this: if my supply hadn’t motivated to conserve Mio sets (which are now my favorites, and of which I have a limited supply), I would’ve changed the whole damn thing at the first hint of a problem last night.  If my supply hadn’t motivated me to conserve Enlites, I would’ve changed it out before the entire six days had elapsed.

Part of me is cursing myself for staying “on-label” and not restarting the sensor before bed, at least so it will last just long enough to get me through the night. But that’s what I signed up for when I started the trial.

* * *

In my line of business, in which the public’s safety can be a factor, it’s not uncommon to require a manufacturer to deliver 10% spares in addition to the necessary electronic equipment needed for operation.

You’d think asking for 11 units to be packaged with a box of ten wouldn’t be an unreasonable request. If we are expected to play by the rules, we can’t do it without the appropriate equipment.

And that’s One To Grow On.

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Posted on April 21, 2014, in Diabetes. Bookmark the permalink. 4 Comments.

  1. I totally agree with this! I am permitted one sensor a week by insurance. Including failures , mis-inserts, tear-outs etc. Thankfully I am pretty good at stretching mine out, but it’s still scary!

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  2. Since there’s no way for the prescriber to order spares, I’d imagine *some people* have a crazy Rx written to accommodate this. (Instead of “change site every other day” and the they automatically including two spares, it’s “change site daily,” which is like fifteen spares.) Your plan (11 per box) is so simple and clever.

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    • You would think. I’m still wondering how I’m supposed to get reimbursed for that one test-strip per vial that is technically assigned to be used with that “control solution” stuff. It’s all a silly, silly game.

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  3. Very interesting story! I’m scared to switch to a new pump because I have such a large stockpile of supplies with my old one (I would definitely go past the three days for the infusion set which allowed me to save up). I can’t imagine when it’s time to switch and I won’t have my healthy stockpile

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