Handling air in the tube?

I'll give you the cliff's notes questions, then follow with the story for context:

1. What could cause air to get into my pump tube?  It's been fine for like a day and a half, but it had air in it this morning (probably before I woke up).  I can't think of much that was different, except maybe that my tube was stretched a little bit more than usual while I slept... But not like, STRETCHED stretched.

2. If you prime air out of your tube, should you assume there's still insulin in the canulla and not "fill canulla?"

3. I'm not at dangerous numbers this time around (thanks to still being in my "honeymoon," I assume), but let's say I ate breakfast then wound up with a BG of like 300+.  In a situation like that, should I correct with the assumption that I'd gotten no insulin at all with my meal?

OK, so here's the context:

So I woke up w/ a BG around 160... that's higher than my usual fasting number by about 50 points.  But I was going to take a short run/walk before breakfast, so I didn't correct... then it was still at about the same before breakfast, so I followed my pump's (Animas Ping's) recommendations to bolus for both food and BG correction...  Got to work and Dexom showed my numbers around 250!  I started checking my pump and discovered air in the tube, which I primed out... though I didn't really "fill cannula" since I thought, you know, there could still be insulin in the canulla.  (I tricked it by "filling" it when it wasn't connected.)

So I get out my meter remote to test and correct... but, what?  153?  So I calibrated my Dexcom (it's been less than 12 hours since putting in the new sensor, so I can't get too mad at the discrepency) and decided that, though I'd normally be lower than this 1.5 hours after a bolus that included a correction (especially since it was a fairly low-carb breakfast), I clearly may have gotten some insulin at breakfast and need to wait to correct.

FRUSTRATING!

2.5 hours after breakfast, down to 129.  Good enough for me.  Must have gotten my full bolus (or at elast most of it) after all.

Glad to hear that the ending to this story is happy.  :)

I'm still new enough at this that every little speed bump is like, "OMG!  A NEW OBSTACLE!  PANIIIIIIIC!"  ;)

Haha, no one blames you for that.  :) 

I've never had air in the tubing after 8 years of using the pump.  It's possible something was wrong with your tubing or reservoir, but that seems unlikely since your glucose came down.  Your pump might be starting to have problems.  Does your pump sound slower or louder when it rewinds to prime? 

By any chance was this the first morning you've walked/jogged in a while?  When I start a new workout my blood sugars are always high (glycogen is released from muscles) for the first few weeks.  Sheri Colberg's "The Diabetic Athlete" book helped me understand how to deal with exercise. 

Good luck figuring it out what the problem was.  Hopefully it was just a one-time thing. 

 

If the pump's having problems, I'll be very miffed!  It's only a couple months old!  (Which means, at least, it's under warrenty.)

I just recently got The Diabetic Athlete!  I can tell it's going to be an awesome tool as I get back into exercising.  Pumping Insulin has a handy section, too.  But to answer your question, yes, this is the first time I've jogged since I was diagnosed in early May.  Everything else has been very low-impact, and not much of it.  So good point, my blood sugar may have lingered in the high numbers because of that.  (Though, there was definitely air in the tube, which I suspect is why I woke up higher than usual.  Hmph...)

 

Thanks!

I've noticed at times with my pump when it is getting near the end of the reservoir that there are quite a few air bubbles in the reservoir and if I dont get them out they will end up in the tubing and will make my sugars go high.  Therefore, I"ve now made it a habit of checking the reservoir once it gets down to being about 1/4 full and checking if there are air bubbles.  If there are alot of air bubbles I will tap the reservoir in order to collect the bubbles at the top of the reservoir.  I will then usually reconnect the reservoir to my insulin bottle and push the air bubbles out and refill the space with insulin.  I will then make sure that my pump is not connected to my site and will reinsert the reservoir into my pump.  This way there aren't any more air bubbles and I always make sure that my pump in not connected to me in case I refilled the reservoir with too much insulin.  My husband actually taught me this little trick (he's been pumping much longer than I have) and so far it seems to work.

I'm almost 100% positive that your reservoir has the problem, not your pump.

Were there champaign bubbles in your reservoir after you put it in? I think those bubbles can merge and then get into your tube. Liquid can't compress, but air will. So if there is air in your tube then you won't get the right amount of insulin because when insulin is pushed into the tube that "force" gets put into compressing air instead of pushing insulin into you....

You don't need to "reprime" after getting the air bubbles out of your tube, your canula still has insulin in it. I wouldn't worry too much about stretching. My pump always ends up danging from my site for a hot second at least once every week (oops) and I've never noticed problems.

I also go high while working out. Honestly, "perfect storms" of mis-dosing, a different physical activity, a different food... that kinda stuff happens. And having a back up insulin delivery method is important if you find your pump isn't delivering.

word. I always have "weirdness" when i near the end of a reservoir. I will get "no-delivery" messages even when i technically have insulin left, something about that last bit (which generally has air in it) is really tough.

John and Amy Martins covered all the important stuff. (Nice job, guys!)

I will say that when I do find bubbles in my tubing. I disconnect from my site, and then prime the insulin out of the tubing, watching for when the bubbles are gone. Then I snap back in and go about my day.

Another note: Be aware that different infusion sets require different amounts of "fill cannula" to be done when you first put them on. For example, the UnoMedical Inset (comes in a handy bun shaped package) requires NO "fill cannula" to be done, while the UnoMedical Inset 30 (angled/ comes in bigger case) requires you to "fill cannula" with .07 of insulin. (Check instructions that come with the sets for more information.)

I learned this lesson the hard way. I used to use the Comfort, which requires a 1.0 "fill cannula" then switched to the Inset (does not require you to fill the cannula) and kept filing the cannula out of habit. Then I wondered why I went low every time I changed my site. DUH!

 

I rarely if ever see bubbles in my tubing. The one time I saw bubbles all over my tubing was the day that my infusion set came out of body and I did not know it. I was still new to my pump at that point. So I would prime the bubbles out. They would go away. The numbers would go lower ish. The set was cannula was not completely out but it was jumping around. So I was getting some insulin, just not all of the insulin. It took me a few hours and panicked calls to my trainer to sort that out. So that is one other thing to be aware of on top of everything else. Since you were obviously getting insulin, my information does not apply, but this is something to watch.

Thanks, everyone, for your ideas and tips!  The reservoir wasn't all that close to empty, and I'm good about filling it with room temp insulin and getting all of the bubbles out.  It's really good to know that's something I should check in a situation like that.