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Re: [IP] re: pump issue for those who use less than 25 U/d

At 07:13 AM 4/3/02 -0500, you wrote:
 ><several of the
 >pumps -- including both Minimed pumps -- are bad choices for people
 >who use less than 25 units of insulin per day. I currently use about
 >30, so this might not be a concern for me (though I understand
 >insulin use may decrease on the pump), but I'm curious what the
 >problem is. >
 >I'm not sure if this is right or not, but when I was pump shopping my CDE 
 >me that the MM pumps would not be recommended for me because my basal rates
 >are low.  She explained that because of the delivery system, there is a
 >greater incidence of occlusion alarms when the basal rate is very low.

Actually, I think that the problem is twofold in nature.  If you're using a 
low basal rate you may be more likely to have occlusions, as with fewer 
infusions per hour your body may have more opportunity to heal the site 
wound and inhibit absorption, more tissue or blood can be forced into the 
cannula between infusions, muscles can crimp it and so forth.  In addition, 
because of the low basal rate you might experience a partial or full 
occlusion but not actually receive an alarm for many hours, if at all.  The 
reason for this is that there is a set amount of pressure in the tubing 
that the pump will tolerate before it notifies you of an occlusion.  I 
think it amounts to a pretty significant amount of insulin for someone who 
uses 25 units a day or less in total. Although I can't remember the exact 
amount I think that it's in the order of 7 units or so. (I have a call in 
with MiniMed to verify this with the engineers and I'll let you know what 
they say when they call me back.)  That means that if you're using only 
basal at a rate of 0.3 units/hour you could receive no insulin at all for 
nearly a full day before receiving an occlusion alarm.

So it's an issue to be aware of, but I don't necessarily think it's a 
reason not to use one pump or the other.  I use about 25 units a day in 
total but since I check my sugar pretty regularly I can tell when there's a 
problem I can't explain.  If my sugars are running high for two or three 
tests in a row and I'm not eating unusual foods, or sick, or premenstrual, 
or experiencing high stress, or anything else that could cause that to 
happen, I change my infusion site. That usually solves the problem. f 
you're really worried about this you can dilute the insulin so that the 
occlusion alarms are triggered more quickly.

In the best of all possible worlds I would want the fault tolerance on the 
MiniMed pump to be either by default lower or configurable by the user, so 
those of us who use smaller amounts of insulin could have more warning of 
occlusions one way or another.  But I expect that both the engineering and 
marketing challenges involved in delivering and selling these benefits are 
significant.  In short, I'm not holding my breath.

But I am holding on tightly to my MM pump, which--despite its minor 
faults--if you want you're going to have to pry out of my cold, dead hands.

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