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[IP] Insulin pumpers (people and things)

[IP] MiniMed 1999 Annual Report

Subject: [IP] MiniMed 1999 Annual Report 
From: Lee Lockwood <email @ redacted> 
Date: Sun, 21 May 2000 10:40:03 -0400

As a shareholder, I just received MiniMed's annual report.  In it, there
are a few items that should be of great interest to this list:

1) Continuous glucose sensor.  While it is not currently available to
consumers, MiniMed appears committed to making it widely available to
diabetics.  Apparently, data from physicians indicates that having
access to 24-hour glucose readings can revolutionize diabetes care.  As
a result, they are building a new, automated manufacturing facility on
the grounds of their new headquarters (Northbridge, CA?) that will be
devoted exclusively to sensor manufacturing.  By next year, they expect
to be producing three million sensors a month - which seems to me an
enormous number.

   If they're right, the continuous sensor will be a great boon to all
of us pump users.

2) Pre-filled insulin reservoirs.  MiniMed has arranged to buy Humalog
insulin from Lily in crystal (bulk) form and will be offering pre-filled
reservoirs to pump users next year.

3) Closing the loop.  MiniMed also appears committed to realizing the
dream of a closed system of insulin delivery -- a combination of some
form of the continuous glucose sensor mated with an implantable pump --
by which the correct amount of insulin will be delivered to the patient
according to his blood glucose level.  It will be similar to the
external pump but implanted under the skin of the abdomen in an
outpatient surgical procedure.  Quoting the report:

   "The implantable pump delivers a basal rate of insulin, with larger
bolus doses delivered before meals, and is controlled by  hand-held
communicator...  Insulin delivered into the peritoneal cavity...is
rapidly and predictably absorbed, and may be particularly well suited to
patients whose diabetes is difficult to control.  The...pump is designed
so that insulin refills can be performed during simple office visits
every three months.  For a patient, this can mean going from four
injections per day to four injections per year.

   Known as the "MIP-XL. Model 2007," it has "an extended battery life
and an anticipated longevity of about ten years for a typical Type I
patient."  It has already been approved for commercial distribution in
the European Union, beginning February 2000.  However, "sales will
remain limited in Europe until the specially high-concentrated insulin
developed by 
Aventis (formerly Hoechst) is approved, which is not expected before
2001 at the earliest." There are about 700 patients already using the
implantable pump, MiniMed says, on an experimental basis.

   The pump is being developed by MiniMed's affiliate, the Medical
Research Group, also in California.

   If you wish more information, the company usually posts its annual
report on its website, but the 1999 report is not there yet.

Date: Mon, 22 May 2000 22:38:59 -0400
From: email @ redacted
Subject: Re: [IP] resouvir question

OK All - time to share the foolproof de-bubblization (sorry for the new word) 
technique.....here we go (and I am talking MM terms here)

1. make sure the insulin is room temp 2. hold the reservoir/syringe vertically 
- move the plunger up and down a few times to spread the lubricant - then pull 
it back to the desired amount you are going to fill.
3. hold the insulin vial vertical - and insert the needle straight up into the 


Inject the air into the insulin. Put resistance against the plunger, and DO 
NOT PULL IT - let the air pressure move it back against the resistance of your 
thumb. Let it fill about 50 units - then push it all back in. Let the air 
pressure push out about 50-75 units again, then push it back in. this time, 
give it a couple of flicks on the side to loosen any bubbles - and push it 
back in again (tightly to the top). Now, allow the air pressure to push it 
back (again against resistance) until the pressure won't push any further. 
then, and only then - do you pull the plunger out slowly to the desired 

Try it and tell me how it works. We NEVER (I shouldn't say never - RARELY) 
have bubble problems.....


> Hi!

> I have a question though, as much as I love my pump, i'm not looking
> foward to the set change tomorrow. I've done two already. Both times,
> it took forever. I had a really hard time getting all the air bubbles
> out of the syringe.
Steve Winer - Dad to Allie
14 y/o - dx 6/97 - MM508 12/99
- ----------------------------------------------------------

Date: Mon, 22 May 2000 22:46:47 EDT
From: email @ redacted
Subject: Re: [IP] resouvir question

if you can get most of the air bubbles out then when you prime the tubing make 
sure to hold the pump straight up and the air goes out with the priming. of 
course it may use a few more units to get it all out but it is less stressful.

to the one who's child is getting an insulin pump for the night only i am 
asking why it would be ordered only for night use? since then you would have 
long acting insulin in her system every day for the day time it would 
interfere with the night time pumping....wouldn't it? i have never heard of 
this so is why i am asking.

also for the lows. i am not sure what the reading of lo on her accu chek 
complete is but alisha had one a couple of weeks ago and was not only ok she 
was swimming in the pool before and after as my mom wasn't home and my oldest 
daughter (who doesn't know anything about diab and won't learn) didn't take 
anything with them when they went swimming at my mom's but her meter and my 
mom didn't return for a while, she has had readings in the teens before and 
not felt them too. so i wonder how low she was.
later she was only 50. and had to retreat her.

for the one with the little girl on a test trial of sets you should try a 
rapid, much less invasive insertion than either of the two you tried.

congratulations to all the new pumpers today!


Date: Mon, 22 May 2000 20:48:19 -0700
From: "Dawn Stricker" <email @ redacted>
Subject: [IP] bubbles in reservoir

My pump trainer showed me the following and it has worked great for me most
of the time.
1. Use room temp insulin
2. Follow directions to fill reservoir (make sure to put the same amount of
air into the insulin vial that you plan to draw out)

Once you have the cap back on the reservoir, bang it on the table for about
30 seconds or so (vertically, of course). This makes a lot of the bubbles
float to the top of the reservoir. Insert it into the pump. I leave my
pump standing vertically when I prime the tubing, this forces the air at the
top of the reservoir into the tubing and then out, of course. Hope this
Dawn email @ redacted

Date: Tue, 23 May 2000 00:04:27 EDT
From: email @ redacted
Subject: Re: [IP] resouvir question - bubbles

In a message dated 5/22/00 7:21:44 PM US Mountain Standard Time, 
email @ redacted writes:

<< I had a really hard time getting all the air bubbles out of the syringe. 
Anyone have any ideas, suggestions,
advice??? All suggestions are welcome! >>

Takes time and practice. One thing I've found helps for me, is to insert the 
amount of air into the bottle that you want to pull up into the syringe. Then 
when the bottle is inverted and you're drawing it up, do it very slowly and 
you'll end up with less little bubbles from the start. Getting a big one out 
isn't too hard, just keep tipping the syringe until its in the middle and push 
through, it's the small ones that are stinkers!

Good luck,
dm 20 yrs, pumping 4 yrs

Date: Tue, 23 May 2000 13:22:49 +0200
From: Andrew Aronoff <email @ redacted>
Subject: [IP] Avoiding Bubbles (was "resouvir [reservoir] question")

Hi, Lyra.

Since I've been on the pump, I've had no problems with bubbles. Here's what I 
do, but of course, as in all
things diabetic, YMMV:

First of all, bubbles aren't magic. They're present because either they were 
_pushed_ into the tubing (from trapped air) or _pulled_ into the tubing (from 
a loose fitting).

1. Before filling the reservoir, pull (not all the way) and pull and push on 
the plunger a couple of times to distribute the lubricant already inside. This 
will reduce the possibility of air leaks around the plunger while filling the 
reservoir in step 4.

2. Before filling the reservoir, twist the filling needle with the plastic 
cover on so it's *tight*. This will minimize air leaks through the needle in 
step 4.

3. Withdraw the plunger to fill the reservoir with air and then inject this 
air into the insulin bottle. If this step is omitted, the insulin bottle will 
be under a vacuum and air will be sucked into the reservoir from around the 
plunger in the next step.

4. Fill the reservoir from the insulin bottle with the needle pointed *up* so 
that air floats to the top of the reservoir. When the reservoir is full, 
withdraw it from the insulin bottle. Holding the needle *up*, tap sharply 
several times on the reservoir so that the air around the plunger is knocked 
to the top. Then, hold the reservoir up to a bright light and push the air 
(and any insulin trapped between air pockets) out of the reservoir. Stop 
pushing on the plunger when insulin starts to flow out the needle and no 
bubbles are left in the reservoir.

This step is NOT included in the "Instruction for Use" of the Minimed 3.0 ml 
Reservoir (REF MMT-103). Instead, Mimimed advises you to get rid of the air 
after you connect the infusion set (step 6). However, it's much easier to 
manipulate the reservoir without the infusion set attached and I haven't yet 
filled a reservoir without seeing air at this point. IMHO, this is the single 
most important step listed for eliminating bubbles.

5. Holding the reservoir with the luer connection *up*, unscrew the (tight) 
needle with the plastic cover, and attach the new infusion set connector. 
Screw it on *tight*.

6. Holding the reservoir with the luer connection *up*, push on the plunger 
until the insulin comes out the needle. Once insulin starts coming out, there 
should be no bubbles visible anywhere at this point. If you see bubbles, get 
rid of them before going any further. Try to figure out how they got there. 

7. Insert the plunger into the pump and (gently) push the driver arms against 
the plunger to minimize the priming quantity.

8. Prime the pump. 5 units should be much more than sufficient (2 will usually 
do). If insulin doesn't appear at the needle tip after 5 units, look for leaks 
and bubbles and try to figure out what went wrong. THERE IS A REASON.

regards, Andy

 This message has not been checked for accuracy, completeness
 or relevance by the author.
 Any need for these activities should be addressed by a message to
 my mommy.

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