Ping Air/Bubble Problem

In December, I started having a problem with a lot of bubbles in my pump tubing. I wasn’t sure what was causing the problem, so I posted the question on the Animas TuDiabetes group.  I had received a bunch of tips with things to try, some of which I was already doing. Right around that same time, I had some bad insulin. Cheri, one of the group members said that she had that problem when her insulin went bad. Because the problem went away after I changed out my insulin, I thought that was the problem.

On Saturday, January 8th, I changed my cartridge and infusion set in the morning. That night before I went to bed, my blood sugar started to go up. I looked at my tubing and noticed that I had a bunch of air and bubbles again. I decided to pull the pump off and went downstairs to get some Levemir out of the fridge. While I was downstairs, I also ordered a new cartridge cap from Animas thinking that would solve the problem. About three months earlier, I had a problem one day that my pump kept needing primed. When I called Animas, they had me take the cap off and look at it. She told me that sometimes if the cap is not on right, it will cause the pump to need primed. When I put the cap back on that day, the priming problem went away. I thought maybe something was wrong with the cap and was causing the bubble problem.

Late Tuesday afternoon, my cartridge cap showed up via UPS. I immediately filled a cartridge and put the pump back on. Late that evening, I started getting air in the tubing again so I called Animas. She asked me a bunch of questions about how I was doing things. She wanted me to change everything out again so I did. She took the lot numbers for both the cartridge and the infusion set and asked me to save them. She would send me a label to send them back to Animas.

It did not take very long for it to start again, so I called back and asked what I should do – the pump was not usable. I was transferred to the person that I had spoken with earlier. This time, she asked me if I was letting the insulin get to room temperature before putting it in the cartridge. I was not. It was after midnight and I did not feel like being up until 2 AM waiting on insulin to get warm, so I said that I was just going to take some Levemir and try letting the insulin get warm once I got up in the morning. She told me that she would talk to her supervisor and give me a call the next day.

Wednesday morning, as soon as I got up, I set the insulin out to let it get warmed up to room temperature. I waited two hours and filled up another cartridge and put another infusion set it. It did not take very long for the air to start, so I pulled the pump off again.

We were getting a lot of snow in the NE last Wednesday, so I was not expecting the person from Animas to call me back, but she did. It was actually her day off and she was calling from home. She had another person on the line with her that was good with bubbles. That person also asked me a lot of questions about the process I was using to fill the cartridge. She asked about my letting the insulin get to room temperature and I told her that I had not been doing that but did it for the fist time that morning. She wanted me to try two things that I was not doing.

I had taken some Levemir that morning so I said I needed to let that get out of my system and I would try the things that I was not doing before. The customer service rep I had first talked to Tuesday night would be off on Thursday, but if I had any problems, I was supposed to call the other woman.

Wednesday evening, I filled the cartridge per their instructions. Everything went good and I went to bed without any air or bubbles in my tubing. Thursday morning, I woke up with my blood sugar in the 30s – it was obvious I did not have any air in my tubing. About an hour after I got up Thursday, I started getting air in the line again. I pulled the pump off and called Animas and left a message for the bubble lady to call me back in the afternoon. I was supposed to have a doctor’s appointment that morning but that ended up getting cancelled at the last minute.

Thursday afternoon, the woman from Animas called me back. I told her that I did everything like she wanted me to and it did good for about 12 hours, but then started getting air about an hour after I was up. She said that she would send me some cartridges and infusion sets to try. I had actually placed an order for new cartridges but they were only supposed to ship on Wednesday and I did not expect them for a few more days. I had a doctor’s appointment in Pittsburgh the next day and told her that I would not be home to sign for it. She decided that she would send it to be there at 10 AM since I was leaving at 10:30. She said that the next step would be to have someone from their clinical department get in touch with me so they could sit down and actually see what I was doing. She could not promise they would call me on Thursday afternoon, but said she would try to have that happen. If not, I told her what time I expected to be back home.

About 5 PM Thursday, the clinical manager for my area called me. I had worked with a different person previously but Animas changed their areas around so I had a different person. She was going to be in Altoona the following Thursday and wanted to meet me. I explained to her that I had not been able to use my pump very much that week so that would be another week without a pump if the new cartridges did not work. I also was not sure I could even get there because I don’t drive. My mother watches my nephew and if school was late or cancelled because of the weather, I would not have a way to get there. She was going to check with me either Friday or Saturday to see if the new cartridges worked before we tried scheduling something.

Around 6 PM Thursday, someone knocked on the door. It was the UPS guy with my supply order. I had cartridges! I took my insulin out of the fridge and also set a cartridge out so it could get warmed up. I let everything warm up for two hours then filled the cartridge. I let that sit for another half hour before putting it in the pump. I was up and running again by 9 that evening.

It was still working when I got up Friday morning except my blood sugar was in the 30s again. I usually don’t go low like that overnight unless there is a reason so that concerned me to wake up low two days in a row. About an hour after I got up, the air in the tubing started again. I took everything off.

I was getting out of the shower when I heard the phone ring. I thought it was my mother about picking me up later and I did not try to get to the phone before it went into voice mail. When I checked my messages, it was the clinical manager from Pittsburgh that I had worked with when I first got my pump. She saw that I was going to be in Pittsburgh and she thought maybe we could meet so she could make sure my technique was OK. We played some phone tag, but she called me back and said that she could meet me at my doctor’s office. I gave her the address and phone number there. My appointment was at 1 and she said she would be there by 1:30. She also said that she would bring saline for me to use instead of insulin.

When I came out from seeing the doctor, she was in the waiting room waiting for me. The nurse told us that we could use the first exam room so we went in there. I brought one of the cartridges that I pulled out of the pump to show her how much air was in the tubing. I asked her to listen to the pump when I did the rewind. I thought it was making a funny noise but I was not sure if I was imagining that since I thought something was wrong or it really was a funny noise. She agreed it was making a funny noise and even got her pump out to compare the two. Hers was nice and quiet. She watched me get the cartridge ready – by then, I decided to go ahead and put insulin in the vial instead of saline. I missed my pump! The only thing she saw that I did wrong was she said that I should only cycle the cartridge two times but she did not think that could cause the problem.

After I got home, the phone rang and it was the bubble lady from Animas. She said that they were going to replace my pump for me. I was supposed to go to my nephew’s birthday party on Saturday at 12:30 – my mother and brother-in-law both wanted the party over with in time for the football game.   UPS delivery was either by 11 or 1:30 so she was not sure it would be there in time. She said she could have the package delivered to my sister’s house. The only problem would be if something happened it did not show up, they would not be home on Monday to sign for it. She said once she put the address in, she would not be able to change it.

About an hour after she called, the air and bubbles started again. I pulled the pump off again and would wait for the new one to come on Saturday.

My new pump showed up about 11 Saturday morning. My sister was picking up the cake near my house, so she picked me up for the party. I took all my stuff with me and had the new pump up and running in no time.

Although some of the stuff I was already doing, I did try two more things (actually three if you count letting the insulin get warm!). I wanted to share some of the tips here:

  • Let the insulin get to room temperature before putting it into the cartridge.  I am now leaving it out for 2 hours before I fill the cartridge.
  • Cycle the cartridge, which I always did.  The clinical manager told me that I should only do that two times.
  • Make sure when cycling the cartridge, only push the blue plunger up and down, not turn it – I only pushed up and down and did not turn it.
  • Put the tubing on the cartridge and make sure both the tubing and the cap are tight, which I did.
  • She also asked about when I first pull the plunger back.  She said it was inevitable that I would get some air in the cartridge.  I always pushed everything back into the vial and she told me to only push the air back into the vial, not the insulin.  I only push the air back in now.
  • She told me to take the blue plunger off the bottom of the cartridge and leave the cartridge sitting like a missile with the needle pointing up for about 20-30 minutes.  I was concerned about that getting knocked over easily because I have a cat so she suggested putting it in the cupboard.  After I get the cartridge filled, I am putting it in the cupboards for half an hour.

Now that I have to let the insulin warm up for 2 hours and let the cartridge sit for another half hour, I need to plan ahead a little better for site changes but if it helps things, I will do it! Did I say I missed my pump the days that I could not use it!
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2 thoughts on “Ping Air/Bubble Problem

  1. Wow Kelly! Not fun at all. Curious about your statement “Make sure when cycling the cartridge, only push the blue plunger up and down, not turn it – I only pushed up and down and did not turn it”

    I also do the up/down with the plunger – to make sure it’s still greased up (but I never turn it around) – are you saying that we should “turn it”. It’s abit confusing how you wrote it above.

    One thing you may not know with the cartridge – if you notice air bubbles in the lube bit around the black rubber – e.g. it’s broken up – then that’s not a good thing. Don’t think this was the cause of your air bubbles, but it’s something I’d come across to look for when “lubing” the plunger if you are going to reruse them. As you know, I reuse my cartridge 5 X – I’m bad right?

    I think it was the pump all along tho’ – something was faulty with yours. I never bring my insulin to room temperature. I basically can do a refill of cartridge / infusion change in under 10 minutes – sometimes faster – depending on whether the cat isn’t wanting to play with me while I do my infusion change!

    Here’s to less problems with your new pump! Sounds like you’ve got a good team there to support you. Not sure how it would be for me here – but will see once I see new endo who actually takes care of insulin pump patients only – that appointment is end of April! Finally, a doctor / team that understands the life of a pumper! Three years later – it’ll be so worth it!

    • No, Anna, we are not supposed to turn it. I guess I should have been clearer on that! I will have to fix that later when I am thinking straight!

      You are allowed to be bad Anna! It is no fun to be good all the time.

      I went 6 months without letting the insulin get warm and did not have a problem so I really did not think that was my problem. I had to go thru all their steps to rule everything out. One thing about it being warm though, I don’t get as much air at the top to have to squirt out.

      I was able to do site changes in about 10 minutes also! The longest part was updating my spreadsheet because I track how much insulin I throw away and stuff (they don’t call me the spreadsheet queen for nothing!). The pump part was easy.

      I will keep my fingers crossed for you that this new doctor is good!

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