A Lifetime of Troubleshooting

Back in the days of working full-time, this used to be my career motto: “Always be a troubleshooter.” That was the advice I gave all the newbies I met about any job they were taking on, whether at McDonald’s or on Wall St. Words to live by… little did I know.

Since being diagnosed with diabetes, I feel like a Meister Troubleshooter. It’s not just some watchword for the workplace anymore, it’s a lifestyle. It’s what is known as diabetes management — just a fancy term for trying figure out what’s going wrong with your blood glucose control every day of your life and how to fix it.

Basal programs, temp basals, insulin-to-carb ratio, that tricky carb-counting (see yesterday’s post), infusion site rotation, wacky readings, warning arrows, high alarms, bum test strips, hidden carbs, dual wave bolus, … weigh & measure! It never stops…Pink_toolbox_2

When your blood sugar suddenly soars and it won’€™t come down, as was the case with me for four whole days last week (!), you run through every scenario: Is my pump malfunctioning somehow? (maybe this pod or that one isn’€™t connected right?) Or is the insulin fried? Am I even getting accurate readings on my meter? Or am I just on my way to developing a nasty cold?

If you think about it, these are the four basic points of failure:

  • The insulin delivery device
  • The insulin itself
  • The blood glucose monitor
  • The human body

The trouble is, the human body is more complex than all the other factors combined. That means no matter how well the technology works, you can always have blood sugar control issues that seem to escape logic.

Nevertheless, it sure would be nice if we knew we could rely on the technology 100%, but we’€™re just not there yet:

* There’€™s been a lot of talk about failure rates in pumps and pods. The fact is, these things do malfunction more often than any of us would like (the manufacturers included).

* Insulin is sensitive. If it’s been stored at too high temperature, or even been jarred around too much, I have learned, it becomes ineffective. But there’s no gauge to tell us that — other than crazy-high BG readings. Yipes!

* Meters aren’t all that accurate. For traditional fingerstick meters, the FDA tolerates (in)accuracy levels of up to 20% (!), and for new CGM systems, up to 30%. That’s a huge margin of error! On top of that, these devices are prone to failure too sometimes, and/or test strips go bad at times.

Let’s be realistic: technology is immature when first introduced, and vendors have to rely on early-adopters to 1) help work the bugs out, and 2) provide the revenue to recoup past R&D costs and secure funds for future R&D. The customer — aka the patient -€“- literally has to pay the price, but what other options are there? At the same time, I think most of us are enormously grateful for the strides the technology has made towards better diabetes care. We’re all living freer, healthier, and longer because of it.

Still, all of this is what makes diabetes management so frustrating. Can you believe that all this was going through my mind last week as I got on the phone to troubleshoot with the Insulet reps? Yup, I was running in the 200s and even 300s, changing my pod over and over, injecting while still wearing it, having some success coming down and then soaring again. What was wrong now?!

Together we walked through every possible failure scenario, and eventually determined a cause of action –€“ without any finger pointing or blaming. Turns out I’d been delivered a rather large shipment of “dead” Apidra. Somehow the contents of at least 3 vials had gone bad before they got to me. Luckily, my wonderful endo convinced my mail order supplier to replace them without a fuss.

But Insulet was wonderful, taking a ton of time to talk with me and follow up, and follow up again. And this is how it should be: while we cannot yet expect flawless diabetes technology, we can expect that the drug and device companies do their very best to support us in a crisis.

My experience has been that I’ve always been able to count on them when needed. But yes, I know, I’m a prominent blogger, so maybe I get pampered a bit… What about you? What has your customer service experience been when your life of troubleshooting hits a high note?


12 Responses

  1. shawn
    shawn March 27, 2008 at 8:21 am | | Reply

    this past tuesday, i had a similiar experience
    i soared into the high 300′s and nothing would bring it down
    correction after correction, big boluses, low carb meals
    i removed the pump, and tried fresh insulin by injection
    i ate a small meal which was weighed and measured, and home cooked-my post meal bg was 400!
    more corrections by injection, and lantus
    woke up at 242-almost a relief to see a 200+bg
    after breakfast i was 119, and have been ok since then
    i am taking a pump vacation for a few days, although lantus/mdi is not as precise
    i thought it was;
    bad site
    bad insulin
    a cold
    air bubbles
    carb counting error
    we will never know but every now and then there is a day like this

  2. Julie
    Julie March 27, 2008 at 8:49 am | | Reply

    This happened to me also the last six days. I tried everything and I finally ended up talking to CVS and getting a new vial of insulin last night before they closed. This morning with the new insulin in my pump my sugars are back to normal. I was also running in the 300 and 400′s even with corrections.

  3. Erin
    Erin March 27, 2008 at 9:30 am | | Reply

    When I upgraded from the Cozmo 1700 to the 1800, the new pump wouldn’t work, but Cozmo rep I talked to that Saturday morning was very helpful and got a new one overnighted to me as soon as we figured out what the problem was.

    I was recently in the mountains, and after playing in the snow for about an hour, I had a string of highs. It took me about two hours to realize that my blood sugar was climbing because the low temperature outdoors had rendered the insulin in my pump inactive, but that was a nerve-wracking two hours. Fortunately once I figured this out and changed out the cartridge, my numbers were back to normal within two more hours.

  4. mollyjade
    mollyjade March 27, 2008 at 10:07 am | | Reply

    THREE bad vials? That’s horrible.

  5. Nelson Sherry
    Nelson Sherry March 27, 2008 at 10:08 am | | Reply

    This isn’t too much of a “test”, but, just yesterday I called Smith’s Medical to see about getting my son’s Cozmo pump replaced because the cap to the battery compartment hasn’t been working right since the day we got it almost a year ago. This isn’t the problem that Smith’s has recently sent out notices on, but something else. Obviously, I’m not too overly concerned about this problem since I haven’t don’t anything about it previously, but the Smith’s support person was very personable, collected all my info very thoroughly and insisted on sending out a new pump in my son’s prefered color overnight. It took all of three minutes on the phone. Smith’s grade for this assignment – A.

  6. Kristin
    Kristin March 27, 2008 at 11:53 am | | Reply

    Just to echo Nelson’s comment, I have had very good experience with Smith’s Medical (Deltec Cozmo) customer service! In my first three years with the pump, I never had any pump failure. But recently got very strange emergency signals with the pump powering down randomly. I spent an hour on the phone with a clinical support person– and when we together could not solve the problem, then a new pump was sent out immediately. The support person’s wife uses the pump- so it was very clear that he understood all aspects of the pump and how important it was to get a new one immediately!

    Sorry to hear about bad experience with ineffective insulin– what a frustrating experience!

  7. Art
    Art March 27, 2008 at 2:39 pm | | Reply

    I was the first person in Virginia to receive an Omnipod. I have found no better customer service organization than Insulet. They even have a sense of humor. When one pod very early on went bad for some unknown reason and was alarming quite loud, and since most the reps knew who I was at that time, it is a long story, knowing that I had just relocated to Powhatan, Va from San Francisco, they suggested I take it out in the woods and just shoot it to quite the pod down. Then I learned the importance of a heavy duty paper clip.

  8. CALpumper
    CALpumper March 27, 2008 at 4:10 pm | | Reply

    My first experience with customer service for my pump (Animas), I received an error while out to lunch during the work day. My friend let me use his cell phone to call the 800 number and they were very patient with my while I panicked. Everything worked out fine, just needed a “reboot”. My first experience was when the monitor went wacky, I called customer service and told them what I was seeing. I said I can still read it, everything else is working and it is delivering insulin. They still sent a new one overnight.

    And last week I dealt with 5 days in a row of consistent 200s. Then all of a sudden, 50s and 60s in the morning. I went through the same list Amy. Came down to one thing, the human body. Throw in that I am a woman and there was my answer. Once a month can be fun for us, really…. :)

  9. Bill Woods
    Bill Woods March 27, 2008 at 4:32 pm | | Reply

    Anytime my sugars don’t go down in the standard time, I automatically change my infusion set.

    Some people who are using the 1800 model CoZmo might also be using 90 Degree CLEOS.

    Last I knew they have one of the smallest gague cannuals. This could be reason for delivery problems past 2-3 days of wear.

    I routinley change every three. My advice, don’t wait until your sugars are high before you change your site.

    Best Regards

  10. Sarah
    Sarah March 28, 2008 at 10:41 pm | | Reply

    This is EXACTLY why I refuse to believe that we are even CLOSE to having the requires technology for a “closed loop pump” (yeah right). Keep the lies coming for more money, JDRF. We will see a real cure before we see a closed loop pump. I personally would never trust my life with such a device.

    As for Cosmo (Smiths Medical) I also have to sing their praises. Their customer service is superb.

    I called for a replacement pump at 6 pm on a Sunday…8:30 am and I had a new pump on my doorstep. Great service each and every time I need it…no hassles…

    I do wish diabetes technology was more precise and reliable. For an insulin sensitive “brittle” Type 1 like me, current technology simply not good enough. It’s a nightmare.

  11. Josh
    Josh April 10, 2008 at 3:56 pm | | Reply

    In response to Sarah:

    I am fairly certain the technology exists. My minimed pump has a bolus calculator, and with the newest model, the ability to receive cgm readings. It would be a minor step to programming the pump to go automatic.

    The only real impediment is the manufacturer’s concern about being sued when the device malfunctions. And we all know the manufacturer would get sued.

  12. Debbie
    Debbie May 6, 2008 at 5:28 pm | | Reply

    I am having trouble with bubble or clogs about 1 to 2 inches in my tubing which cause my bloodsugars to rise. I have tried silhouette, quick set, and rapid D. I also have had my Cozmo pump replaced. I am on low basal patterns of 0.40, 0.35, lunch is 1.0 then back down .45 I was told that wasn’t low enough to cause bubble or clogs. I do keep the insulin out for about 1 hour and do the priming. Total loss what to do. My trainer is running out of solutions as well. help

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