Temporary disconnection of pump

[Judith21]

I have had the tandem slim/ dexcom cgm in place for 6 months and had quite a few challenges along the way. My worst moment was having the occlusion alarm go off loudly in a roomful of people playing bridge.
i now fear a repeat of this, expecially when I am singing with my choir on stage for a couple of hours. It would just cause me so much stress that I would like to disconnect my pump and remove it for the evening. Of course I have my longacting and short acting pens to use. But how do I go about this process? Any
advice/ experience of this out there? By the way, I have all my alarms set only to vibrate so I don‘t know why I get the loud three notes for an occlusion alarm. And if you are not in a position to do anything about the occlusion at that moment, then can you stop the pump continually reminding you with an alarm?

 

[Lucyr]

It would just cause me so much stress that I would like to disconnect my pump and remove it for the evening.

Would it not be more stressful to completely change your diabetes management methods just for the occasional performance? As a musician myself I can’t imagine doing a completely different routine for a performance, I have a set routine of eating, timing, dosage adjustments, to make sure that my blood sugars are good throughout performances.

I don’t use a pump so will leave pumpers to suggest what to do, but I’d guess your concerts are only 45-60 minutes each half, so you wouldn’t likely need lantus, just enough bolus to cover the gap.

 

[Inka]

Welcome @Judith21 🙂 How often do you have occlusion alarms? I wouldn’t bother taking my pump off at all. If your worst moment was having a pump alarm going off when people were playing bridge, you’re doing ok I doubt anyone would notice your alarm even if it did go off when you’re singing.

I’ve taken my pump off for a few hours before (due to rough environment), but then you’ll need to watch for your blood sugar going a bit high. It’s just not worth it.

 

[Inka]

I meant to say that perhaps the occlusion alarm can’t be silenced? I don’t have the T Slim but I’ve been pumping for 20 years and an occlusion is a major alert due to the risk of DKA so you wouldn’t want to miss it.

If you’re getting a lot of pump alarms (you mentioned putting them on silent), then maybe you could try to work out why that is. I’ve had my current pump more than a year and I’ve had no alarms on it so far. That’s quite normal, I think.

 

[SB2015]

I am on a different hybrid closed loop (Medtronic) and like you sing in a choir.

Each of the Hybrid Closed Loop system uses an algorithm that makes decisions based on our sensor glucose and past data. If you disconnect there will be interruptions in the data it is using. I think the idea of using basal bolus for a period would confuse the system.I will tag @everydayupsanddowns who loops with the tslim as he will have more info your system.

How often do you get an occlusion? How often do you disconnect? I only disconnect briefly for a shower, and let the pump continue delivery. This has not caused any occlusions, so far.

I can understand you concern about alarms going off in quiet public places. I had an alert go off on my pump in our very first concert. No one in the audience heard it, and the choir and MD were used to it in rehearsals. I now switch my pump to vibrate and no sound for alerts, but cannot switch off alarms when looping. I now ensure that I set aside time to make sure that my levels remain in range and I find that the looping takes account of the inevitable rise in levels during the concert. I also do a check during the interval, just in case. I think that disconnecting and mixing injections and looping would be far less predictable. I think it would be easier for you to find ways round your concerns whilst still looping.

 

[SB2015]

Just thinking bout concerts. Can you use the rehearsals to work out a successful strategy for concerts whilst looping. I know D doesn’t always behave and will no doubt buck the trend but it might be worth thinking about.

 

[helli]

The problem with temporary removal of a pump is that you then have no basal insulin.
There are a couple of ways to overcome this
- inject long acting insulin. The challenge with this is that it lasts longer than a couple of hours so when you reattach your pump, you would then need to suspend your basal for the life of the injected insulin which is at least 12 hours (Levemir).
- regularly inject fast acting insulin. This could be needed every 30 minutes or more to provide the ongoing background insulin. I have done this when at a spa - I reattached my pump, gave myself a small bolus and then detached again.

Neither of these approaches will take advantage of the closed loop function of your pump. When I am "performing" (typically, presenting in a meeting), my blood sugars rise but some people are more relaxed and find their levels fall.

Unlike the 780, the way I understand the T-Slim closed loop is that it works from an input basal profile and does not "learn" what your body needs. So, I would assume (but I am not a doctor or DSN or ...) that the externally input insulin will have less affect.

In short, it is possible to temporarily detach the pump but only you will know if you think the "faff" is worth removing the low risk of an occlusion alert.

(Of the pumps I have used, none allow the occlusion alarm to be silenced. It makes sense - I need to know that my basal is not working and will not start working.)

 

[everydayupsanddowns]

Sorry to hear about the stress that pump alarms are causing you, especially during performances @Judith21

I suspect that occlusion alarms cannot be cancelled, because of the risk that non-delivery of insulin can cause. I’ve been using the tSlim for 3 years, and have had plenty of alarms, but never an occlusion one. Do you get many? I wonder if perhaps the type of infusion set you are using doesn’t suit you if you are getting occlusions more than once in a blue moon?

Most alarms on the tSlim can be set to vibrate-only, bit there are a few (eg urgent low) which can’t as far as I am aware.

I am also involved in performing. Sometimes pub gigs, where the volume of my regular alarms has no chance of cutting through the general hubbub, but also in church, where any volume can feel more intrusive at times. I have my alarm volume set fairly modestly (there are 3-4 volume options).

I have reconciled myself to accepting that occasional untimely alarms are part of hybrid-closed-loop life. Just as employers / venues are required to make ‘reasonable adjustments’ to accommodate my diabetes, I have concluded that I also have to make some ‘reasonable adjustments’ to the way I feel about things like this, and any potential embarrassment involved.

In terms of your pump-disconnect plan, personally I think it would be challenging for just an occasional day here or there. Mostly because my diabetes seem to take a few days to adjust and settle into to that sort of change.

I would not recommend it, but when I initially started on pump, I stopped my basal the previous day, and made up the gap with a series of tiny bolus doses spaced apart. If you had a half unit pen, I suppose theoretically you could attempt to cover a few hours‘ worth of missing basal with a mini bolus or two (each acting over 4-5 hours. I’d worry about hypo risk though, as it would be all splurged in chunks, rather than gently trickled in. And in performance terms I see hypos as considerably worse than a potential alarm that no one might hear, and may not go off anyway!

Hope you find a way through this puzzle that works for you.