For diabetes caregivers, friends, family members and, of course, T1 AND T2 diabetics, this article regards one of many operational defects involved with having to wear an insulin pump.  Let me [try] to familiarize this phrase for you: “Occlusion Detected.”

Occlusion plainly means “blockage” – something has been blocked. “To close or shut off” is the printed definition in The American Heritage Dictionary.  In this case, the delivery of insulin through the tubing (infusion set) of an insulin pump into a subcutaneous (just beneath the skin) area of the body has been stopped.  The reasons depend upon a number of variables that I will momentarily address.

I began wearing a name brand insulin pump, Disetronic, in 1996.  Much to my dismay, approximately four years later, the Disetronic Company was ‘bought out’ by another insulin pump provider known as AccuChek.  (https://www.accu-chekinsulinpumps.com/ipus/.)  In a state of mourning, I did not want AccuChek.  I was being forced into using their product.  I did not like the aggressive attitude of the sales person whom was assigned to my case.  Therefore, negative plus negative equals zero in my book.  However, because I had a multiple-year warranty contract in existence with Disetronic, I had to get an AccuChek brand, initiating another contract, or purchase one on my own for $5k without medical insurance assistance, or submit to their rules.  I submitted.

The transfer from the usage of one pump to the other was quick.  I learned the machinations of this new pump and smoothly glided along in heels.

After a few years of use, this pump failed.  I did not aggravate it on purpose!  We actually befriended each other, so to speak, and I used it night and day caring for it as directed.  A replacement was sent to me.  Occlusions continued.  And continued.  These repeated occlusions decidedly and ultimately cancelled the contract.  With the immediate assistance of an endocrinologist at the time, the MedtronicMinimed brand and company was highly recommended (http://www.medtronicdiabetes.com/products) and replaced the AccuChek.  The year is 1998.

I conceded with the fact that my medical insurance would pay the expenses.  Initial adjustments went along smoothly, once again.  After all, wearing an insulin pump 24/7 was better than having to physically inject insulin multiple times per day.  Or was it?  Hmm…

Oh, about ten days into wearing this particular pump, one early morning about 7:00am, I was washing my face, getting ready for the day.  Well, a drop of water – a single drop – landed on the pump.  I wiped it off and proceeded with my day.

MANY hours later, just before 10:oopm, my blood sugar was irregularly high for no apparent reason.  I bolused and continued to bolus until 4:00am.  My blood sugar measurements were now past the 400mg/dc mark!  Yes, highly alarming, frightening and sickening.  There was no Occlusion alarm – or any other type of alarm!

Confused and vomitous, I drove myself to the nearby hospital.  I was checked in with ketoacidosis and remained there for four days with the precise goal of stabilizing my blood sugar levels.  (http://en.wikipedia.org/wiki/Diabetic_ketoacidosis.)

In my numerous decades of living with diabetes, I have NEVER had ketoacidosis.  I NEVER want to be in that state again.

While I recuperated in the hospital, my attending physician had expressed alarm at not being able to get through to a MiniMed representative.  He adamantly wanted me to get back on the insulin pump, being familiar with an insulin pumps’ best-diabetes-control-practices.

To shorten this part of the story, this doctor told me that he had to threaten the MiniMed company with a lawsuit in order to get me an immediate (same-day-air) insulin pump delivered to the hospital.  Finally, it was done.  It arrived.  You might have thought it was Christmas in July!   Once he excitedly brought it to me, I knew exactly what to do as he watched me go through the processes of initializing, programming and inserting the infusion set (a stainless steel needle thinner than the stainless steel head of a thumb tack) into my tummy area.  That night, I was watched closely, carefully taken care of and grateful to not only be alive, but especially to the efforts of my attending physician.  I was released that fourth day.

Reviewing all this drama with my endocrinologist, I practically begged him to get me off this thing.  Get me another pump.  I no longer trusted the MiniMed brand name.  Asking me what I preferred, I answered “Disetronic.  I had been on their pump for four years without a problem.  I want to go back.”  “You can’t,” he said.  “They are no longer in business.  You’ll have to use the AccuChek again with their updated model.”

Okay, this scenario didn’t last too long.  I ended up with an Animas model that I utilize to this day – when it works.  You see, in the past 2 1/2 years since I began with this model, it has been replaced 7 – yes, seven – times!  It has occluded at least every three days.  Once it starts there is no stopping it.  Changing the infusion site, nor changing the cartridge, nor changing the battery has helped.  Over and over and over again.  June, 2012, was the last replacement.

All in all, I’ve used four different brands of insulin pumps over the last sixteen years.  Initially paying out-of-pocket for my first insulin pump, the followers were cost-effective and covered through my medical insurance, each with a four-year warranty contract.   That’s all fine and well for the company, but it screws up my mind, body and routine horribly when such chaos strikes. You see, without the pump, I have to resort to six injections per day, the same time every day, using two different insulins – a short acting type and a long acting one – in order to maintain my life.  I have since learned to travel with these insulins whether I am attached to the pump or not.   It is my “Plan B,” my emergency back-up plan.

The insulin vials with syringes are packed in a cooler of ice along with juices and crackers. I am no longer shy about bringing the cooler with me wherever I need to be, conducting business as usual.  My blood sugar readings tell me what I need to do: take insulin or get juice.  I test my blood sugar 8 – 10 times a day. Discretion is always used.

For instance, recently re-attaching myself and wearing the thing for three days, after being without the pump for three weeks due to my bad attitude that leads to depression and awaiting replacement product from the company, the pump is presently alarming once again with a reading “Occlusion, Occlusion.” This means the insulin is stuck and can’t deliver through the tubing (aka: infusion set). Such instances ALWAYS happen in the wee hours of any morning or during a speaking engagement. It happened yesterday afternoon at a book signing. The alarm is LOUD and attracts attention! Alas, fatigue, depression, no energy, ho-hum, bad attitude.

When in public, I discreetly excuse myself, go into the restroom – or my car – and fix the situation. Fixing entails one of three decisive procedures: either (a.) “priming” the pump (pressing one of the buttons to pass about 10 units of insulin through the tubing to clear it) or (b.) removing, then re-attaching the infusion set to another body site or (c.) completely removing the darn thing and resorting to injections.

It’s a machine. I am a cyborg and take care of it and me as time and circumstances avail. Ugh. Often embarrassing and often uncomfortable.

Contacting the various company(ies) about problems has been frustrating. You see, the technicians on the other end of the line ALWAYS blame me for the machines’ malfunctions.  Either I didn’t tighten the screw heads on one end or the other, or I put in the wrong battery, or I didn’t expirate the cartridge, or (and this is the best one that I have repeatedly been told) “you have too much scar tissue.” Duh.  No kidding.  I’ve been diabetic for 53 – yes, fifty-three – years!

The variables are non-stop.

2012 – Please pray for a cure.  This expensive disease is chronic, baffling and tiring.

Truly, A. . Buckroth (at Amazon.com).

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