Having lots of highs - back to MDI?

[mwalt2]

Hi. I've had diabetes for 5 years now and have been on an Animas IR1250 pump the last 2 years or so. I've had good A1C's since my initial diagnosis. I think the highest has been 6.1 with most in the low to mid 5's. For the past couple of weeks, I've been having lots of highs (and I'm sure that nice A1C won't be there at my endo appointment next month :mad:). I've been increasing my basals and adjusing my I:C ratio, but I still get the highs.

During the morning and afternoon, my basal used to be .875 U/hr, but now I am up to 1.5 U/hr and it does not seem to help. There have been some mornings where I wake up at a normal blood sugar of ~100 and do not eat breakfast. A few hours later I'll be up to 250 without eating a thing (even after increasing my basal). My total basal is not a little over 30 U/day, when it used to be 19 U/day.

This has been going on too long to be attributed to being sick, having a bad site, insulin (have tried different vials from different lots), etc. The weird thing is that when I bolus using my old humalog pen, the insulin seems to work much better than when I bolus using my pump - more like it used to (even though the insulin in the cartridge is a lot older than the stuff I'm pumping with).

Sorry for the long post, but I thought I'd see if this has ever happened to any other pumpers out there and see if anyone had any advice or opinions. I don't know if the pump sites just don't work anymore (I do rotate across 6 areas and change them every 3 days) or what is going on. At this point, I am thinking of going back to MDI with lantus/humalog. I am trying to get an appointment sooner with my endocrinologist, which of course isn't easy since I'd like to go now and not in 3 months. Thanks.

[Funnygrl]

I really am not a believer in giving up on the pump when control isn't satisfactory, unless it's because of lots of infusion set problems, which I don't think it is in your case. The pump is a better system than MDI, hands down. So, if MDI can work, so can a pump.

I prefer "fixing" the pump system.

Firstly I would try different types of infusion sets. Some feel people absorb insulin better from angled sets, like the Comforts.

Next I would test all basals. Make small changes. It sounds like this is your problem right here. If you test evening basals and are good until a certain point, then when you test to see if your change worked, you only need to test around that certain point.

Then, I would really hone in on carb counting. I would look up everything, weigh stuff, and test carb ratios with known foods.

If all that doesn't work, I would then change carb ratios, one meal at a time.

If you still aren't getting control, I would try a different type of insulin.

And of course, frequent testing and immaculate logging through all of this.

It's a lot of work, but I would be surprised if at some point you didn't get the control back.

I love the book "Think Like a Pancreas" and highly recommend it.

[Dewey]

Funnygrl touched on some very good ideas.

A few other thoughts I'd like to add are:

1. If you've gained weight at all, or are using 90 degree angled sets, try a longer set (i.e. instead of using 6mm, try an 8 or 10mm).

2. If you don't object to taking shots, try doing something like the "untethered regimen," where 75% of your basal is given via injection of long-acting insulin (can either do one shot, or split the dosage in two over the course of a day), and use the pump (fast-acting insulin) for boluses & 25% of the basal. If your sugar levels rise, it may not be as dramatic as (it can be) with only fast-acting insulin.

Just a couple of thoughts. I too, have experienced some more highs lately, but I've gained a little bit of weight. I believe that longer infusion set lengths are needed, but currently, I only have 6mm sets. Next time, I'll order either 8 or 10mm Rapid-Ds.

[mwalt2]

Thanks for the replies. I'm usually pretty good with carb counting and am not making all of the changes all at once. I haven't had any changes in my weight. I did switch to Novolog and am trying that now.

I think I may have jumped the gun this afternoon when I wrote this post. At that time I was pushing up to 380 despite having a correction bolus that did not help. I then checked my site/tubing (1 day old) and saw some blood actually moving up the tube away from my site. I unhooked from the site and primed a little bit to see if any insulin was coming out and there was none :eek: . It was all leaking out of the plunger side of the cartridge and air was bubbling up from the gaskets which are supposed to seal the insulin in (which I found out when I removed it).

Animas is sending me a new box of cartridges and a pre-paid envelope for the remaining one I have from the same lot number as the one that gave me this problem.

[xMenace]

Do you rotate sites?