Need Some Advice, New To Pump

[gobbly2100]

Hey,

I have only been on the pump a month or so, I have been running on 0.9 units an hour and I have been having what I would call perfect control to where I could test my blood no matter when and would always be between 4.5 and 7.5.

The past few days though my numbers are creeping up and hitting a few highs now, I seem to be hitting between 10 and 14 which I don't like.

I feel like I am really high though as I just can't stop peeing.

I put my pump up to 1.2 units an hour but the blood is still creeping up even 4-5 hours after food so I now have it set to 1.5 because am getting frustrated.

Any ideas or suggestions fellow pumpers?

[Funnygrl]

Are you rotating sites enough? How often are you changing your site? What sites are you using? What sets are you using? How old is the insulin?

NEVER jump your basal from 0.9 to 1.2. It seems small, but that's a change of over 7 units over the course of the day. You would have upped your Lantus-or whatever the heck you were on before pumping-dose by 7 units at once, would you?

[BlueSky]

If your blood glucose is still going up after such a big increase, either the insulin is bad or maybe you are getting sick. :o

[Subby]

Yes, more details needed... when was your last set change? It could be just a problem with your current site. And could the insulin be bad? I do find insulin can suddenly lose potency, despite al claims of weeks and months stability etc. Try replacing it ASAP.

[shabbie]

hi gobbly, are you coming down with something?

you can use temporary basal settings on the pump, trying 10% increases until your bg are stable would help you.

(well done on getting a pump btw ;))

[kgm0612]

I have the same thoughts as everyone else. Either Gobbly's coming down with something or needs a site change.

Karen

[fgummett]

Agree: insulin may have lost potency, site may not be as receptive as previous, stress or sickness, and only increase basals slowly with extra testing

[gobbly2100]

Thanks for the replies guys, here are answers to your questions if it helps, I am still fighting going high today so still need some ideas.

Are you rotating sites enough?I change my site every 3 days

What sites are you using?I am using my abdomen

What sets are you using?I use the Paradigm Quick-Sets

How old is the insulin?It is all within a month old as I have not been on the pump long

When was your last set change?This morning

I am due to start on a a complete new bottle of insulin tonight right from the fridge so maybe that will help me sort this problem out.

I have been fighting the highs for the last 3 days and I don't feel ill really, only while I am high it makes me feel a bit rubbish.

[morrisma]

When you pull the site, check the canula before tossing. It may be kinked or otherwise obstructed. If that's the case, you'll know to replace quickly when that happens in future.

I agree with the suggestion to limit changes to basal rates to 10% or less. Also, pumpers often have basal rates that change throughout the day. Mine is high for a few hours before dawn, lower through the morning, a little higher in the afternoon. This was a result of lots of testing and the occasional 3-day cgms.
Good luck,
Mike

[Jan B]

This won't fix everything, but it might help a tiny bit!

I was noticing every other time (approx) I changed my cannula set, my bgs would go up. It was really bothering me. I think I finally figured out what was going on. I think every time I disconnect for a shower I might lose a bit of insulin out of the tubing. However, since I pre "bolus" 20 minutes worth of basal before disconnecting, I was only going high after changing the cannula set.

Make sure your tubing is totally primed before you attach and do the Fixed Prime to fill the cannula. I'd rather "waste" a bit of insulin that go high. A problem I was having was a little insulin coming out of the tubing when I was disconnected (in the shower). Last time I changed the set on my body, I did a fixed prime without attaching and watched for insulin to come out of the tubing . . . not one bit of insulin came out . . . so I did it again and saw some finally come out. Then I attached and did one last fixed prime.

If you continue with quicksets, you might do better with the 9mm instead of 6mm needle length. (The 9's hurt me a bit.)

[Funnygrl]

Quick-sets are well known for infusion problems. I can't think of a single person who has used them successfully. True story. I would ditch those in favor of silhouettes or sure-ts.

I would also rotate sites through more than just your abdomen. I use arms, thighs, abdomen, sides of abdomen, and upper butt.

[Subby]

Good luck. I know how frustrating it can be when it could be 5+ causes, and many of them take a while to work out.

With the insulin. I recieved an entire batch fresh from the chemist that had all lost it's potency somehow. (Not out of date). Wouldn't you know I went camping for 4 days afterwards and the entire time I ran high and felt lousy. eventually deciding it was the insulin. Got back to civilisation, new insulin, and bam in 2 hours it all started working again.

The point to my story, is never ever assume anything about insulin potency, always have options or backups. :) It may not be the problem for you at the moment, but keep it in mind for later. I also prefer buying 3 ml penfils to suck out of because that way much less is unsealed and less to carry out of the fridge (emergency supply).

[fgummett]

Did you see this thread with someone else's experience using Quick-Sets: http://www.diabetesforums.com/forum/pumping-insulin/26564-trying-the-silhouettes.html

[xMenace]

Quick-sets are well known for infusion problems. I can't think of a single person who has used them successfully. True story. I would ditch those in favor of silhouettes or sure-ts.


I agree. If it's the last thre days, it's likely a set problem: scar tissue, bent canula, tennelling, occlusion, or whatever, it just didn't work well. When I get unexplained highs like that, I change sets asap.

[Karnicki]

Hey,

I have only been on the pump a month or so, I have been running on 0.9 units an hour and I have been having what I would call perfect control to where I could test my blood no matter when and would always be between 4.5 and 7.5.

The past few days though my numbers are creeping up and hitting a few highs now, I seem to be hitting between 10 and 14 which I don't like.

I feel like I am really high though as I just can't stop peeing.

I put my pump up to 1.2 units an hour but the blood is still creeping up even 4-5 hours after food so I now have it set to 1.5 because am getting frustrated.

Any ideas or suggestions fellow pumpers?
Being your blood sugars were good in the beginning, I am wondering if you are Bolusing enough insulin to match the carbohydrates you are eating.

[gobbly2100]

Could I already be having absorption issues only a month in to pumping then?

Before pumping I never actually used my abdomen.

EDIT: One thing that has seriously changed is that I am not getting proper sleep lately and I just checked on Google and found the following which could very much possibly explain what is going on:

Inadequate sleep results in changes in glucose control in the body.
Sleep deprivation (lack of sleep) can result in higher blood glucose
levels because of increased production of glucose by the liver.

When sleep is fragmented, there is a release of hormones that can
worsen blood glucose levels. Certain hormones related to stress
may also become elevated, increasing blood glucose levels or
affecting other body functions.

****, I am going to try getting back in to a better sleeping routine if this is the problem.

Thank you for all the posts, it is very much appreciated, I am still open to all your suggestions.

Thanks!

[Funnygrl]

I agree. If it's the last thre days, it's likely a set problem: scar tissue, bent canula, tennelling, occlusion, or whatever, it just didn't work well. When I get unexplained highs like that, I change sets asap.
What type of sets do you use?

[gobbly2100]

I currently use the Paradigm Quick-Sets.

I really am confident now though that it is my sleep that has messed everything up because before my sleep was messed up I had everything calibrated so well.

I hope it is sleep I really do because then I can stop being worried.

[Subby]

Hi gobbly, hope things are starting to get better. Lack of sleep certianly can stuff things up. Get some good sleep 2 nights in a row and if you feel more rested and control improves that may well be a factor for you.

With the absoption issue and whether you could "already" have the problem - the thing is, scarification can be a major cause of absorption issues... but then again, not always. We commonly have parts of the body that may have absorption issues, aside from scarification.

I for one have a few spots around my body where I never injected but I don't have any luck with sets there. They just don't seem to work. Some are particular small areas on my belly. I am considering getting them tatooed so that I can remember them! :)

So in other words be prepared to find some areas that just don't work so well. It could be whole sections (thighs, butt, belly) or just little areas (a couple inches diameter here and there, etc)

[Scarlett]

first thought when i read into the probs-BOLUS!!!!???!!! maybe the ratio needs adjustment

[palefacegirl03]

Quick-sets are well known for infusion problems. I can't think of a single person who has used them successfully. True story. I would ditch those in favor of silhouettes or sure-ts.

I would also rotate sites through more than just your abdomen. I use arms, thighs, abdomen, sides of abdomen, and upper butt.

I have used the quicksets 9mm since I started pumping and I have not had a problem.
I have tried the sils and had two of them come out.
I will stick with the quicksets unless a problem comes up.

[SugarLife]

What I do when I'm going high and can't find the reason, is change the whole pump thing: new insulin, infusion set, cannula and site. If this doesn't work and I know that I haven't changed anything, I contact my diabetes practitioner to adjust the dose together with her. I've been pumping for 7 months now, and I would now not wait for her to say what to do, but suggest something myself that I think would be right and then ask her what she thinks - but the first 3 months I needed her to say what I should do, because I didn't have enough experience with it yet.

[pegasus]

One question, two thoughts:
* Has your activity changed in any way in the last few days? Given the new fineness/subtleties of your options, any minor changes--eating time, office meetings, stress at home--could affect bgs.

* While it's possible that one can do well w/the same basal throughout the day, intuitively to me it seems unlikely over the long run. Have you tried temp basals? Have you tried programming in different basal rates throughout the day? Changing the entire day's basal rate all at once might cause a rebound, which would then make it harder to get your bgs back down. One of the biggest virtues of the pump is the ability to finetune it; I wouldn't take the initial adjustment period as an absolute measure of what your current and future needs might be.

* On insulin potency: one of the minimed tech support people told me that one of the reasons we have to change every 2-3 days (aside from possible skin sensitivity) is that the insulin -- once in the reservoir -- is affected by body temp/heat. So while it may be fine, from a new vial, when you change sets, if you don't change soon enough, it may be affected while you're wearing it.

Good luck!

[gobbly2100]

Well everything that you guys are saying is certainly something to think about if the problem happens again.

I changed all my pump settings while having the problem but now everything is 100% just as it was set before which is crazy.

I did see my nurse to check the sites and she said my sites are all good so she did not think it was that.

I am 99% sure now it was my sleeping as the last couple of days are back to normal and I have been working to get plenty of sleep again within the last 3 days or so.

I did try changing everything such as insulin, quick-set, site etc and that did not work which is why I feel even more sure it was simply the sleeping.

I can't believe how crazy it makes your blood glucose just from not sleeping enough, wow!