HIGHS after changing set. ? .

[ultrafine]

Hi Friends,

I'm having some pump problems and was wondering if anyone can give me some advice.

After I change my set, I am running into highs. I don't know why. It raises about 7-10 mmols :eek: . So I end up giving myself a correction bolus, wait, test blood, still high (not going down but going up), change set again, test blood, check keytones, give myself a maual bolus, keep drinking sugar-free liquids and keep on testing until sugars are normal. (It takes about 6 hours until my sugars are normal).
The insulin in the reservoir is the same insulin that I use for the maual which is taken from the same vial. I know that the insulin is good because when I do the maual, it brings my sugars down.
After my sugars are normal everything is fine for the next few days, until the next set change.
I make sure that the luer lock is connected right, all the air bubbles are gone, prime (no air bubbles), fixed prime and check for kinks in the tubing.
Also, the cannula, when I take it out is never bent and when i pull the needle out it comes out straight and clean.

I'm in a pickle...Why does this happen? Help~! :confused:

[Jan B]

This was happening to me too, but not anymore. Now I just automatically add an extra 1 1/2 unit every time (for me, that would be 24 carbs!), immediately after changing sets & it has been working well. Strange, huh!

[fgummett]

At a pump club I attended one person suggested that they leave the "old" infusion set in for an hour or two after the change over, to combat this behaviour.

[Richard157]

What is your BG immediately before you remove the old set? If you are experiencing the beginning stages at that time then that is what frequently happens to me and several of my friends. You and I and my friends are all using the MM 522. To keep this from happening I have started changing sets with 10 or more units of insulin still remaining in the pump/tubing. I am no longer having a problem.

[solox316]

At a pump club I attended one person suggested that they leave the "old" infusion set in for an hour or two after the change over, to combat this behaviour.

I do this all the time, especially if a bolus was given in the last hour or so...

Not sure what else to suggest, other than the latest post about changing the set with a decent amount in the reservoir... air bubbles tend to exist more nearing the end of a reservoir. so it might have more to do with your old cartridge/set than the new one..

Or be sure to get a good half dozen drops from the new infusion set before inserting... My 23" quickets, I prime 12 or more units, but get my first drop at 9 units...

[ultrafine]

Thanks Friends for the reply!

Yes, it is very strange! :confused:
I think I will try leaving the old set in for a while and see if it will help. If not I will try adding extra units. :)
As for bubbles in my reservoir, I dont notice any. I fill my reservoir with around 1.2u and I still have about .3u left when I change it. :T
These are all very good suggestions and I thank you all very much! My next set change is on Monday, I will keep you all posted on what happens. :D

Hope you all have a wonderful weekend!

[duck]

At a pump club I attended one person suggested that they leave the "old" infusion set in for an hour or two after the change over, to combat this behaviour.

Agreed...we discussed this same issue here on this forum years ago, and a couple of us who never removed the old set at the same time as putting in the new set never went inexplicably high (I leave the old one in just in case the new one has some issue).

Anyway, I have no good reason why this is, just that it is. And yes, I have been able to reproduce the "remove the old set immediately" high on a few occasions. Weirdness.

[xucub]

Assuming no air bubbles, assuming you are priming the pump until you see drops of insulin - the problem could be scar tissue. I have had this issue for years, and the nurse practitioner and I have decided that we would do a fixed prime of 2 units after the new set was placed. I wait about an hour and if BG is rising, I go ahead and do another 2 units. Sometimes I have to prime up to six units to get the tissue good and saturated. Occasionally, the 2 unit bolus/prime gets me in trouble (low BG), so you might want to use this system but start with a lower fixed prime until you determine what works best for you.

[Subby]

Hi Ultrafine, I find this too, gotta say it is a lot less pronounced in the Sillhouettes than the quicksets for me. So bear in mind there may be differences between set type.

I usually squirt in enough to cover 2 or 3 hours of basal into my old set first, really reducing the immediate spike (some very small snacking over that time stops a hypo, and this metabolic "hum along" situation is far better than effectively "no delivery").

The best discovery I made was to really think about what time of day, what the situation is, when I change my set. A couple things I think about:
- Are my BG in a really good range? If high, and it's not the actual set that's the problem, I will correct and defer until at a good spot.
- Are there any major boluses coming up? Just say I was going to have a large carbs lunch in an hour or two. This is not a good time to change set. UNLESS you can bolus now through your old set, then put the pump over to the new one. Then it may be a good 5 hours before a sizable bolus is likely to be required, and the set may be kicking in by then. Perfect.
-maybe, like me, you have periods of high resistance, high basal, etc. Another good time to just stick with the working old set until the tide has turned.

Of course we have to have our own approach to when to change, and there may be certain times of day etc it's the most convenient. The question to be juggled is what is most convenient for you in each situation, if you factor in the big spike as a matter of convenience. For me, putting up with a slightly painful set (that still works) or having to excuse myself at work, in order to pick a good time to change, far outweighs going high as I wait for a new set to kick in.

[AJ21]

hmmm this is really interesting...
i've noticed I have this sometimes as well when i switch spots....
I also spoke to someone at medtronic and they told me that if it still 'hurts' after 5 minutes, it means you shot the needle into muscle and you should take it out.
I just figured maybe my first bolus was going into some form of fat and taking forever to finally go into my blood stream...
thanks for the suggestions - i also insert and take out as soon as it starts to work and not block.

[pegasus]

The best discovery I made was to really think about what time of day, what the situation is, when I change my set. A couple things I think about:
- Are my BG in a really good range? If high, and it's not the actual set that's the problem, I will correct and defer until at a good spot.
- Are there any major boluses coming up? Just say I was going to have a large carbs lunch in an hour or two. This is not a good time to change set. UNLESS you can bolus now through your old set, then put the pump over to the new one. Then it may be a good 5 hours before a sizable bolus is likely to be required, and the set may be kicking in by then. Perfect.
-maybe, like me, you have periods of high resistance, high basal, etc. Another good time to just stick with the working old set until the tide has turned.


An added thought to this list is, are you approaching a change in basal rate from a higher one to a lower one?

[ultrafine]

Hello Friends!

Earlier this morning I changed my set. I decided to leave the old set in and see what would happen to my sugars. An hour after changing my set I tested my blood. It was 7.0 mmol!YaY!:D It worked! :T
Thank you all very much for the responses! :)
I greatly appreciate it!

[RobiJo]

When I was initially trained to use my old Disetronic pump I was taught to prime the insertion set 1u after pulling out the insertion needle. I was never told to do this with my Minimed, however I still do 1u right after I put the new set in. The needle is taking up space and once removed that space should be filled with insulin. Otherwise you are without insulin for however long 1u would take.... If I forget to prime it, I go high within an hour.

[solox316]

When I was initially trained to use my old Disetronic pump I was taught to prime the insertion set 1u after pulling out the insertion needle.

My first Minimed, 507c they told me to do the fixed prime... the Cozmo they didn't (but they were the same quick-sets anyway...) and they totally stressed remembering to do it with my 722 pump start.

I never thought to ask that question... this can be anywhere from like .4 units and up if forgotten, a good cause to go higher.