Thoughts or suggestions?

[tanyatype1]

Hi guys ~ hoping some of you might be able to help me figure this out......I've been running higher the last couple of days ~ feels like I'm constantly trying to get control of the high bs. Working out in the garden today I started to feel sick to my stomach - checked my blood and the metre read HI. First time that I've seen that! Well I took a blast with my pen (10 units) One unit usually brings me down 3 points. (mmol) Half hour lately the metre still read HI and I was starting to get worried that I'd be making a trip to the ER (which would totally suck of course!) So I tried putting fresh insulin in my pump from a new bottle, and gave myself another 5 units. I came down to 16.5, ate a small salad and took another 2 units. Well my bs is climbing again and I'm getting mad. BTW, I feel totally healthy, I haven't been sick at all, and I just can't think of what might be causing this. Sure I can keep loading up on giant doses of insulin but that's nerve-racking too. What am I missing everyone????

[xMenace]

Is your basal insulin ojk? An old vial maybe?

[Eddy]

I second the notion on questioning basal/pump insulin.

Re corrections:

http://www.diabetesforums.com/forum/diabetes/29567-im-shots-putting-rapid.html

Some of us break the rules and shoot into muscle for faster corrections. I know that it takes me a while to correct from 200... so I can't imagine how long would be needed to fix a 500+ reading.

Any allergic reactions from being outside?

[viranth]

I've been sick recently, first time since I was diagnosed. What I experienced then, was that I could set a lot of insulin and the BG wouldn't go down.

I would check my basal and assume that you are about to get sick, or been sick.

[Subby]

I notice you are on the pump, so this is what I'd do (in order of convenience, really). You've already covered some of this, I'm putting it here to cover everything I can think of:

- Immediately temporarily cut out big amounts of carbs to allow reduced action of insulin to act more effectively. in a bid to avoid DKA.
- Change set, line.
- Try correcting by injection, to see if that works better (this can be a faster, easier diagnosis of bad set than actually changing set and waiting to see if new set might be dodgy, too).
- Change insulin (I for one have had a whole bad batch: if needs be buy fresh insulin from another chemist)
- Put on a temp basal of say 120% for a while, take it easy, make a few adjustment doses down, see if it doesn't "adjust" me back down in some hours. Sometimes (often) my metabolism likes to shift gears away from the good BG zone, especially if I'm doing things out of the ordinary (sleeping alot? gardening a lot? Some stress past few days?) If my BG has been creeping up my body adjusts to the changed "common BG". It's like a small magnet moves towards 15 and my BG gets pulled towards that, rather than falling back lower more easily. I don't know of you get this or your chances that it's this kind of thing, just put here for all possibilities.

Keeping an eye on BG and ketones, ready to go to doctor, if things just can't settle and the effects get worse. Cancel any stress, including driving, work, etc. All will probably spike one further if leaning towards 15. Drink extra water, you'll be getting dehydrated if you are around 15 for long. Keep a little active.

Then, if after a while none of this has worked, I'd probably be getting looked at by a GP to see if there is a sickness encroaching I can't see. For example, I get ear infections I'm not completely aware of for a while, but they impact my BG.

Hope it's coming down, whether by itself or by you adjusting doses. I'll always adjust doses to try and keep in range, it's well worth the extra insulin as if that's what your body needs, that's what your body needs! That's how mr pancreas would do it...

Take care...

[notme]

I find that once my blood sugar has gotten over the top high, correction factors pretty much go out the window. Be very careful of stacking insulin while correcting. You will find that you will crash at some point if you don't keep track of the IOB, then you will be chasing highs and lows. Forget about bolusing with your pump for now and just use injections.

The first thing you need to figure out is why your blood sugar got that high in the first place. Bent cannula? Bad insulin? infection? forgetting to bolus? pump malfunction? I would definitely open a new bottle of insulin and assume your old bottle was bad if you can't figure out the reason for the HI.

One thing you can do to make sure your pump is function is to take it off and run a bolus of a couple of units through it and check the cannula ring for drops of insulin. If there are none, change the set out and try again. If still there are none, call your pump manufacturer. Also check your set for large bubbles in the line.

Good luck. Don't mess with it too long. Call your doctor or go to the ER if you are still high in a few hours.

[xMenace]

I notice you are on the pump, so this is what I'd do (in order of convenience, really). You've already covered some of this, I'm putting it here to cover everything I can think of:

- Immediately temporarily cut out big amounts of carbs to allow reduced action of insulin to act more effectively. in a bid to avoid DKA.
- Change set, line.
- Try correcting by injection, to see if that works better (this can be a faster, easier diagnosis of bad set than actually changing set and waiting to see if new set might be dodgy, too).
- Change insulin (I for one have had a whole bad batch: if needs be buy fresh insulin from another chemist)
- Put on a temp basal of say 120% for a while, take it easy, make a few adjustment doses down, see if it doesn't "adjust" me back down in some hours. Sometimes (often) my metabolism likes to shift gears away from the good BG zone, especially if I'm doing things out of the ordinary (sleeping alot? gardening a lot? Some stress past few days?) If my BG has been creeping up my body adjusts to the changed "common BG". It's like a small magnet moves towards 15 and my BG gets pulled towards that, rather than falling back lower more easily. I don't know of you get this or your chances that it's this kind of thing, just put here for all possibilities.

Keeping an eye on BG and ketones, ready to go to doctor, if things just can't settle and the effects get worse. Cancel any stress, including driving, work, etc. All will probably spike one further if leaning towards 15. Drink extra water, you'll be getting dehydrated if you are around 15 for long. Keep a little active.

Then, if after a while none of this has worked, I'd probably be getting looked at by a GP to see if there is a sickness encroaching I can't see. For example, I get ear infections I'm not completely aware of for a while, but they impact my BG.

Hope it's coming down, whether by itself or by you adjusting doses. I'll always adjust doses to try and keep in range, it's well worth the extra insulin as if that's what your body needs, that's what your body needs! That's how mr pancreas would do it...

Take care...

Good advice.

[poodlebone]

I wish I could help you but I'm having the same problems. For the past week or so I've been needing a lot more insulin. Nothing else has changed - diet, exercise, stress levels are all the same as usual. I've tried changing infusion sets, putting a fresh battery in the pump and I've tried THREE vials of Humalog all from different lot #s. I had just done some basal testing before this all began and that was looking great.

My problem is going high after meals, the same stuff I usually eat. 2 hours might be okay and then it immediately starts to climb.

Also, I go for a walk after lunch every day, usually for about an hour. I had been giving my lunch bolus 100% as a square wave over 3 hours and setting a temp basal. That was working great. Now I'm doing dual wave, no temp basal and sometimes still end up high. Not HI on the meter high, but higher than I should be.

I've increased basal rates, changed I:C ratios, changed every consumable part of the pump. I use a lot of different areas for sets so I'm not overusing the same one or two places.

It also took 4.5 units to correct a morning high of 243 today. Normally 4.5 units would have put my BG at a negative number.

I'm wondering if I should think about trying Novolog or Apidra, but I have never ever had any insulin problems and this all started suddently.

[Subby]

My problem is going high after meals, the same stuff I usually eat. 2 hours might be okay and then it immediately starts to climb.

Also, I go for a walk after lunch every day, usually for about an hour. I had been giving my lunch bolus 100% as a square wave over 3 hours and setting a temp basal. That was working great. Now I'm doing dual wave, no temp basal and sometimes still end up high. Not HI on the meter high, but higher than I should be.


If your BG scenario has just "changed" since your basal testing (no matter how recent), sadly your basal is almost certainly out again now too! Bad timing, sorry for your bad luck... chances are they need to be adjusted again in some way.

If you have specific times that has suddenly become problematic, why not cut to the chase and just basal test (or half test: minimal carbs/bolus), see what happens.

If basals check out I'd concentrate back on the meal/bolus.

You say you increased your lunch time dose? Did you increase to the stage you start to be dipping at 2-3hr rather than climbing? Until then, the course is clear! Insulin needs is insulin needs, whether we understand why or not!

Something for both of you to consider: some people seem to get BG changes based on seasonal changes. Me I put hot weather as causing an increase need of 15% at a guess. Has there been seasonal changes for you lately?

[tanyatype1]

Thanks for your replies! I started to feel really sick to my stomach and had cramps in my back so my hubby took me to the ER. They gave me some Gravol, insulin and fluids by IV and my bg's slowly came down. They didn't know what caused me to go high in the first place ~ no obvious infection etc. I was home by 4 am with a bg of about 10 which is still high for me! A couple hours later I was 17 and throwing up again ~ really driving me nuts now! I did try all the different things that you all suggested before going to the hospital~ new infusion site, new bottle of insulin, checking to make sure the insulin was definately dripping out of the tubing, blasted myself with my pen needle.......well, ya know what the whole bloody problem ended up being????? It was my fresh infusion site from the morning! My old site was a bit sore, and my bg's were elevated - that's why I decided to change my site that morning. My fresh site looked and felt perfect, that's why I assumed that it wouldn't be a site problem. Couldn't believe it! After I was home from the hospital, and my bg's were going up again, I decided just for a last ditch effort before going back to the hospital, (worried that I had some horrible hidden infection or something) that I would change my site again. Well sure enough, the cannula was bent at a 90 degree angle! I was so mad at myself!!!!! Since putting in another fresh site ~ everything's been great again and I woke up this morning at 4.9! Yeah!:) This was my first ER trip since getting D, and I've learned from the experience!

[Subby]

Good to hear in the end alls well. One things for sure, you won't fall into that trap next time. :)

It reminds me of my fun today. Last night my old site/set packed up just before supper is my guess, and I woke up (very late) a nice 20. I got onto a new set but it takes a quite a few hours for sets to start working for me - and of course it was extra slow, this time. So I had the same double whammy, and a really bad day just holding things in check with rapid shots (which are always variable for me too). I need to get a medium acting in the fridge for these situations.

[Mich]

Whew! What an ordeal, Tanya. Great advice from everyone here though! I could only add my personal observation that in summer, the insulin in my pump is pretty ineffective on the third day. I notice it was finally acknowledged by Diabetes Forecast Magazine this issue in the advice column.

Sooo, there's yet another thing to consider if things aren't working correctly.

Ideally, I would change my site every two days, but of course it would require the pre-authorization tap dance with my insurer and my busy doctor's office.

Glad you got to the bottom of it, Tanya.

Mich

[Eddy]

Pardon my naivete about CSII, but I thought that pumps had alarms to indicate when delivery flow was blocked. Or did I misunderstand?

(I'm happy with MDI, but just as interested in picking up more about CSII as I am in learning about type 2. Knowledge is good...)

[Subby]

Sometimes a site becomes innefective, as apart from a no delivery problem. Reasons - bad tissue you've gone into, irritation to the insertion point, probably a range of other factors specific to cannula technology. The practical outcome is that it loses effectiveness and the answer is to replace it with a new set/site.

Some people get these problems with set/sites quite a bit, some occasionally, some not at all. You know the score - it's diabetes!!!