Levels 25.8 plus Ketones +4

[donnellysdogs]

With a pump (or mdi) you should be able to get normal levels within 5 hours.

To me the fact that this wasnt possible indicates that you may need a check list or something was missing. Did you go back to MDI after first correction didnt work?

You do not want to end up with dka from pump.... this to me is the concern here.

I had many trials of pumps and failures and never had levels of 4 with ketones.

I think you need to check out with Dsn and Accuchek that everything was done in correct order etc.

 

[Tony337]

I am so glad you are on the mend.......

Tony

 

[Tracyann35]

You said you changed your set, did you also get your insulin from a different vial? Sometimes even the replacement set fails, so it is, on occasion, a case of keep changing 3 or 4 times but I have had insulin "fail" on me a couple of times now in recent months.

I am on this insulin

 

[Tracyann35]

I didn't use Mdi maybe I should have, managed to get hold of my DSN she's suggested maybe coming off pump but reason they put me on it was because of my liver pushing out high levels in the early hours so I don't know!

 

[Tracyann35]

Also there could be an absorption problem going to hospital this afternoon to see what they say

 

[paulliljeros]

I am on this insulin

Is it possible the insulin you are using has gone off? A bad batch, or spoilt whilst out of the fridge, or become too cold whilst in the fridge. I have had insulin that has been fine for the first 24 hours, and then just lost its potency. Its not happened often, but it has happened.

 

[donnellysdogs]

If you are having liver dump then this is manageable and is the actual best method to manage liver dump. Just needs your basal rates set up correctly. Nurses dont always know the best for this to be honest.. or at least thats my experience.

I will load a picture up just recently used in a different post, so excuse all the detail in it. You can see how I had to hugely increase my doses for liver dump. This day pump had an occlusion so levels jumped because of that.

If absorption isnt good then this too can be managed. However, I am the only peeson I know that my skin actually stops any insulin going through for 15 hours and tgen it coukd pump through and still get an occlusion 36 hours in... as in example photo..

You need to identify whether its foods, or even your acting time being wrong. They normally set you up to 4 hours but this is now being recognised as not being long enough for some...

Have you got a cgm or libre?

Whatever is happening with your body... it is not being handled correctly when you have a high... you should be advised when levels are above xx to give a little more bolus to correct. To swop everything or be able to identify problem but you must correct by pen if pump does not bring you down. Your levels should be near target within 5 hours.. not before.. but should not still be high longer than 10hours unless you may have an illness..

 

[Tracyann35]

Ok thank you maybe Insulin was off. at hospital waiting to see DSN so will see what she says

 

[Tracyann35]

So have seen DSN a lot of my insulin sites are blocked! So need to change that to see if it helps and meeting with Rep from Roche to go through pump with her. They are going to check my carb ratios as well. Thanks for everyone's help!!!! Xxx

 

[donnellysdogs]

My skin blocks cannulas... and this was reason I had to come off pump. It took 5 years for this to suddenly happen to me. Tried Accuchek combo, insight and medtronic. All sets the same.

Are you using steel cannulas?

Glad you saw DSN. Accuchek are good and there is one superb chap there that is now Manager and he saw me thru hell to try and help me. But in end I went back to MDI.

Now, I prefer it although I loved pump at the time.

Normally if skin blocks you would get highs for about 15 hours (or more or less) after a set change and no amount of set changes or insulin or extra bolus will bring levels down... The only thing that would bring my levels down was a jab... and that tgen could be too much or too little because you dont know how much insulin has managed to seep thru if any....

I so hope that change if area or length of set may help you.

If you are battling set change highs altering carb ratios may not work either as one day your body is fighting insulin getting thru and the next day its settled a bit.

I so hope that this can be resolved.

I know people said to me so many alternative sudeway cannulas/longer/plastic etc but the problem is my skin.

 

[LizzieNI]

My skin blocks cannulas... and this was reason I had to come off pump. It took 5 years for this to suddenly happen to me. Tried Accuchek combo, insight and medtronic. All sets the same.

Are you using steel cannulas?

Glad you saw DSN. Accuchek are good and there is one superb chap there that is now Manager and he saw me thru hell to try and help me. But in end I went back to MDI.

Now, I prefer it although I loved pump at the time.

Normally if skin blocks you would get highs for about 15 hours (or more or less) after a set change and no amount of set changes or insulin or extra bolus will bring levels down... The only thing that would bring my levels down was a jab... and that tgen could be too much or too little because you dont know how much insulin has managed to seep thru if any....

I so hope that change if area or length of set may help you.

If you are battling set change highs altering carb ratios may not work either as one day your body is fighting insulin getting thru and the next day its settled a bit.

I so hope that this can be resolved.

I know people said to me so many alternative sudeway cannulas/longer/plastic etc but the problem is my skin.

So interesting Donnelly's dogs. I have ketones and high BG at the mo and have switched sites and it seems to be coming down. I was hospitalised in July for an unknown cause DKA, but I've just realised it was the same area as today. Will have to avoid it. It's worrying as I switched to pump as insulin wasn't getting through on MDI. Hope they reignite the insulin inhaler research....

Sent from my G7-L01 using Diabetes.co.uk Forum mobile app

 

[donnellysdogs]

So interesting Donnelly's dogs. I have ketones and high BG at the mo and have switched sites and it seems to be coming down. I was hospitalised in July for an unknown cause DKA, but I've just realised it was the same area as today. Will have to avoid it. It's worrying as I switched to pump as insulin wasn't getting through on MDI. Hope they reignite the insulin inhaler research....

Sent from my G7-L01 using Diabetes.co.uk Forum mobile app

For me when my levels rose so sugnificantly from skin blocking cannulas the only way to bring levels down was to use an mdi pen.

However, this can cause problems.. one because you dont know exactly how much insulin (if any had gone in) and if over 12 in my case I need to give a lot extra...

I would ensure that you monitor after every set change without fail and more closely for first 3 hours.. good if you have a libre or cgm...

If normal set changes are good then if you see a sugnificant rise within 3 hours you need to discuss with DSN when to do a set change or to have a shot by injection..

The trouble is if you do an injection to quick and the set is working but you have stress etc the injection could cause a low.

Also if you are doing set changesbin the morning and you have DP then this until you get your DP sorted could also show a false thinking that its your set.

Were you using your stomach? Even though I havent given injections in stomach more than a couple dozen times in 30 years... sets and injections have neverbworked there. Bum cheeks were brilliant but I guess they eventually filed after 30+ years. I only inject in my legs now. My legs would bleed chronic with sets, blood would run down to my ankles...so not ysable for sets.

I'm concerned that you are still having DP and also doing set changes at that time.

You may also find with DP and pumps that if you have a lie in that you need a separate basal rate for lie ins and you would need to put this on the nught before.

I know they say not to do set changes at nught and I agree if you are getting admittance and high levels and DKA so the first thig to really address is getting your basal rates right to counteract the DP to enable better set changes.

Keep in contact and let us know how you are getting on... xx

 

[LizzieNI]

Thanks DD that's a lot of info, I'll process it and take your advice. Thanks so much. Xx

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[donnellysdogs]

Thanks DD that's a lot of info, I'll process it and take your advice. Thanks so much. Xx

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Only advice.... you can take it, leave it, adapt it.. its just my experiences.... but I hope you can find a way to get improvements..

Wishing you the best... xx

 

[LizzieNI]

Thanks DD. Xx

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[mark4785]

Please don't take this the wrong way but you need to get off your computer and go and run round the block or walk depending on your fitness levels.......
Perhaps I should say that is what I would do in your unfortunate position........

Not being rude

Tony

With elevated ketones you don't want to be telling somebody to run as they will be severely dehydrated and breathlessness and there will be a risk of ketoacidosis. If you are +4 for ketones with hyperglycaemia and are breathless you should call for an ambulance immediately. This is the advice I'm given by my Diabetes Nurse.

 

[donnellysdogs]

Thanks DD that's a lot of info, I'll process it and take your advice. Thanks so much. Xx

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