Set Change Day

[dtennant9]

I have a few issues every time I change my set and just wondered if anyone else sees a similar trend.

When I change the set it always seems like my BG goes up, like it takes the set a while to warm up. I usually end up having a low later on in the day so its like it catches up with itself.

I see this trend everytime I change and give myself 1.5 units over my intended Bolus for my breakfast after changing, but generally still see an increase over what I would normally expect.

Any help would be appreciated.

 

[himtoo]

I get this exact thing myself.
I started out by setting a temporary basal rate for an hour or 90 minutes on the new set -- but this didn't really seem to have that much effect.

so Now I test every hour for the first 3-4 hours of the new sett and the first sign of a rise of more than 1.5 mmol -- I slap in a 2u pen inject -- this always does the trick -- ok I end up with a mild hypo that is easily treated

I suppose I could set a basal program that increased rates for the morning of set change but I have not got around to doing that as of yet !!

 

[Juicyj]

Hi @dtennant9 - Can you tell us what pump/set you are using ?

 

[dtennant9]

I use the Mio Sets on the Medtronic Paradigm 754

 

[dtennant9]

I get this exact thing myself.
I started out by setting a temporary basal rate for an hour or 90 minutes on the new set -- but this didn't really seem to have that much effect.

so Now I test every hour for the first 3-4 hours of the new sett and the first sign of a rise of more than 1.5 mmol -- I slap in a 2u pen inject -- this always does the trick -- ok I end up with a mild hypo that is easily treated

I suppose I could set a basal program that increased rates for the morning of set change but I have not got around to doing that as of yet !!

I've not tried pen corrections yet, but I did increase my Basal to 125% this morning which did have a bit of an effect.

 

[Snapsy]

I'm sure you'd know if you hadn't done this @dtennant9 , but are you doing a cannula fill with each new cannula? That's what I've found I've forgotten to do when I've gone high unexpectedly after a change.

 

[dtennant9]

I'm sure you'd know if you hadn't done this @dtennant9 , but are you doing a cannula fill with each new cannula? That's what I've found I've forgotten to do when I've gone high unexpectedly after a change.

Yeah I do a 0.3 unit fill for a 6mm cannula.

 

[Snapsy]

Yeah I do a 0.3 unit fill for a 6mm cannula.

Coolio. Perhaps Medtronic cannulas are different, but for my 6mm Insight Flex ones I need to fill with 0.7u.

 

[catapillar]

When changing a pod I avoided the issue by leaving the old pod on for ~6 hrs after starting a new pod.

I've not noticed highs from changing site with Medtronic. I use a 6mm cannula and my DSN set me up to fill the cannula with 0.5 units.

 

[Snapsy]

When changing a pod I avoided the issue by leaving the old pod on for ~6 hrs after starting a new pod.

Oh, I do this too - whatever day I change my cannula I leave my old one in situ until bedtime.

 

[dtennant9]

When changing a pod I avoided the issue by leaving the old pod on for ~6 hrs after starting a new pod.

I've not noticed highs from changing site with Medtronic. I use a 6mm cannula and my DSN set me up to fill the cannula with 0.5 units.

0.3 was just what the hospital told me originally, maybe I need to increase it a bit.

 

[Juicyj]

0.3 was just what the hospital told me originally, maybe I need to increase it a bit.

I use the medtronic 640g and sure-t's I always do a 0.5 fill, I also prime the reservoir too so that there are no bubbles, I never get a high BG reading after a set change doing both these things, sounds like the 0.3 isn't enough for you.

 

[dtennant9]

I use the medtronic 640g and sure-t's I always do a 0.5 fill, I also prime the reservoir too so that there are no bubbles, I never get a high BG reading after a set change doing both these things, sounds like the 0.3 isn't enough for you.

Yeah, I'll maybe try 0.5 when I change again on Thursday.

 

[tigger]

Just to say 0.3 is what medtronic say for 6mm mios. I do it on mine and it works fine. I don't think a 0.2 difference is likely to make as much of a difference as you're describing especially if you're already doing a 1.5 extra with your bolus.What you need to factor in are the following:

1. What time of day you're doing it and if your basal is high or low then?
2. How long you disconnect when doing a set change? (are you calculating the difference? do you need to?)
3. How stressed you get by set changes? (this can raise your levels for a while and then cause a crash when stress goes)
4. Whether you keep your old set in and if it's still giving some insulin at the same time.
5. Amount of air bubbles and whether you're warming insulin before using.
6. Your technique.

3, 5 and 6 may all make a big difference. I think there's someone here who says they have to run 150% basal for a while post set change to deal with the anxiety of doing it. I'm not as bad any more but did have a lot of failed sets at one point which made me very stressed about each change. I still tend to extra bolus just to prove that it's working i.e. if I'm going low it's working.

I tend to do a set change first thing in the morning and keep my old set in until lunchtime. Most of the time providing the set goes in well and the site is fine it works well. I hope this resolves soon for you.

 

[dtennant9]

Just to say 0.3 is what medtronic say for 6mm mios. I do it on mine and it works fine. I don't think a 0.2 difference is likely to make as much of a difference as you're describing especially if you're already doing a 1.5 extra with your bolus.What you need to factor in are the following:

1. What time of day you're doing it and if your basal is high or low then?
2. How long you disconnect when doing a set change? (are you calculating the difference? do you need to?)
3. How stressed you get by set changes? (this can raise your levels for a while and then cause a crash when stress goes)
4. Whether you keep your old set in and if it's still giving some insulin at the same time.
5. Amount of air bubbles and whether you're warming insulin before using.
6. Your technique.

3, 5 and 6 may all make a big difference. I think there's someone here who says they have to run 150% basal for a while post set change to deal with the anxiety of doing it. I'm not as bad any more but did have a lot of failed sets at one point which made me very stressed about each change. I still tend to extra bolus just to prove that it's working i.e. if I'm going low it's working.

I tend to do a set change first thing in the morning and keep my old set in until lunchtime. Most of the time providing the set goes in well and the site is fine it works well. I hope this resolves soon for you.

Yeah I keep the old set in for a while incase there is a real mess up with things.
Insulin is always at room temp when I'm putting it in to the reservoir and I get rid of the air bubbles etc.
I do the set change first thing in the morning before I've had anything to eat.

 

[noblehead]

but I did increase my Basal to 125% this morning which did have a bit of an effect.

How long before the set change did you do the TBR @dtennant9?

I find the same thing happens, I do a bolus around 30 mins before to counteract the bg rise.

 

[Snapsy]

I hadn't realised that set changes had such potential for raised blood glucose! I've been very lucky so far (apart from the two when I forgot to fill the cannula afterwards), but will be eagle-eyed from now on, just in case.

 

[donnellysdogs]

Had crazy rises for 15 hours 9 out of 10 set changes. All started 5 years after pumping. Only thing to bring levels down was pen.
Back to MDI now.

 

[dtennant9]

How long before the set change did you do the TBR @dtennant9?

I find the same thing happens, I do a bolus around 30 mins before to counteract the bg rise.

Just when the set goes in @noblehead
Guess it should be longer.

 

[dtennant9]

Had crazy rises for 15 hours 9 out of 10 set changes. All started 5 years after pumping. Only thing to bring levels down was pen.
Back to MDI now.

I remember reading your posts about this before @donnellysdogs
Hope it is all better now that you are back on MDI