HELP! High BSL - Absorption issue?

[Estelle_C]

Hi everyone,
I'm desperately seeking help to use the pump successfully.
I have the Accu-check Roche combo. I started it in March 2018, using the Flex-Link insertion set. For three months it worked perfectly and I loved it.
Then suddenly I started getting sky high blood sugar levels, with no explanation. I took out my insertion set, but it wasnt kinked and I couldn't see anything wrong with it.
I tried changing insertion sites, moving to different parts of my body, and changing them more regularly, with no success. I put a thermometer in my fridge to make sure my insulin wasnt going bad - it wasnt. I sent the pump back to the manufacturer for testing - they said it was working fine.
I don't get a skin reaction to the plastic cannula, but decided to test some other options anyway. I tried using the Rapid-D insertion set with a steel cannula, but it made no difference.
I have found the only way to get through these periods of high blood sugar is to increase my basal rate, sometimes by as much as 200%. But this is a slippery slope, as no sooner have I figured out a rate that works, suddenly the requirement changes.. and I'm constantly swinging between high and low.
I have sought advice from three different endocrinologists, a diabetes educator and a GP who both happen to have Type 1. No one has a clue what's wrong. Some suggested I was just failing to make the correct adjustments to my basal and bolus, and that I just wasn't giving myself enough insulin. But when I go back to pen injections, my insulin requirements are the same as what they were when I first started on the pump!
I use novorapid in both the pump and the pens, and it works perfectly in the pens. I've also tried Fiasp, which works in the pens, but hasn't helped resolve my troubles with the pump.
I believe the issue is absorption, but I just cant figure out how to fix it..
I don't understand how this problem started after three months of trouble free pumping, when I didnt do anything differently.
I've had diabetes for 22 years. My control has always been stable, and I've never struggled like this before.
Today I'm trying the TenderLink angled insertion set for the first time and hoping it might give me more consistent absorption..
Is it possible that my body is just rejecting the sets completely?
I'm desperate to find a solution, as I loved the freedom the pump gave me when it worked. I've also been advised that it's the best option if I want to have a baby.
Has any one else had this problem?? Is there a brand or type of insertion set that is known for improved absorption that I could try?
If you have any ideas I would love to hear from you! Thank you in advance!

 

[Chas C]

Hi @Estelle_C I did go through a similar issue as you for maybe a month or so, with the same thoughts, in the end I moved to a longer cannula (10mm ?) which seemed to help. After a while everything returned to normal and I moved back to my 6mm cannula's. I use the nylon sets.

I'd not tried coming off the pump and going back on to pens like you have though.

The only thing I could put it down to was maybe a virus of some kind that I'd not been aware of.

Hope you get sorted soon.

 

[vic hill]

Estella C
wow somebody else that has the same problem as me
yes one blood sugar can be say 8.4 then say before midday snack go up to 20.1 or so on i have same pump go on my 5 th pump this month ..all Acc-chek
now one thing you do not say is what sites do you use to put in needle in , i can only use the steel .
i had to give up the new one which is like a smart phone but i glad i did to slow does not hold battery charge very long AND SOME IDIOT said you can put needles in bottom hence no longer made because well thats another story
when i get a very high or very odd high sugar reading i change line and needle and also do one purge charge 24 mils the another say another 5 ml to MAKE SURE ALL AIR BUBBLES HAVE GONE IN THE LINE ,,AND THE PUMP CARTRIDGE ,,, OK HOLD IT TO DAYLIGHT or very bright light source led if poss to see bubbles ..
now i can only inject in my stomach as arms and legs sites are shot to many old fashion jabs needle way back when needle
were like shotguns tubes now were near as fine as we have today
hope this may be of comfort to you .
62 YEARS ON INSULIN .. PUMPS since 2007 after kidney transplant ..
so key facts steel needle s and do purge line and needle , so no air bubbles ,insulin out of fridge for say oe hour or more also go for the family my dear life is for living

 

[vic hill]

ps my needle length is 6 mm stomach area used only

 

[Estelle_C]

Thanks for your replies @vic hill and @Chas C
I have tried the steel cannula, but no luck.
I also replace the cannula, cartridge and tube immediately whenever I get extraordinarily high BSLs - but even a new set doesn't make difference.
I will try a longer cannula if the angled set doesn't work.. but I'm worried about hitting muscle!
As for the possibility of a virus.. this has been going on for nearly 18 months.. you'd thing a virus would have been picked up by my doctor? I had some blood tests done when the problem started, but nothing showed up.

 

[Chas C]

@Estelle_C I'd kind of guessed from your original message, plus length you've been IDD, that you'd probably tried everything else, not sure if your using 6mm cannula's but definitely try 10mm ones. 18 months is a long time to have to deal with this and I do hope you can find a solution soon.

Are you rotating sites effectively ? always moving and not reusing for a month ?. I do this and even with this if I get a bruise (hit a vein) then this area is not effective for up to two months for me.

 

[Estelle_C]

@Chas C Yes, I rotate my sites around my abdomen and sides, and also the hip area around the back. I don't have issues with absorption when using pens at any site... Which makes me think it must be the insertion set.
I will persevere. Thanks for your suggestions!

 

[vic hill]

Thanks for your replies @vic hill and @Chas C
I have tried the steel cannula, but no luck.
I also replace the cannula, cartridge and tube immediately whenever I get extraordinarily high BSLs - but even a new set doesn't make difference.
I will try a longer cannula if the angled set doesn't work.. but I'm worried about hitting muscle!
As for the possibility of a virus.. this has been going on for nearly 18 months.. you'd thing a virus would have been picked up by my doctor? I had some blood tests done when the problem started, but nothing showed up.

just like to say no comments on air bubbles so i assume you do ok on this issue vic

 

[Ann48]

Estelle_C, I’m not on the same pump as you, I’m on Medtronic 640g , I’ve been experiencing problems with cannulas and high BS. Im about to change to steel tips. I think my problem has been the sites not absorbing insulin, what I have noticed, I can keep doing corrections via the pump to no avail. I was 25.9 last week after a couple of hours of inserting a new cannula,I used 2 units of Humalog via the pen and I came crashing down to 6mmol. I think the insulin is pooling and the pen kick started it. I would also mention I’m now inserting the cannulas on my leg and it seems so far
to be working well! Good Luck! Hope you sort it out quickly.

 

[Chas C]

@Chas C Yes, I rotate my sites around my abdomen and sides, and also the hip area around the back. I don't have issues with absorption when using pens at any site... Which makes me think it must be the insertion set.
I will persevere. Thanks for your suggestions!

Sorry I could not be of any more help, really hope you can find a solution that works for you. Apologies for asking about rotating site but you'd be amazed how many don't .

Last thought, how long are the pen needles that work well - are your cannula needles/teflon same length ?. Also have you tried changing cannula's maybe daily instead of every 2 to 3 days.

 

[vic hill]

are yes sorry i should have said i use disposal syringes to knock down from say 20.00 give 6 units of novorapid i unit to knock down by 2 points so 6 x2 = 12 12 off 20 about 8 after 6 hours
still no reply how any purge insulin before pump goes in to delivery mode thanks vic

 

[Estelle_C]

are yes sorry i should have said i use disposal syringes to knock down from say 20.00 give 6 units of novorapid i unit to knock down by 2 points so 6 x2 = 12 12 off 20 about 8 after 6 hours
still no reply how any purge insulin before pump goes in to delivery mode thanks vic

Yes, I check for air bubbles all the time. I've tried all the obvious things!

 

[Estelle_C]

Sorry I could not be of any more help, really hope you can find a solution that works for you. Apologies for asking about rotating site but you'd be amazed how many don't .

Last thought, how long are the pen needles that work well - are your cannula needles/teflon same length ?. Also have you tried changing cannula's maybe daily instead of every 2 to 3 days.

My pen needles are 4mm... hence why I'm a bit scared of the longer cannulas, but I will give it a go - I've just ordered some.
I don't seem to get better readings when I change cannulas earlier.. most of the time if I'm getting high readings, changing the infusion set and trying a couple of different sites doesn't make any difference.

 

[Estelle_C]

Estelle_C, I’m not on the same pump as you, I’m on Medtronic 640g , I’ve been experiencing problems with cannulas and high BS. Im about to change to steel tips. I think my problem has been the sites not absorbing insulin, what I have noticed, I can keep doing corrections via the pump to no avail. I was 25.9 last week after a couple of hours of inserting a new cannula,I used 2 units of Humalog via the pen and I came crashing down to 6mmol. I think the insulin is pooling and the pen kick started it. I would also mention I’m now inserting the cannulas on my leg and it seems so far
to be working well! Good Luck! Hope you sort it out quickly.

Yes, this is exactly what happens to me!! How often are you experiencing this? I haven't tried my leg because when I was younger I found absorption was poor there... but I will try anything at this point! Good luck with the steel cannulas! Would love to hear how you get on.

 

[Ann48]

Yes, this is exactly what happens to me!! How often are you experiencing this? I haven't tried my leg because when I was younger I found absorption was poor there... but I will try anything at this point! Good luck with the steel cannulas! Would love to hear how you get on.

Estelle_C, with the quick sets a few times, with the Mios a lot, I had to use the pen to do corrections. I’ve switched back to quick sets and they seem okay, as long as their on my leg. I’ve just received the Sur e T’s, so will try them. It might be worth giving your legs a try. I insert them top of my leg. I’ll let you know when I’ve tried the Sure T’s.