Panic

[Hazza]

I was at work this afternoon when I got a phone call from my wife. She was in a right panic. She had given Lily her tea at 5pm and she had crusty bread and roast chicken, followed by a Cornetto which is pretty usual stuff that she has had many times and then some cherries. Her BG was 9.8, a little high, anyway she gave her a bolus of 8.5 units which covers the 85 grams of carbs she was going to eat. Not a problem so far, but when she checked her BG at 8pm she was 30.6 . :shock:
I suggested that she give her 3 units correction as 1 unit wil bring her down about 8 points allowing for some insulin still on board.
I left work early and changed her cannula as soon as I got home in case of a problem with the site. She normally goes 3 days between changes with no problems but I think that 2 may be better for her if this is going to be a trend. I checked her at 9pm and she had started to come down and was 23.3 still high but at least it was going in the right direction. I will check her again before I go to bed at around 12 and see how she is then. Fingers crossed.
Her mum was really upset and is blaming herself for doing something wrong, but today was no different to most other days.
Just wanted to get it off my chest, thanks for listening.

Harry

 

[iHs]

Hello Harry

With a bg level of 30.6 I wouldn't bother with the pump at all and use an insulin pen instead. Reason being a pen you can trust to deliver insulin, a pump can sometimes develop problems.

If you are using an Accu chek Combo and Flexlink Plus sets, change them every 2 days if you start to see a trend of bg levels starting to elevate. Think about trying out the Rapid D Link 6mm set. It's much better than the Flexlink or Flexlink Plus although you do need to insert it without the Link Assist.

 

[ruralweb]

Our daughter can show the same ie really high readings for no apparent reason. We have tracked some of them down to her teeth coming through which seem to act like a switch that sends her into the 20s. We usually put on a 200% temp basal on her pump and give her a large correction - she can need this for several days at a time.

Over the last year using the pump I have discovered that there is no final solution and you need to make small changes almost daily. DONT blame yourself for the highs/lows just treat them and move on.

 

[Hazza]

Thanks for the replies, I tested her at 12pm and she had come down to 14.4 so we were heading in the right direction. When she got up for school at 7am this morning she was back to 4.7 so we were well pleased. I hope that the site change was the culprit. She has woken up for the past 3 mornings now at 4.7... maybe just coincidence.
Using a pen when she is so high sounds like a good idea but when you are in a panic you don't think straight. I will certainly remember that in future though.
I never thought of increasing her basal rate temporarily, that also makes sense now.
We are using the flexlink plus 6mm cannulas and still have a few left but we will certainly look into the other options when we order some more.
Thanks for all the suggestions it is very much appreciated.

Harry

 

[ruralweb]

Using a pen when she is so high sounds like a good idea

TBH we try and avoid this and work with the pump. The reason is that unless you know 100% that the cannula is blocked ie the pump is alarming to tell you its blocked then you can very easily give an overdose of insulin as the pump may have been delivering ok and its just the fact that the readings are high due to something else.

Ive found that a temp basal or new profile work best as you can gradually increase it until BGs start to drop and then back off if needed - this gives you a great deal of control especially if you have CGM and can see in real time what is happening. With a pen you will need to give quite a large dose which is a guess and then the effects are delayed or rapid especially if the pump has been working.

As you say it always happens when you are very tired but being high for a few hours is not the ned of the world what is worse IMO is giving too much insulin and going too low to recover easily.

 

[iHs]

The Spirit Combo unfortunately is prone to give off E4 occlusion warnings but sometimes it can take quite a few hours of non delivery of insulin and bg level going higher and higher for the E4 to start warning. A bg of 30.6 is extremely high and I wouldn't want to wait to see if the pump was working ok or not. I'd rather just use an insulin pen and tell the pump through the handset that I was using a pen and then keep testing to see how my bg levels were dropping and then use the pump to deliver a bolus when my bg levels were ok again.

 

[donnellysdogs]

Harry

Don't be in a rush to blame 'sites' for issues.....I and others have had problems with accuchek flexilink plus and flexilink sets and connectors. I sent a batch of sets back to accuchek as they were causing me to have high's. I also know others doing this too.

I found that if I have had a 'bad site' then I felt it straight away, either when I put it in, or when I moved, or when I did the first bolus. I would either find blood coming out or the cannula bent. I knew this immediately.

I personally don't like to go back to pens when I have hi's, as then I haven't found out what the problem is. If I had done this, I would have blamed bad basals or bolus's, but I was able to establish that it was none of these, but everytime I had put in a new specific set from a particular batch.

Very hard for a parent to know what to do in instances like this. I do sympathise with you having such highs to try and manage for your daughter, as you only want to do waht is best for her.

Me personally, I would try to get some samples of the rapid d sets from Accuchek. I agree with iHS that they are much better than accuchek other sets. They have to be put in manually, but they do not bend, and their connectors are superior to that of the other sets.

Hope that levels being able to stabilise at lower rates for you all....
Sharon

 

[Hazza]

It's so difficult to know what to do for the best sometimes.
Since we have changed her set she has been much better with numbers like 4.7 this morning and 4.8 at dinner time. Then when she came home from school she was 3.3 so her mum gave her a glucose tablet and a biscuit and by 5 oclock she was in the 12s. It really is hard to get these things right sometimes, but we will not be beaten. :? Mum has just phoned me at work to say that she is 6.0 at 8pm so looking good .... Fingers crossed.

Thanks for all the help

Harry

 

[iHs]

I'm glad Lilly is ok again Harry.

Sometimes problems can arise because of the infusion set and sometimes because of eating food that sends bg levels way too high or low even though we think we've bolused correctly according to the carb info on packaging.

Cornetto is fairly high I think in carb and I would imagine that a slice of crusty bread is hard to determine the exact carb value because it has been cut off a loaf.

You might be better to give Cornetto a miss and just use yogurt pot size icecream (screwballs) with some sugarfree chocolate or strawberry sauce or eat the icecream inside the Cornetto but leave the cornet.

Good luck with the pump and keep an eye out for high bg levels for no real obvious reasons.

 

[Hazza]

Thankyou all for the support that you give. It really helps to know that advice and help are always there and that others are willing to share their experience and pass on knowledge that has been gained.
I really don't feel qualified to offer others advice and admit that I hold back from some of the forum topics. I will however offer any support to anyone newly diagnosed as I understand exactly what they are going through. I may not be diabetic myself but as a parent you live through what your child does, and learn all sorts of things along the way.
So, again, a big thankyou for being here, and long may it continue.

Off to check on Lily again now,...

Harry

 

[donnellysdogs]

Harry

Already you have managed to bring Lily's levels down to good levels with a few hiccups, but honestly I think you are doing fantastically and must give yourself, your wife and Lily some credit for achieving this, over Christmas especially.

I think there are a number of us with 1st time Christmas experiences this year with a few blips in our levels. What we learn this year will be great experience for future parties, Easter, and next Christmas!!! By then we will really be used to the mechanics of the pumps and our bodies.....

Give yourself credit and praise Harry. You are managing fantastically.

And thanks to iHS for screwball treats!!!!!(May well try her suggestions!!!!)

Have a great New Year Harry....and take some credit....
Sharon

 

[Verve09]

Harry,

First of all, as a pump user myself, I know how tricky it can be to get things 100% right all the time. And then to get a random 30 on the blood glucose monitor it can really shake you up. Even though it's horrible and you can spend ages blaming yoursel,f I don't think there is much benefit in feeling guilty or bad about this for too long. You, your wife and Lily will always be learning about diabetes. Easier said than done, but try to view everything as part of the learning experience. Try to remember all the good things you can take on board. In this instance - changing cannula sites more often, experimenting with different kinds of icecream, using the pens if you feel the pump isn't working quite right...

After your corrections, to wake up with a 4.7 is fantastic.
Good luck and well done!

 

[Hazza]

Thanks Verve09, we still get the odd high number, mid teens, but they can mostly be explained with snacking at friends and not knowing the proper carb values. We tend to err on the side of caution and correct when we next test her. It seems to be working so far.
Weekends are the most difficult as there is less structure to meal times.
Sharon, thanks for the thumbs up, it is still early days and changing her site every 2 days seems to be working better. How was your new year? I hope you didn't overdo it too much

Harry

 

[sugar2]

Hi Harry,

Liek Sharon says, you and your wife are doing a fantastic job, helping Lily with her pump...please coudl you look after me too?

Seriously, I don't think any of us can claim perfection...certainly not me, and the the thing I still do wrong, eben after being diabetic for years, is to overtreat hypos. The sane, none low me, know that I really only need about 7 g of carbs to bring my levels back up to 5 (my target)...but can I stop there? No! I have to stuff my face, mistaking amount with speed. It is something to watch out for perhaps with Lily?

We are all stil learning

 

[donnellysdogs]

My treats are when I am hypo, and also I like to treat my hypo's fast, so I actually like to overdose on the treats....not all the time, just occasionally I do want to stuff my face when hypo!!!! Same as Sugar2, but good to know I'm not the only one!!!

 

[Hazza]

Lily would love to be hypo all the time.
We got an E4 occlusion error at lunch time (still at school). The teacher is going to test her at 2 and let me know the result, then we will decide if we need to change everything straight away or wether it can wait till she gets home. I disconnected and primed the pump then reconnected and gave the bolus, it all seemed OK but she is due for a change today anyway.

Harry

 

[donnellysdogs]

Oh gosh Harry, E4 occlusions are quite hard to establish the reason for them. Accuchek advised me to change everything including the battery in the pump and all the connectors, although it doesn't say (I don't think), to do all of that in the training manual.

Myself and another person I know has also had a fiar share of occlusions recently, my most recent one whilst my mum on her first night staying with me when I did my evening meal bolus with all of us sat around at the table....it beeped at me 3 times telling me I had an occlusion. I turned all 3 warnings off, checked just my tubing was right, and it was and did another bolus without changing anything and it worked perfectly and continued to do so till the 4th day when I had to do a cartridge change.

Other times, my levels had gone up really high prior to the occlusion warning, and I have had to change everything.....and I have never found out the reasons for the occlusions!!!! Only that it wasn't due to a bad site.

It is really worrying when they occur, especially when you don't know the reasons for them occuring.
There are other accuchek combo users here, that may be able to give help on what they have found has caused their occlusions, but mine have really stumped me. I had 4 months without one, and then a month when they kept occuring.

You did the right thing. It sounds like you also have a great teacher too!! Bit worrying for Lily when her pump suddenly starts alarming in school! I hope her fellow classmates understood and that Lily handled it okay. What a worry!!!

Let us know how she got on....

 

[Hazza]

Well, teacher checked her at 2 oclock and she wad 5.9, then Lily had an after school club so the teacher checked her again at 3.20 and she was 6.5.
She had a biscuit and some juice and was given 0.3 units to cover it and when we checked her at tea time she was 4.8. The whole set was changed as it was due to be, and everything seems back to normal.
Her teacher is fantastic and is very aware that Lily will need to be checked from time to time and has no problem with this. I would trust her to do the right thing and she knows that we are only at the end of the phone and she rings us if she has any questions or is unsure about something.
I know that some schools are not so good but I have nothing but praise for the one that Lily attends. It may well be a different matter when she goes to the senior school but she will be more capable herself by then although she is a very quiet and shy girl. She also has a friend who looks out for her who is in the same class. They have been close friends for about 4 years now and I hope that it continues.

Harry

 

[jopar]

One of the first things I check if I get an Occlusion, is there anything pressing against the infusion set! As waistbands etc pressing against the infusion set can cause and occlusions..

If not then I disconect, set about 3 units and see if anything is going through if it is, next cause of action if eating is reconnect and bolus for my food, see if it alarms if it does then I need to change the infusion set only..

Always check if you've changed the infusion set then check the canular to see if it bent? As it may have been sat against the muscle etc...

If I'm near the end of a cartridge I change it at the same time to rule out any blocking of the insulin...

If you are statified that you don't need to change the infusions set or tubing, it is advisable to do some etc checks to ensure that insulin is still getting through and BG's are rising..

 

[donnellysdogs]

Wow Harry, got to say you have got Lily's levels managed so well, so quickly.

It is so lovely to hear that she has such a fantastic teacher and also best friend. THat will help her enormously, especially good that the teacher has learnt so much about the levels to achieve and how to get them. Got to say again, be **** proud of yourselves.

You are a credit, and soon enough you will be giving us and other parents of pumpers your advice on how you achieved this so quickly.

Jopars advice on cheking for causes of occlusions was good, some of which I had forgot that I do.

Fantastic that Lily's levels returned to a good stabiulity so quickly, more so that after the occlusion there wasn't a panic to over bolus and then go hypo.....

What a lovely teacher to have...