High BG after set change.

[Bobr17]

Hi all,.first question if anyone could throw some.light on my problem,.that would be great thank you
I have a Medtronic 640 pump currently and am my 4th pump I recall and have always had this issue. When I do a set change I follow instructions and rid the reservoir and tube of bubbles and fill 2 units of insulin ( 1 more than recommended), however 9 times out of 10 my BG can go well into late teens for 3 to 4 hours? If I correct I always come crashing down to Hypo and sometimes will have 2 after this 3 to 4 hour period. I have spoke with Medtronic but have had different cannula prescribed but, this has no change of outcome?
Any help would be appreciated.
Regards RR.

 

[sleepster]

Hi @Bobr17, are you taking a long time to change your set?
When you say you rid the tube of bubbles and fill 2 units of insulin, I'm not sure what you mean, when I fill the tubing it takes 5-6 units for the 60cm tubing, I don't recall exactly (I accidently ordered 80cm tubing last time and that takes nearly 9 units) and then I fill the cannula with the 0.3u needed for the cannula I use. Where has the 1 unit recommendation come from? Apologies if I'm just not understanding correctly or if that's what's recommended for the tubing or cannula you use.

 

[Bobr17]

Hi Sleepster,
Thank you for your reply.
I fill the Cannula with 2 units and I would say I fill the tubing with up to 10 units approximately?
My Diabetes team believe it could be trauma of the set change, and an addrenelin rush giving me the spike in BG afterwards?
It's a shame I get this but I set change every 3 days and ruins a decent BG performance?
Thanks BobR17.

 

[Bobr17]

Hi Sleepster,

I also take a couple of minutes to do a set change?
Thanks again,
Bobr17.

 

[sleepster]

Ah that's quite the puzzle then. Do you think it's the adrenaline? Do you get symptoms that suggest that's what it is, sweating, shaking, anything like that?
Could you try inserting the new cannula before you change the reservoir etc and see if that makes a difference? So you'll have the cannula in your skin for a little while before disconnecting from the old cannula, rewinding the pump etc, might be worth a go if you haven't tried that already, as I'm assuming that's where the trauma part comes in and you don't have a needle phobia or anything like that?

 

[Talo]

Hi all,.first question if anyone could throw some.light on my problem,.that would be great thank you
I have a Medtronic 640 pump currently and am my 4th pump I recall and have always had this issue. When I do a set change I follow instructions and rid the reservoir and tube of bubbles and fill 2 units of insulin ( 1 more than recommended), however 9 times out of 10 my BG can go well into late teens for 3 to 4 hours? If I correct I always come crashing down to Hypo and sometimes will have 2 after this 3 to 4 hour period. I have spoke with Medtronic but have had different cannula prescribed but, this has no change of outcome?
Any help would be appreciated.
Regards RR.

Hi Borb! I also had a 640g for years and had the same problem (I recently switched to tandem and I think its the same, but too soon to tell).

I used to do more for the filling tube. Something like 15 units to be sure. And this is something that nobody specifically recommended but right after a change and depending on my BG I would give myself a bolus of (0.3 to 1 unit). That helped a bit but I always found the change of set problematic. I just tried to avoid carbs for the first couple of hours and keep a close look.

 

[Bobr17]

Hi Sleepster,
No sweating or anxiety, honest answer, like most pump users, it's just part of life? I will try your theory about putting the Cannula.in a couple of hours before.
Thank you BobR17.

 

[Bobr17]

Hi Tali,

Good point about the Carb intake also? I do a set change at evening and just before an evening meal, usually because I am less resistant.to insulin at that time of day but, something to try also.
Thanks BobR17

 

[dancer]

@Bobr17 have you tried using an increased temporary basal for a couple of hours after a set change? Trial and error would give the correct percentage.

 

[Nometype1andproud]

I also have the same problem and find it very frustrating as it often sends me high overnight as I do tend to have my set changes early evening, I have done a temp basal a couple of times but then find I can be going too low before bed.
I wonder why it does this

 

[Bobr17]

Hi Dancer,
Thank you for your comments. Yes tried temporary basal, same affect unfortunately?
Thanks, Bobr17.

 

[Bobr17]

Hi Nometype1andproud,

Thanks for your reply,
Yes, I am going to try a solution earlier in this post and actually insert the cannula an hour or so early, before I do the actual set change as, that is the only thing I have not tried. Currently I am taking 4 units if bolus 15 minutes before set change and 2 to fill up the Cannula and still I go sky high, well into late teens and then overnight gradually slowly go back to normal or, if I correct the high BG as you normally would, come crashing down early hours. Blots a good BG every 3 days, very frustrating?
Regards,. Bobr17.

 

[himtoo]

Some pumpers note that their Blood Sugar rises after they change their infusion set. One of the reasons for this may be that insulin "leaks" from the old site when you remove the old set.

When you insert your new set, try leaving the old set in for a length of time equal to the amount of time that your insulin is "active". For Humalog users, this is at least two hours, for Regular or Velosulin users, this is at least 4 hours. That's right - for a while you will have two sets inserted, but only one will have a tube and pump attached to it!

 

[DunePlodder]

@himtoo Another benefit of this comes if there is a problem with the new cannula. You can quickly, temporarily, swap over to the old one if it's not convenient to insert a new one immediately.

 

[Bobr17]

Hi Him too,

I will try that keeping the old Canulla in for the required time, thank you,
Regards Bobr17.

 

[Bobr17]

Hi Duneplodder,

Thank you for your comments,

Regards, BobR17.

 

[Bobr17]

Hi Himtoo, first set change utilising your suggestion and " hey presto" it worked? Fingers crossed.going.forward. thanks all,

Kind regards Bobr17.

 

[Peter03]

I have been pumping for the last 18 years and have also had this problem, I have tried having extra insulin after set change as I find it takes a while for the insulin to find its way into my system it works most of the time but not always so I will also try leaving my old canulla in for a while, I have lately been thinking I may need a infusion tube fixed permanently inside my body as with the internal pumps but that does mean you have a tube sticking out of your body, not even sure if you can still have it done, another possible problem could be where you put your infusion set as I find I have a few area's now that are no go places on my body because of the time I have inserted or injected there