Blood from my cannula!

[Mike]

Hi
I've been reading this forum regularly since hooking up to my pump on the 19th January but this is my first time posting a question.

My cannula came out the other night in my sleep. I reckon it had been out a couple of hours or so as I had done a 2am bs and all was fine then. With bleary eyes at 6am I replaced it and although it felt uncomfortable, I thought it would settle down as it usually does within half an hour or so I thought no more about it. By 2pm it was bugging me more so I decided to replace it and start again. I fitted the new one and rather than wait before removing the old one I couldn't wait to pull it out as by then it was very un-comfortable. However, for the first time since starting pumping, blood shot out. I was at work in a back office in my suit. My shirt instantly absorbed the blood and I looked like something out of Texas chain saw massacre! My only option was to return home for a change of clothes.

Just wondered if this had happened to anybody else and if so how often? It's kinda put me off replacing a cannula/infusion anywhere else other than home. There was no pain although it has left an almighty bruise. I'm using a Teflon cannula as supplied by Roche for a Accu-Chek Spirit.

 

[jopar]

Hi Mike

I am assuming that you put a new infusion set in…

I’ve yet to experience the gusher, but understand that it is something that can occasional occurs with sets… You’ve caught one of the very find capillary veins that lay under the skin, with injections you tend not to notice that you’ve caught one of these, unless you see the bruise that is left behind…

The normal procedure pumpers use is, put pressure on the site, using cotton wool or tissues hold this down for a about 5 -10 minutes to stop the bleeding…

I use the Accu-check Spirit pump, and as yet never managed to pull out one of the infusions set, at work one of the dogs standing and basically swinging on the tube hasn’t pulled mine out… If this is becomes a problem, then perhaps a change of infusion sets…

 

[Mike]

Hi Jopar

Must admit I've caught the tube on door handles before and it's never come out so was surprised when I awoke to find it had. Think I must have just been unlucky with the replacement cannula. Never had anything like it before but it was a bit of a shocker (looked worse than it felt). I guess the moral of the story is, if you put one in that doesn't feel comfortable within half an hour, change it before you leave the house. Nice to know this shouldn't be a regular occurance!

Thanks

M

 

[mmackay20040]

This has happened to me once (in coming up for 3 years of 'pumping'). It was quite frightening as I didn't know what on earth I'd done!! It was fine though and when I asked my DSN about it, she said it can happen occasionally. It's nothing to worry about though. As for the kit coming out in the night, this has also happened to me on a couple of occasions. No explainable reason that I can see but it's not happening often at all. Hope you get on well with the pump

Marie xxx

 

[Steveee]

Mike,

I have had a cannula come out a few times, but that was more to do with too much sun tan lotion. Soon learnt to use soap and water....

I do get blood from the cannula site when I remove a cannula. Yes it can be scary. If I am away from home and need to change the set, I do not remove the old cannula until I can deal with a bleed.

Don't let the scare restrict you. I regularly travel overseas. I have changed an infusion set in the most obscure places. These include a loo in Munich airport, a tent in the Samburu game reserve in Kenya and in the car on the eurotunnel whilst under the channel.

I just make sure that when I remove the old set, I have access to tissues in case there is a bleed.

 

[Mike]

Thanks for the advice.

Haven't had any since but it's good to know this is perfectly normal.

Still learning pump. Something new seems to crop each week! Have you ever had a hypo during or immediately following a meal. My pre meal BS was normal so surprised when it happened. Fortunately hadn't bolused but I went extremely high two hours after. Looked it up in Pumping Insulin by John Walsh and it seems to be due to 'Insulin stacking' or the 'bolus on board'. This is a new experience for me. I know some pumps have wizards that work all this out for you and this may be something the New Spirit Combo will have when it comes out in May but in the meantime should I be learning more or is it unusual?

Any opinions are good to get.

Thanks

Mike

 

[nash]

Hi Mike,

I too use the Accu chek spirit (since may 07). I have on occassion had the uncormfortable cannula and then when I removed it had blood - but not to the same extent as you describe - NASTY!
What cannula's do you use?
I use the Flex Link (Roche Accu chek ones) and I also use the link assist - which is a device to help insert the cannula. It's great, just like a stapler!
I haven't experienced a hypo or low whilst eating my meal so soon after a good blood reading but I know different insulin work at different speeds - had you done a correction bolus earlier that was now just catching up with you?
I use Novorapid which I believe takes some time to work so over correcting is often my biggest problem.
Have you had an HBA1C check since the pump? Is it going down?

Best Wishes

Nash

 

[Mike]

Hi Nash

Snap! Same pump,Infusion sets and Insulin. Also diagnosed five years ago!

The first time it happened I hadn't corrected at all so it was more alarming as I hadn't bolused since breakfast 7 hours earlier. Admittedly on the second occasion I'd corrected 3 hours earlier so it could have been due to that. It's made me alittle more cautious!

My last A1c was February, 6 weeks into pumping. It was 9.3 (down from 9.5). Wasn't too disappointed it hadn't dropped more as it took into account Christmas and also 2 weeks of flu when I just couldn't get by bloods out of the late teens. On the other hand I'm expecting great things for the next one. Can't beleive how much effort goes into pumping, although I do admit it gets easier as you go along. I've watched my carb intake and the average on my meter for the last 4 weeks is 7.8 so I have high hopes! The person I started pumping with dropped to 8.3 so she kind of laid down the gaunlet so to speak for me to beat her on the next one!

The hospital says we should get the new Spirit upgrade. From what I can see it has a kind of PDA with built in meter that can bluetooth your pump with the bolus! Sounds groovy!

When I read the above I hardly recognise myself. Pre pump and Bertie course I hardly ever tested, enjoyed a rollup and binge drank on Fridays. Now I still do some of the aforementioned occasionally but I'm testing 6-8 times a day, reading everything I can on the subject and feel determined to improve my A1c - happy days!

Kind regards

Mike

 

[jopar]

Hi mike

Have you tried the extended or the mulit-wave bolus’s yet with your meals, as these can be very usefull indeed…

I find when eating high fat content meals, that I need the mulit-wave bolus, which I normally have a bout ½ of the dose at the beginning of the meal, and then time the rest for around the ½ to 2 hours delivery… this does really help with stopping the hypo followed by a high of your BG’s… It takes a bit of tweaking to get the best split and timed delivery to match different meals… I also use it at breakfast has I require a 2 units – 10g of carbs, but finding that if I did a straight bolus I would have trouble, so I mulit-wave it as standard practice, with the timed split set to ¼ of hour works well.

The extended bolus I find very useful when I’m going to eat a low carb meal and my BG’s a very good around the 4 mmol/l mark, I usually have my dose delivered again over a ¼ of hour I find this helps prevent a hypo before the carbs adsorb fully.

And another thing that I use as well is the Temporary Basal Rate, if I’ve got good BG’s and decide that I want a little snack I quite often rather than a straight bolus I will use the TBR for around ¼ to ½ hour at around the 110-120% to keep things even as I find with a small snack that if I bolus then it starts to work before the carbs start to adsorb..

I found with my first 3 months of using the pump, there wasn’t a huge improvement with my HbA1c’s but with saying that, they had actually improved as they were more representative to what was actually going on, as there were no hypos to undercut ad drop the HbA1c’s to a masked lower level… But every 3 months my HbA1c has continued to drop as my control improves and becomes more stable and tighter … I know what my latest is on Friday if I can get into see my DSN, other wise I have to wait until next week for it when I see my consultant…

 

[nash]

Hi mike and Jopar,

Good to read your stories seeing as you on same pump and experiencing same issues.
I've never been able to get on with Multiwave or Extended, despite roche rep saying about it every time - I can never get it right!
Mind you today is a nightmare day....got a slight cold and blood in late teens. Running at 200% and corrected loads but i can't get it down....ideally need to go for run but looking after kids!
I've got HBA1C next week- hoping for in the 7's but not going to get hopes up too high.
Don't think hormones help too much either...hey ho such is life!
Nash

 

[kegstore]

Mike,

First gusher I got was a bit scary, second just a bit tiresome. You tend to know (i.e. on insertion) which sites have struck a blood vessel - kind of a localised dull ache for the few days its in use. Nothing to worry about as long as they heal OK and there's no infection. Sometimes needs a hefty plaster and a bit of pressure at first...

And on topic 2, I couldn't live without the multi-wave, square-wave whatever you want to call it bolus on my pump. I can now eat pasta without fear of hypo or bg in the high teens

Jo

 

[Mike]

Hey Guys

Interesting to read all your views on Extended/Multiwave bolusing. I do use both features but never quite sure whether it makes a difference. I suppose your bs 2 hours later should be evidence enough. Think the advice we received when we were first hooked up was to use Multiwave when we are bolusing over 6 units and the Extended Bolus for high fat meals such as pizza etc, so it's with interest to read jopar's advice on using the Extended bolus for low carb snacks. I shall give it a try.

Bad times yesterday! It was my day off so I treated myself to a piece of my wifes birthday cake for breakfast!!!! Yes I know, in hindsight not a sensible decision! Bloods crept up throughout the day until they reached 19.1 at around 5pm. I'd given myself 3 correction doses and skipped lunch to try and get them down but they just wouldn't until I finally crashed and burned at 7pm with a hypo. What a waste of a day off. Felt lousy all day. Any ideas on how I should have dealt with it? Thought I'd bolused correctly when I ate it, even exercised in the afternoon to try and get them to drop. Should I have set a TBR at 120% for a few hours? Think my basal rate is fine. No more birthday cake for me. Would like to swear about it but wouldn't wish to affend!

Good luck with your A1c Nash. Funny how we cant wait to find out now, whereas pre pump I would always dread hearing my results! Think I'll try for a 7 next time!!!!!!!!!!!

Regards
M

 

[Stuboy]

I've been using the extended bolus feature for heavy carb meals and high fat meals.... Im not sure the Animas has a multi-wave bolus feature on it?? I've not seen it...

 

[jopar]

Mike,

Could have been several things going on, I assume that you ruled out, tube/infusion set delivery problems!

Some people find that above a certain mmol/l that they need to increase there correction ratio’s as they become insulin resistant so take more insulin to correct… Also above 14mmol/l using a standard injection instead of the pump quite often works better, as this can rule out a blip caused by air bubble that’s caused the high..

Other things is that you under estimated the carb count of the slice of cake you eat, and/or the cake had a higher fat content that raised the bg’s later in the morning..

Another reason could have been because you missed your dinner, and exercised if your levels were higher, then you might have needed a bit of extra insulin to get the body to utilise it better…


Stuboy

I think animas calls there a dual-wave, there should be different bolus of a pump,

1, standard = just like an injection delivers the whole lot in one go
2, extended = you set the amount, and the time you want it to be deliverd, i.e. 15 mins, 30mins, 45 min etc, it then delivers the insulin equally over that period.
3, multi-wave = you set the amount to be delivered it splits the amount, the first part is delivered straight away, then the second part is delivered over a timed period… Both the first delivery amount can be alter to suit, and so can the time period to suite…

Some manufacturers have slightly different names for the extend and multi-wave bolus, i.e, square wave = extended, and dual wave = multi-wave…

p.s stu the 2nd paragraph onwards is for general information of all!