ACCU CHEK COMBO HELP

[stoney]

James did a complete change of cartridge and infusion set before tea today. Had his tea and did a BG 2 hours later before having a shower and it was up to 17. He did a correction dose and 1 hour later is still 17. We have done priming again, checked for bubbles and now he has connected up again.

He wants to have his usual supper of 70g carbs and bolus for it, but what happens if this insulin does not go in either. Any suggestions as to what we do next.

I think possibly we should ring the Roche care line?

Yvonne

 

[Riri]

As it's important to get the insulin in and working (and having experienced high numbers in the last 2 weeks for the first time on the pump) I would suggest that you use the fast acting pen to do the correction and supper bolus now so that his BSs come down, then you can phone Roche. Hopefully someone will be along very soon with the same pump who can offer more advice but you may also need to change the infusion set just in case. With BSs that high you should also check for ketones. Hope it settles down very soon.

 

[CarbsRok]

James did a complete change of cartridge and infusion set before tea today. Had his tea and did a BG 2 hours later before having a shower and it was up to 17. He did a correction dose and 1 hour later is still 17. We have done priming again, checked for bubbles and now he has connected up again.

He wants to have his usual supper of 70g carbs and bolus for it, but what happens if this insulin does not go in either. Any suggestions as to what we do next.

I think possibly we should ring the Roche care line?

Yvonne

Hi Yvonne,
does James leave his old set in when he does a change? If not then he needs to do so. This way if a problem acures he has backup also any insulin left in the old cannula drips through so to speak until the other is up and running.
Hope this makes sense I'm well and truly hypo in charge of a keyboard (2.8 ) due to decorating.
With a blood sugar of 17 he can not eat 70 gms of carbs either :shock: that's asking for trouble. Has anyone explained to James or is the pump capable of delivering an extra correction % of insulin over a certain bs level?

 

[iHs]

Hi

Yvonne

It can be difficult at times to know exactly why bg levels go so high... it could be slight kink in the tube, tube clip not attached to the set properly, set in a dodgy area on tummy, air in cartridge, the tube and set not primed correctly, carb calculation not right, basals not correct and so on......

If my bg went up to 17mmol for sure I would go straight for my pen and not chance the pump just in case something wasn't right and bg ended up going even higher. On the bolus wizard there is an option when you click on standard, to also use manual pump, pen or syringe, multiwave, extended. If you select pen you can then use that and the pump will know that youve used a pen to deliver the bolus instead of the pump..... By using a pen or syringe you can be sure that bg levels will drop. However, as youve used the pump to deliver the correction, it looks like the correction has worked as James's bg is still 17mmol after 1hr. If it hadn't worked, bg level would be more likely higher... What will happen now is that it will take about 3.5-4hrs to lower James back to a target level so it wouldnt be that wise to eat a large 70g carb meal while the bg is still high... Can James eat something like a 2 egg omelette which will fill give him something to eat but will be something equivalent to about 4g carb? and then you just keep monitoring his bg levels until they return back to normal.....

 

[Riri]

I hope things have improved for James overnight Yvonne. All the best.

 

[stoney]

Morning All

Firstly thanks for your prompt replies and good advice.

Well the readings were as follows:
20.10 = 17.3 - 2.8U correction dose via pump
21.05 = 17.0 - 0.4u correction dose via pump (even though I told him the pump only gets the one chance)
21.57 = 15.3 - 77g carbs even though I said he should not have his usual supper) = 8.3u
22.53 = 18.2 correction dose via pen (4u)
23.39 = 16.3
03.01 = 12.3
07.07 = 9.2
08.55 - 8.2
09.26 - 9.7 - 77g carbs - 8.9u
He has not gone to school today as he said he would probably spend most of it with the nurse (fair comment).

We are waiting now for 2 hours after food to see what his readings are and if not good, we are going to change the whole infusion set again.
When we had a problem changing the last time the DSN said to put it around his lower back, which we did with her (which was convenient cos it was James's first day back at school and we had arranged a visit with the school nurse, so it was done then and it worked. Now we have done the same again on the opposite side so I think it is possibly the site. Unfortunately James does not have a lot of meat on him and I think we are struggling for best sites. The DSN said to avoid the tummy for a while as he has been injecting there for 12 years. We asked about the leg but both the Roche Nurse and our DSN said it was not a good idea for fear of it coming off with the rubbing of trousers?

Another question: When James does a correction with the pen, he put it through the handset, all fine and the pen sign showed up. What does the pump do, as it was still running and attached through the night, does it still do its usual insulin every 3 minutes?

I think I am getting a bit paranoid now and although James seems to know more than me he still needs to be reassured.

Thanks Again

Yvonne

 

[iHs]

Hi

Firstly.... I hope that James will have learned from the mistakes he made last night by eating a large carb meal wth really high bg levels. I'm not surprised that his bg has been a bit elevated..... Your DSN needs to look at the basal rates and the correction factor set although the higher the bg is the more insulin is needed to do the correction.

Regarding using a pen to deliver a bolus or a correction as long as you tell the pump what you have done, it will be able to keep track of the insulin injected and if a pen is used as a correction only, then the correction from the pen will still show up as being active. Regarding your other question about the pen...... the pump will still carry on delivering the basal insulin set by your basal rates regardless so dont worry about that

If James would like to use the Flexlink in his leg then it will probably be ok as long as he puts the set in so that the tube attaches from the side instead of at the top or bottom and then the set wont catch in his trousers with any luck. Another set to consider for the legs and also the backside is the Rapid D which is a small 6mm or 8mm insulin pen like steel needle attached at a right angle to a circular adhesive backing and is dead easy to insert and is also very flat so doesnt stick up at all. The set tube has about a 5" tail to it which has a tiny swivel like connector which then joins to another length of tube (you decide how long you want it to be) by twisting the swivel connectors together and its virtually impossible for the tube to become disconnected unless the swivel connector is undone. Ask the DSN about this when you next see her........... You should also ask her to see you if James finds that his bg levels are higher through using his backside for the sets as insulin is probably being absorbed slightly slower than it was in his tummy. Frequent bg testing will reveal all............

 

[CarbsRok]

Tell James to think about using some tubigrip over his cannula if he has it on his leg. It wont come out then. (cannula not leg)
When you said about doing a complete change, you don't change both cartridge and cannula at the same time do you?
You only need to change the cartridge every six days and cannula every 2 or 3 days depending on which he is using.

Personally I don't think he needs to change his set anyway. Those highs are due to far to many carbs whilst his blood sugar is too high. I've always been taught no carbs until blood sugar is below 8.
With a 17mmol James would have massive insulin resistance at that level hence the struggle to get his numbers down.

 

[stoney]

Thanks again for the replies. James has now come down to 6.3, 2 hours after breakfast (what a relief). We have now taken all your advice on board and I have also made him read the comments and hope he takes them on board now.

When you said about doing a complete change, you don't change both cartridge and cannula at the same time do you?
You only need to change the cartridge every six days and cannula every 2 or 3 days depending on which he is using.

.

31.8.12 Started on pump - Flexlink
Monday 3rd Sept - changed cannula
Wednesday 5.9.12 changed both cannula and cartridge as pump bleeped with minimum insulin
Friday changed cannula owing to football match on saturday wanted to make sure everything working ok for that
Sunday 9.9.12 changed both cannula and catridge before tea as not enough units to take him through school today (and not confident enough yet to do before going to school this morning); even though he has not gone today.

Am I getting this right

 

[CarbsRok]

Thanks again for the replies. James has now come down to 6.3, 2 hours after breakfast (what a relief). We have now taken all your advice on board and I have also made him read the comments and hope he takes them on board now.

When you said about doing a complete change, you don't change both cartridge and cannula at the same time do you?
You only need to change the cartridge every six days and cannula every 2 or 3 days depending on which he is using.

.

31.8.12 Started on pump - Flexlink
Monday 3rd Sept - changed cannula
Wednesday 5.9.12 changed both cannula and cartridge as pump bleeped with minimum insulin
Friday changed cannula owing to football match on saturday wanted to make sure everything working ok for that
Sunday 9.9.12 changed both cannula and catridge before tea as not enough units to take him through school today (and not confident enough yet to do before going to school this morning); even though he has not gone today.

Am I getting this right

You are doing just fine :thumbup: I asked about the changes as many new pumpers seemed to think they had to change both at the same time.

Things will become easier and quicker after a couple of weeks. To start with everying is a steep learning curb, it's almost like being newly diagnosed.
Glad to hear Jame's numbers have come down now.
Not to sure what you have your minimum insulin set at but you can go into set up to change it if you want to.
Mine is set at the lowest of 10u for my pump, which is half a day's insulin for me, so I tend to just ignore it and change when I must.

 

[stoney]

Hi Everyone panic over (well for now at least). James's readings settled down for the rest of the day and we went to see his DSN at the end of her clinic today.

We talked over a lot of things and it ended up that we were not priming the pump and the cannula properly so James was getting about a 2 hour delay before insulin was reaching him.

We have now written an idiot's guide (for myself that is) and I think we (well James seemed confident) have grasped that now, so we will wait and see for the next infusion change which is either Friday or Saturday depending on how much insulin is left by tea time on Friday, whether we HAVE grasped it.

I would just like to say THANK YOU ALL VERY MUCH FOR YOUR REPLIES, I don't feel so alone when I have such great advice on here :clap:

Yvonne