Cannula fail and possible ketones

[megan]

A few times my blood sugars have got higher, 14 and into the 20's, and I can't seem to get them down. Then I notice the transparent plastic on the cannula is filled up with drops of insulin. So it's not been going into me for a while, previously told by tandem it will be condensation not insulin, I now don't take that as an answer. It IS insulin. So I change cannula and site. Then there's time waiting for the blood sugars to come down. Positively aided by an injection too, but negatively aided because you don't know how much insulin is working on board, just very slowly... and of course the new understanding I now have that a new cannula means several hours before it's 'bedded in' I've heard it referred to. The time it takes than new cannula to have a positive impact on your blood sugars. Hadn't heard of it before I read it on here. Now I'm very aware of it. Don't know why it's a real thing.
So **** blood sugars later yesterday and partially through the night.
Today sugars good. Went out to the beach feeling very dizzy (3rd day of it) and nauseas all day. Struggling climbing cliff back up from beach then vomited a lot.
Got home went to bed.
Had some food and water and whilst I'd dismissed a ketone issue because I figured things were better today, I decided to test. Blood test ketones 0.1
Urine test ketones very high!
So could someone give me their insight into this and the cannula issue. Feeling a bit shook up

 

[EllieM]

I'm a tslim user too, with truesteel cannulas.

How old are your blood ketones strips @megan ? The ones I use go out of date quite quickly....

I hadn't heard of the cannula bedding in issue but the one time I managed to pull my pump off overnight and then inserted the new cannula wrong (top tip, remove the plastic cover from the needle before insertion ) I had to manually give myself quite a lot of extra insulin because my insulin resistance goes up with my bg. And you don't have much clue as to how much insulin is in your system because the pump's record is inaccurate until you are 5 hours into the new cannula, at which point all the old IOB will be treated as gone.

I'd logically expect bg ketones to be more accurate than urine ones (the urine ones can be cause by dietary ketosis and are a record of past ketone levels)

But I'd be worried by those symptoms if I were you. Can you ring 111 for advice? Do you have someone with you who could take you to A&E or ring for an ambulance if you passed out?

Diabetic ketoacidosis

Find out about diabetic ketoacidosis (DKA), including what the symptoms are, when to get medical help and how to prevent it.

www.nhs.uk

I hope you feel better soon. I would also consider ringing 999 in your position.

 

[searley]

A few times my blood sugars have got higher, 14 and into the 20's, and I can't seem to get them down. Then I notice the transparent plastic on the cannula is filled up with drops of insulin. So it's not been going into me for a while, previously told by tandem it will be condensation not insulin, I now don't take that as an answer. It IS insulin. So I change cannula and site. Then there's time waiting for the blood sugars to come down. Positively aided by an injection too, but negatively aided because you don't know how much insulin is working on board, just very slowly... and of course the new understanding I now have that a new cannula means several hours before it's 'bedded in' I've heard it referred to. The time it takes than new cannula to have a positive impact on your blood sugars. Hadn't heard of it before I read it on here. Now I'm very aware of it. Don't know why it's a real thing.
So **** blood sugars later yesterday and partially through the night.
Today sugars good. Went out to the beach feeling very dizzy (3rd day of it) and nauseas all day. Struggling climbing cliff back up from beach then vomited a lot.
Got home went to bed.
Had some food and water and whilst I'd dismissed a ketone issue because I figured things were better today, I decided to test. Blood test ketones 0.1
Urine test ketones very high!
So could someone give me their insight into this and the cannula issue. Feeling a bit shook up

Typically the appearance of fluid in the cannula plastic is condensation.. leaking insulin is normally absorbed by the adhesive pad

You don't say what insulin you are on, or how long after installing the cannula this problem happens

The pump is only approved for 2 insulins. Humalog and novorapid... Novo is a 3 day set change and human should be a 2 day change

People use other insulins but these are not approved fiasp is known to cause problems with the tslim

Another big problem with standard cannula is bending on insertion so there is no insulin typically because the cannula does not enter the skin and as stated above even this insulin is absorbed by the adhesive pad which can be seen by colour change in the pad

ALL my cannulas get condensation in them so I really suspect something else is happening

You could also request samples of other cannula to try see if they are any better

 

[searley]

as followup to previous on Facebook groups dedicated to the tslim there are many posts about people who can have massive BG rises in the first few hours after cannula insertion - not an issue I suffer from.. im not sure if this is because in some the insulin only takes effect one the tissue get a certain amount of insulin or if its a body reaction to the cannula

in these cases a cannula change may help, or if its something that routinely happens you can try pen corrections in the first few hours or even try corrections from the pump which may help with getting a little more insulin around the cannula area helping absorption (if thats the issue)

maybe even a small manual dose using the old cannula prior to insertion of the new? but there are thing you can try if the issue is at the startup of a new site

 

[megan]

Thanks for the replys.
I have tried 6mm and 9mm needles. I've tried the trusteel and autosoft 90. I find on the 3 rd day no matter which cannula that I get a big lump left behind from the insulin and it stays for a long time even after daily massaging the area.
The two recent leaks have been on day 2. No leaking into the adhesive, I've only had that once. The evidence I have is droplets in the plastic cannula window that smell strongly of insulin and my blood sugars are high and won't come down. I take that as insulin failure to go in.
It doesn't make sense to me for there to be an issue in the first few hours of a cannula change because we'd expect absorption from an injection so why not a fresh cannula?
I do give a little extra insulin now during the change over. As someone else has said I also leave the old cannula in place for a little longer incase it helps.
I use Novorapid.
All ketone testing equipment is in date. Urine this morning is still high in ketones which doesn't make sense but I've ordered more from the dr. I don't have access to 111 or anything similar. I will inform my pump team but people on here are always great at responding with suggestions. Much appreciated

 

[Juicyj]

I have only recently started to learn about pooling of insulin under the skin from another t1d group which explains my issues with insulin absorption, I use the tandem slim, ljumjev and sure t sets so steel tipped, I have to change every 2-3 days now as I have issues with painful sites due to the preservatives in the insulin which cause me site pain, I tend to get up and move more if I feel myself going higher as prefer to use exercise to combat this rather than more insulin. I also find if I am taking more insulin than usual that I can run with a stubborn high for a while afterwards, again I think this may be due to pooling under the skin.

 

[EllieM]

All ketone testing equipment is in date. Urine this morning is still high in ketones which doesn't make sense but I've ordered more from the dr. I don't have access to 111 or anything similar. I will inform my pump team but people on here are always great at responding with suggestions. Much appreciated

How are your symptoms going? Are you still vomiting?

 

[megan]

No it stopped yesterday thanks

 

[megan]

I have only recently started to learn about pooling of insulin under the skin from another t1d group which explains my issues with insulin absorption, I use the tandem slim, ljumjev and sure t sets so steel tipped, I have to change every 2-3 days now as I have issues with painful sites due to the preservatives in the insulin which cause me site pain, I tend to get up and move more if I feel myself going higher as prefer to use exercise to combat this rather than more insulin. I also find if I am taking more insulin than usual that I can run with a stubborn high for a while afterwards, again I think this may be due to pooling under the skin.

I was taught originally a long time ago that I was not to exercise on higher blood sugars, like 14 and above, the same with ketones

For 30 odd years exercise didn't help to bring my sugars down apart from the odd occasion. I seem to be an anomaly. I'd have to take insulin for a meal as if there were carbs when there weren't any.

Since ozempic my body has behaved more like a 'normal' diabetic if there is such a thing.
I am type 1 with insulin resistance and am on metformin also

 

[searley]

Thanks for the replys.
I have tried 6mm and 9mm needles. I've tried the trusteel and autosoft 90. I find on the 3 rd day no matter which cannula that I get a big lump left behind from the insulin and it stays for a long time even after daily massaging the area.
The two recent leaks have been on day 2. No leaking into the adhesive, I've only had that once. The evidence I have is droplets in the plastic cannula window that smell strongly of insulin and my blood sugars are high and won't come down. I take that as insulin failure to go in.
It doesn't make sense to me for there to be an issue in the first few hours of a cannula change because we'd expect absorption from an injection so why not a fresh cannula?
I do give a little extra insulin now during the change over. As someone else has said I also leave the old cannula in place for a little longer incase it helps.
I use Novorapid.
All ketone testing equipment is in date. Urine this morning is still high in ketones which doesn't make sense but I've ordered more from the dr. I don't have access to 111 or anything similar. I will inform my pump team but people on here are always great at responding with suggestions. Much appreciated

If it is definitely insulin then it's just bad luck and a faulty cannula.. not something's I've seen anyone else report in the lastv5 years though

 

[searley]

I have only recently started to learn about pooling of insulin under the skin from another t1d group which explains my issues with insulin absorption, I use the tandem slim, ljumjev and sure t sets so steel tipped, I have to change every 2-3 days now as I have issues with painful sites due to the preservatives in the insulin which cause me site pain, I tend to get up and move more if I feel myself going higher as prefer to use exercise to combat this rather than more insulin. I also find if I am taking more insulin than usual that I can run with a stubborn high for a while afterwards, again I think this may be due to pooling under the skin.

Lymjev is NOT approved for use in the tslim but it does get prescribed 'off license'. It's virtually the same as humalog except withe the additives..

Humalog was only tested and approved for 2 day infusion wear so that will also include lymjev and this would help with the lump size too my lumps tend to go in 2 - 3 days

The sling with lymjev tends to subside over time the body gets used to it.. but I still get the odd painful one sometimes so bad I have to remove the cannula

My last prescription I reordered humalog