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cannula priming

H

Hazza

Well-Known Member
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169
Location
Huddersfield
Might be a daft question but, we are using flexlink plus cannulas and the DSN told us to prime it with 0.7 units when we do a change. This has seemed to work OK for us but I have just been checking the official site and it says to prime with 1.0 units. Now 0.3 might not be a huge amount but it is more than an hours basal for my daughter. I don't want to say that our DSN is wrong as we have not had a problem so far but why the conflicting advice.
I would expext Sharon to probably have an answer for this one as I know that she has had a few problems with the flexlinks. Does the length of the needle have an effect? we are using 6mm ones.

On another note, last night at 5.00 we changed her cannula and then bolused for Lily's tea which was crusty bread and chicken and 1 piece of garlic bread Followed by a crunchie... I know loads of carbs, 75 in total we bolused for a ratio of 1:10 so 7.5 units which we gave as a multiwave half up front and the other half over 1 hour. Well at 8.00 she was over 19 so we gave 1.5 units to correct. After an hour and half she went to bed and was still over 18. Checked her at 12 oclock and she was 14 so starting to come down a bit. Checked her again at 5am and she was 7.1. I don't think we were so far off with her carbs so what caused her to shoot up like she did, could it have been the crunchie? Did I answer my own question? Just looking for some thought here.

Thanks in advance

Harry
 
Hi Harry

Cannula priming:- I was also told 0.7 by DSN and read differently in training book. Accuchek helpline DSN also said 0.7 units, which suprised me. I used to do 1.0 but then I wondered if the extra 0.3 of insulin had gone in to me, so I reverted back to 0.7. I don't know why there is a conflict between HCP's and Accuchek reps and literature. No HCP or rep or even the manual states anything about length of cannula affecting the prime, so I don't think the length is a factor....the rapid d' sets that I am now using don't have to be primed in the same way, users have to prime them before putting them in to the skin, so never any worries over priming them now.

Your 2nd question regarding high levels. There may be conflicting advice on this. For me personally I wouldn't have done a multiwave...but you did do it over a short period of time, so shouldn't have made that much difference. What was Lilly's levels before eating?
Have other levels been ok after previous evening meals, or have they jumped more than 3.0?
Depending on what your answers are, it will give more idea whether the carb ratio is wrong or the evening basals. My ratio's are now 1 to 10 for breakfast and lunch, but 1 to 8 for my tea, as I generally sit down in the evenings.

When my levels went that high on my 2 practice christmas eating days, I also gave myself 250% tbr as well as correction bolus's to bring my levels down quicker. Once I saw my levels dropping to 8 I switched the TBR off, as I knew it was going in to my system for the next few hours and would still be working. I would only do this when my high's were in the morning, as I wouldn't want to be worried of going low during the night.

It is still very early days yet, so don't get panic'd.....by the time Lilly eats that food again you will know what to do......all trial and error initially, but I would be interested in knowing what the reading were before tea? and whether her levels normally raise more than 3 in 3 hours after eating....

Bye for now
Sharon
 
Hi Sharon, before eating her BG was 5.4 so it really shot up considerably. It normally doesn't go up more than 2 or 3. This is when you start to question if you have allowed the right bolus or have even forgotten to give it ??? We also thought that maybe the new site was not working properly.
However her morning BG was Fine. She was also high at lunch time today at 13.3 but had has some chocolate with a bolus only an hour earlier so possibly this affected it today.
We will see how it goes at teatime and then decide wether to change her cannula again.

Thanks

Harry
 
Harry

I would change the set asap, and then start again. Check the cannula when you take it out to see if it has any blood or if it is bent.... I think the carb ratio's may not be quite right though. Has Lily ate the same foods/choc before?
Make sure you write down in the log book exactly what foods and bolus was done, and if she eats the same again, do a larger bolus.

I'm not great on dealing with chocolate bars and how they affects levels, and whether it may be an idea to do a TBR of say 200% for an hour when having a choc bar, now if it was drambuie I could have definitely given an answer for that....I only ever get to eat my mini mars or mini milkyways from lidls when I am hypo, and I know they will only raise me by a maximum of 3.

And I got to ask, are you a 100% sure that Lily hasn't sneaked anything extra----that only stems from thoughts of my own childhood!!! Not at all blaming Lily....just know what I was like!!!!

These unexplained high's - have they been after you have changed a set rather, than after you have changed the whole tube and set? Have you started a new box of sets?

So many things to think of............Sharon
 
If you check the booklet that comes in everybox of canulars it will tell you how much insulin to prime that particular canular, I was told by the rep to prime my canulars with 0.5u which but should have been 0.7 for the ones I use!

This could explain the reasons why an high after a set chance, some people find leaving the old set in for an hour or so after they've changed to the new one stops the high after a change...

You might have a combination of things going on that increased her levels, the rebound high after the change, as already said she might have sneak more sweats after you bolused (normal practice for a diabetic child) also you may have miscounted her carbs and the carb effect at that level!

Personally I would discourage foods such as crunchie one hell of a wack of carbs difficult to work out the asorbtion rate with the combination of the honeycombe middle which is basically pure sugar and the high fat chocolate content.. Much better to guide her to sweets, such as mikly ways, snickers as slightly lower carb value but just has nice as a treat, the fun size one are far easier to curtail the carb count, and gives the notion she had a tad more than she really has..

Truefully speaking even though insulin pumps give us a very high degree of control and flexiabilty opening up our regimes and foods... It doesn't enable free eating of carbs in reality, we still fair better and find it easier to control our levels when we stick to eating moderate amounts of carbs...
 
I wouldn't have done the multiwave to cover the Crunchie. even if you did a standard bolus for a crunchie I think it would be hard for the insulin to work and peak a quickly as as the sugar in the chocolate bar. Maybe do multiwave for the meal and then bolus separately for desert. I think if if she came down to a normal level then you add doing fantastic with ratios, it's hard to make injectable insulin to work as good as a human body would and if our insulin works anything unto 4-5 hours then sugary treats may cause spikes.
 
Thanjs Jopar and Dusty, we are doing pretty well with the control, but are still finding things that will make her spike. It's all trial and error ( a lot of error sometimes). We are finding that her bolus ratios change if we make a change to her basal. We are trying not to change her basals too much as a very small change has a big effect. She seems quite insulin sensitive. Her ratios are 1:13 for breakfast and lunch and 1:10 for dinner/tea. Her night time basals seem pretty good and she gets up in the morning with numbers between 5 and 8 depending on what she is like when she goes to bed.
We are expecting some change in the next few days as she had the flu vaccine on Wednesday so we expext her to run a little high for a day or two. So far though she has been fine.

Thanks again

Harry
 
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