• Guest - w'd love to know what you think about the forum! Take the 2025 Survey »

Day 3 of pump and mega highs with ketones

dani-a

dani-a

Active Member
Messages
27
Location
Kent
Hi guys,

Well started insulin on pump on Monday,,,,,,was fine until Tuesday evening (had my last lot of Lantus at 22.30 on Sunday).
Then before bed B was up at 22.....continued to ruse through night despite corrections and ended up with Ketones at +4 and BG of 28 at 5am....changed infusion set and gave correction via pen. Ketones gone by 8am
Contacted pump clinic first thing and eventually got to talk to someone at 14.00....upped my basal rate from 0.5 to 0.6 per hr ( was previously on 15u Lantus) and was told to eat some lunch
Did that but by early evening BG on the rise to 17 and ketones again......on advice from Roche disconnected pump and gave myself my normal Lantus dose at 20.45......finally got BG down to 6 by 5am this morning.
Not sure what has been going on but couldn't live with these very high readings with Ketones esp with the complications I have.
Now I've been T1 for over 40 yrs on MDI's and have a good idea on how my body reacts and what my requirements are.
The DSN has set my meal ratios at 0.5:1 across the day.......my previous ratios were 1.3: for breakfast and lunch and 0.6:1 for tea, I think that my early ratios need to be upped until my body gets used to pump therapy or am I just looking for answers far to early into starting this.
Has anyone else new to pump therapy experienced these type of problems and how did you overcome them?
Sorry if I haven't given enough info or have been a bit waffly i my post but I am a desperate woman!!!!!!
Any advice more than welcome
Dani
x
 
Your starting basal rate of 0.500 units per hour sounds about right. If I remember correctly it's your 24 hour basal units (15 for you) divided by 24 less 20% as usually on the pump you need less insulin than injected, that gives you a starting point for your basal rate but from there it's quite possible tweaks will be needed.

What type of cannula/infusion sets are you using? Is it possible if you're using teflon cannulas that the cannula might have kinked during insertion? That would result in high readings because your insulin isn't getting through properly. If you think it might be the cannula kinking then you could try using steel cannulas which will rule out problems due to kinking. Maybe even if you use the steel ones for the initial few weeks just to know that the pump is correctly set up, once you are reliably getting good readings then you can go back to teflon if you prefer them. If high readings happen then you know it's quite possibly the cannula kinking on insertion. Is your pump's occlusion sensitivity set to high?

Your carb ratios might need to be changed but to me if your bg was rising through the night despite correction boluses then it's either the basal or an insulin delivery problem. Have you check if there are any air bubbles in the reservoir or tubing? I find that when we've put in a new reservoir then within 24 hours we need to remove it and knock out more bubbles that become visible that weren't visible initially. It's quick and fairly easy to do and now is part of our routine. We can then put the reservoir back into the pump (reload cartridge and prime tubing) and no more bubbles seem to accumulate after that until the next reservoir change.
 
Hello Danni

Although Sophie has got a point regarding the infusion set cannula kinking and also air bubbles in the cartridge which will affect bg levels, I think that your problem at the moment is probably the insulin in the carb ratio is not right and that is what is causing you to have sky high levels. Don't be afraid to do anything about it though as a pump is just a battery operted insulin delivering device so once you start to alter your settings , then your bg levels will start to get much better.

A good bit of advice that my friend's consultant gave her was to test bg levels frequently (every 2hrs) and if bg levels were going high or low 2hrs after eating - then alter the insulin to carb ratio accordingly. If bg levels were on the high or lower side 4hrs after eating - then alter the hourly basal rate accordingly about 1 or 2hrs before the change in bg levels. Everything with a pump requires fine tuning so only make tiny changes - not big ones and remember to note down on paper what you have changed etc.

If you are using the Combo pump then you dont go far wrong with Flexlink or Rapid D infusion sets - both are a doddle to put in. Cartridge filling is an art though and there are various ways to fill cartridges so that you dont get air bubbles appearing but even if you do, dont worry, as long as you point the pump downwards with the tube coming out the bottom instead of the top, any air bubble will just rise to the other end of the cartridge and not go into the tubing. When the pump cartridge gets towards being empty (last 6u) you can just take the cartridge out (the air bubble if any will still be there) and then refill again.
 
Hia - good advice from others. Just to let you know that it's not unusual to have to tweak basal and bolus rates for a while to begin with. I started with a pump last November and there's not a week gone by where I have not had to adjust my basal rates up or down (I think I may be a bit unusual here?!?!). But to give you an idea, the consultant started me off on a flat rate basal of 0.5 through the day, that was soon upped to 0.6 as my BSs were in the high teens. Since then I've managed to work out that I need 9 different basal rates through the day ranging from 0.5 in the middle of the day to 1.2 for a four hour slot in the evening. It really makes a difference if you can get the background insulin to me as accurate as possible.
It's amazing what small differences to basal rates over a few hours will make - so baby steps and it will come I'm sure. Please keep in touch if you want to know anything at any time. :D
 
Thanks everyone,
I am using the Accu Chek Combo with Rapid D Link, so don't think the issue was the Infusion set, I thoroughly checked for bubbles and always wear the pump around my neck so is always facing down, so again I don't think it was an air bubble blockage......I do understand that it is going to take an awful lot of time and fine tweaking but did not expect to have BG's in the 20's with +4 Ketones.....and am not ill, well certainly don't feel unwell.
They have taken me off the pump until Monday to get myself stable again and we'll try again the so the DSN has advised me to take only half of my Lantus on Sunday6 night and has upped my basal rate to 0.7 per hour and adjusted carb ratio to 1:18 from 1:20.

IHS, thanks so much, was just what I needed to know regarding whether to adjust basal or carb ratio so feel I have the tools now, did ask the question at clinic but got the distinct impression that they didn't want us to meddle just yet!!!!

Just another quick point, do you guys get bruising where the sticky pad has been, I have a few circular faint bruises where the cannula has been, and am using an anti lift wipe to remove them
Cheers everyone
Dani
x
 
Hi

Not sure how 0.70u per hour basal will affect your bg levels using a carb ratio of 1u for 20g carb but if you test yr bg levels frequently you will be able to see then what to adjust on the pump and what to leave alone. Just be really careful that you dont end up going hypo in the night so definately set yr alarm clock and make sure that you get up to test. You might have to adjust the basal rate setting and reduce it a bit or go the other way and increase it......... everyone is different so dont worry. As a very rough guide, try to balance yourself out using a 50/50 approach to begin with, so whatever yr daily basal ends up being, see if your daily bolus also ends up being more or less the same. If I start to use a lot of bolus to cover corrections, I then look at the basal rates. With time you will be able to start to do some daytime fasting and then you'll be able to find your true basal rate without eating any food.

Regarding the marking from when you take a Rapid D, yes sometimes you will bruise a tiny bit but this is due a bit to pressure from clothes etc. The bruise will go but you can dab it with a bit of witch hazel etc. Just make sure that you use adhesive removal spray as the Rapid D sticks really well and is murder to pull out without using anything.
 
Thanks iHs, I will be putting all your good advice into practice once I'm reconnected on Monday!!!
In respect of this bruising, I have a faint circular bruise at every insertion point since running the saline and insulin, I wondered if this has anything to do with my high BG's or am I just being paranoid?
i don't carry an awful lot of fat around my middle, and wondered if the cannula had been pushed in to far so the insulin wasn't being absorbed properly.
def going to be doing hourly checks with my basal rate at 0.7, esp through the night as used to suffer bad hypos when my lantus was at 17u!!
Dani
x
 
Hi Dani,
I have no idea which length of cannula you are using but if it's a 6mm try an 8mm instead this will make a world of difference.

You need to keep your carbs the same with each meal and have set meal times to start with on a pump. This will help you sort things out easier.
Also do buy the book pumping insulin by John Walsh. This will be more use than your DSN by the sounds of it.
 
Back
Top