Hi
@Agast, A truly unpleasant experience for you ! As a T!D pumper, not as medical advice or opinion:
Being on an insulin pump myself for 7 years and on insulin for 52 years all up, I know how easy it is for an absorption of insulin/cannula or other pump problems to send BSLs and ketones into orbit !!
Did you and do you have a
plan made out with your DSN or doctor for times when BSLs continue to rise or repeatedly rise?
Now is the time to revise or make that plan.
My plan, and since we are all different, it is individual and that is why you are best to see and
work out your own plan with your DSN/doctor:
1) BSL up > 4 mmol/ within 2 - 3 hours after changing cannula, or unexplicably* > 14 moml/l other times-->
test for ketones**
2) change cannula/infusion set and ring DSN to report BSL and blood ketone level to recheck possible causes * and confirm next step
3) ketone blood level < 4 discuss correction doses and other strategy***, Ketones > 4 consider hospital
but any vomiting or serious other problems like diahorroea, vomiting, high fevers > 38 degrees C means hospital anyway.
4) otherwise review BSL and ketones at least 2 hourly with further insulin and food until settling or not.
* Check list I use:
Insulin problem; inactivated by being frozen in fridge or elsewhere or exposed to heat > 30 degrees C, or more than 30 days out of the fridge?, incorrect dose and basal settings
Food /diet: overeating? unusual food, maybe with added sugar ?
Illness: feeling like a cold is coming on, ? urine infection (sometimes no symptoms or high BSL confuses things like having to pass lots of urine), sore tooth, rash etc
Stress/upset: sudden or recent emotional upset or stress of impending exams :
Pump problems: a)
machine and software - alarms about pump and ring helpline, flat battery or loss of battery contact OR that I have lost my pump somehow or left it at home !!!!
b)
delivery to subcutaneous site and absorption from there: ? leaking tubing/connections, ?dislodged or bent or blocked cannula ? cannula in scarred tissue from previous infusion over the years!
Other: nothing definitive I have for this category yet but always like to keep an open mind ?e.g. cyber attack !!!
** Ketone measurement: some meters have separate strips and the capacity to measure blood ketones: It would make sense if all insulin pumpers had these meters, and glucose and some ketone strips prescribed in the UK
(but as an Aussie I have no say in such a sensible suggestion not even when we have to purchase ours (on a subsidy) in Oz.)!!
And please see the
ketone graph picture below (kindly provided by another poster a while back) for some idea about ketones
but it is up to your DSN and doctor to interpret your results and advise you.
*** Strategies: will depend on what is or is not happening.
A cannula change is always a good starting point I find as this, to me, is the most obvious first and easy step to do and the 'weak point' of insulin pumps. (and provided one carries spares everywhere) !
One problem after 52 years of injecting myself is that there is
scarred tissue built up at my injection sites. The trick was to choose sites not used before and to alter the length of the cannulas to better access unscarred tissue.
Once BSLs are heading down a bit I try to have a little something to eat as I need my body to not be burning fat and producing more ketones, so insulin in and a little food.
I do not try to exercise as this sends my BSLs up further (if BSL > 14 mmol/l)
With an
infection I will be upping my basal and bolus doses and using increased correction doses in steps that work for me, and seeking medical or dental help as needed.
One trick I have learned and worked out with my DSN is, in the case of situations where ketones and BSLs are rising is to make a
correction dose with use of intra-muscular short-acting insulin. This requires me to possess syringes and needles which will achieve that (I have some 1" needles which are more than adequate) and the ability to give myself such an injection. So that may not be suitable for others. The IM injection seems to start working within one hours whereas the usual subcutaneous routine takes as least 2 hours. I feel immense relief when I can feel the high BSL starting to fall !!
I have never experienced a
pump failure but always carry spare short and long acting insulin in case, with a plan for how to restart mdi if needed.
I hope your plan saves you finding yourself in the a DKA situation again and I am very glad you have survived.
I can only guess that maybe your slow recovery is related to the initial cause of your high BSL, ketones and DKA.
And that my my reading it seems that it can take time for the body to adjust back after changes in the salt composition of the blood during DKA. (se mayoclinic.org - DKA)
Best Wishes for an improved recovery time!!
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