Highs after cannula change

[martina]

Hello, my daughter uses the accu- check combo pump and at the minute we are finding that her bgs going really high after every cannula change. I was just wondering if this happens to anyone else. It is so frustrating so I was wondering if anyone knew why this happens and what I can do about it. Martina

 

[Spiker]

Do they settle down after a few hours, or do you need to correct, or do they stay high?

Do you change the cannula location? Do you also change the pump reservoir at the same time?

Are all the cannulas from the same batch? Have you called the Accu Chek (Roche) help line?

Yes it does sometimes happen. There can be a delay in insulin delivery while the insulin depot under the skin is reestablished.

 

[Patch13]

After I have moved the cannula I give myself 0.30u in order to fill the new cannula (this was the amount I was told to give myself - but I'm on a different pump so you may need to check how much to give for the accu-check).
When I forget to do this Then my sugar gets higher.

Do you do this with your daughters pump?

That's the only thing I can think of that might be causing it to get higher.

 

[Spiker]

The cannula fill amount depends on the length of the cannula so check the packet instructions for the cannula, if you are not doing this. Failing to do this will cause temporary highs.

 

[CarbsRok]

Do you change the cannula before a meal and leave the old cannula in for a couple of hours? Changing the cannula before a meal or snack allows extra insulin to be pushed through the cannula and enable a smooth start to the new insert. Also as already mentioned make sure you fill the cannula to the correct amount.

 

[martina]

Thanks for replies, always prime a unit through when have changed cannula. I need to correct for sugars to come down but once I have done that its back to normal. She does rotate the sites too. I have emailed Roche and waiting for a reply. We will try changing the cannula before a meal to see if it helps. Martina

 

[iHs]

Hello @martina

Some times bg levels can start to change due to many reasons.
If inserting the cannula in a different area doesn't work, then try a different type of set or get a cannula that's longer in length to see if that sorts things. I need to use different sets for different areas.....6mm for tummy, 8mm for backside or 30 degree angle, 6mm steel needle for top back part of arm and 30 degree for top side of legs.
If you think the sets are faulty, then use the bolus wizard sub menu and tell the Combo that the bolus is going to be delivered by pen or syringe and then see what happens to bg. The cause of the high bg might be basal related or could be bolus needing to increase.

 

[Spiker]

If you think the sets are faulty, then use the bolus wizard sub menu and tell the Combo that the bolus is going to be delivered by pen or syringe and then see what happens to bg.

Wow I wish the Animas Vibe had that feature.

 

[CarbsRok]

Wow I wish the Animas Vibe had that feature.

All you do is inject via pen/syringe then disconnect pump and bolus via the pump. Thus you still have IOB

 

[Spiker]

All you do is inject via pen/syringe then disconnect pump and bolus via the pump. Thus you still have IOB

Yeah, but. A pretty poor workaround, the "squirt on a napkin" solution. Animas could have exercised one brain cell and lifted their little finger to implement the same feature the Combo has.

 

[CarbsRok]

Yeah, but. A pretty poor workaround, the "squirt on a napkin" solution. Animas could have exercised one brain cell and lifted their little finger to implement the same feature the Combo has.

In all honesty by the time you scrolled through menu to implement it you might just as well disconnect.
Personally I would rather the pump delivered coffee but no such luck

 

[Spiker]

Personally I would rather the pump delivered coffee but no such luck

And beer and fags.

 

[iHs]

In all honesty by the time you scrolled through menu to implement it you might just as well disconnect.
Personally I would rather the pump delivered coffee but no such luck

in all honesty it takes no more time (3 or 4secs) to tell the Combo that a pen or syringe is going to be used. It's all on the bolus button on the remote along with the different type of bolus waves. I would imagine that Accuchek have also featured this on the Insight?

I'm not sure why Animas have not featured alternative ways to deliver insulin but maybe they think that their pump and sets will never malfunction and that everyone no matter what, can replace a set or replace a cartridges, when real life, it's not always easy depending where you are. I always have my pen filled with about 20u every month and if I dont use it for set problems, I use it to deliver the bolus if the cartridge is running low and I want to leave replacing it till a time that's convenient.

I use the Expert to display the IOB if I use my pen....easy once you know how

 

[bilb_baggins]

hi I have the same problem with my pump when I change my set my bg goes up I rotate my sites I am still battling with the high bg hopefully it will sort itself

 

[Spiker]

I'm not sure why Animas have not featured alternative ways to deliver insulin but maybe they think that their pump and sets will never malfunction and that everyone no matter what, can replace a set or replace a cartridges, when real life, it's not always easy depending where you are.

Yes I suspect Animas were not applying "real world" thinking to how the system is used in practice. Or, it might be another example of the stupid "intellectual property wars" where Animas was afraid of being sued for adding a sensible and obvious feature, because other manufacturers "thought of it first".

 

[donnellysdogs]

With the insight pump the fill for a set and tube is set in the "background" both depend upon the length of cannula or tube.

I also found that I went higher after every set change using the standard set up amount recommended.

I had to increase the set fill qty but cannot remember for the life of me how much I increased it by.

I never left the old set in. Giving a little extra on the preset fill solved everything.

I used to have to set change every 24 hours in the morning.. Without any eating or bolys.. This was how I identified that the set changes caused probs.

 

[Spiker]

I used to have to set change every 24 hours in the morning.. Without any eating or bolus. This was how I identified that the set changes caused probs.

You know that's very interesting DD. Because the pump DSNs train us the exact opposite, to do a set change before a meal or other bolus. Which they say is to verify the bolus is working. Fine, but it obscures problems with the basal flow not working. Often times I have had set problems where a bolus would mostly work but the basal flow was ineffective.

 

[donnellysdogs]

I found once that I ate and bolused and had a prob with a set.... And no where or no way to change it....levels went up to 30 within 40 mins.

Never did that again!!!

As I only eat once a day and my levels on pump and now on MDI are so static then it was highly noticeable that set changes etc were a prob.

 

[Applenerd81]

I always prime a new site with at least 0.25 iu (the handset only recommends 0.05 for steel cannula), this has stopped my post change hypers. Try a small bolus when applying a new set (start by adding 0.1-0.5iu and testing).

 

[donnellysdogs]

I also found that the preset fill size for cannulas with the Insight pump was not enough a nd had tweak the preset amount.

Insight you also must remember if you change length of tube or type of cannula or length of needle that the background fill settings must also be changed.