ketones and the pump

[baroque541]

I am really pleased with my pump, have had it for 8 months. It has made me feel better all the time, especially at night, when I always had the feeling that Glargine was irritating my bladder.

Usually I do not get ketones. Four weeks ago I got a really bad chest infection - no cold, just pain on breathing in which started very quickly one night. I thought briefly about a heart attack, it was so uncomfortable, but only on the inward breath. Had some antibiotics for a week, it improved a bit. Then 2 weeks later it came back with a vengeance, this time with ketones.

Can anybody tell me;
- why do I have ketones now when I never had them before? Maybe this is a worse infection than anything I have had before.
- how come just doubling the correction dose as advised has very little effect? I have to treat the ketones very aggressively with pen, especially when the pump recommends 0 bolus or something silly like 0.5 because it keeps a record of the insulin I have had recently. I have been going back and editing my results when I take an injection with the pen.

The result of this is that usually the ketones go down within a couple of hours or a bit more - but I can't tell you how awful I feel when I have ketones - and then I often go hypo. Of course I would rather be hypo than have ketones, but it is very hard to manage food, as I feel so bad I don't want to eat when I have ketones, and with these antibiotics I usually feel a bit sick after meals.

 

[SophiaW]

Are you setting a temporary basal rate if your readings are running high due to this infection? Making a correction bolus is necessary if your reading is high but we find that setting an increased temporary basal also helps to control high readings very effectively when they are high because of an infection. The temporary basal for my daughter is more effective at controlling the readings than doing a correction bolus every few hours - often we do a combination of the two, temp basal plus bolus corrections when necessary. The ketones may be worse this time because of the infection being more agressive or are your readings maybe running higher than they did the last time? If you're doing correction boluses with a pen be careful that you don't "stack" your insulin resulting in a hypo, you can then end up swinging from lows to highs as a result of the hypo which you want to avoid. Keep testing ketones and if they get too high and don't appear to be coming down then make sure you get help as high ketones with a pump can become dangerous very quickly. Also make sure you keep doing pump checks and cannula/site checks to make sure the high readings aren't a result of a pump/site problem rather than the infection. I hope you get over the infection and start to feel better soon

 

[baroque541]

SophiaW -
Thank you very much for your reply. I did discuss a temporary basal rate with my specialist but she was not keen because of the occasional hypos even during the day. However she now says I should do it in the morning when the pattern is that I go high and get ketones - sometimes even before the bloods go up much! When they do go up they go quickly, so I have been using the pen in the mornings. I think you are right about the TBR being better than keep giving a correction bolus.
Thanks for the advice on being careful not to 'stack' the insulin - this is actually part of the reason I went on the pump, because stress (I'm a musician) can send blood sugars up a lot, then they used to go down just before a concert because of this stacking - and I don't even suffer from nerves!
As for the ketones, I wasn't getting them at the start of the infection, and had never had them before.
The other worrying thing is that my temperature has been so high - 103 yesterday evening. I am taking Nurofen for this, and think it helps. Not so high this evening, 101.5 - so I feel a little better.
I will check cannula and pump as you suggest. Thanks again.