Pump - changing sets and getting highs

[donnellysdogs]

Back to Accuchek pump. Which I do have use of previously for 4 years without problems using the rapid d sets.


Three set changes done with the 6mm sets.

1st high, put another in and high over night but too tired to care and the next day ok.

Monday: new set at 8.30. Was going to evening basal test so did a breakfast bolus... Fluffing around before having breakfast and levels started to climb before I got round to eating. So for first time ever I actually left the set in. I had 6.8 of corrections (two injections) and a peak of 17.9 and NO breakfast! But they did come down by 5pm.

Tuesday perfection with the same set in. All levels between 3.8 to 6.9.

Overnight to today perfect. Woke up at 5.0. Did cartridge and diet change at 8.30.
Levels then dropped to 4.1 by 9.30am.
No eating at all. No bolus's. By 12.13 including a 0.7 correction on pump I was 13.5.

Correction by pen of 2 units and down to 6.2 by 4pm.

My question is... How many people have to guesstimate a correction... Which effectively I did have of 6.8 units without it working until 5pm Thor every set change.

My pump adviser is telling me that it isn't "uncommon" for people with steel sets to have Unknown rises after set changes and to do a little ahead correction to ward them off. My problem is that even the corrections do not work until I do the with a pen and 8 hours later the set seems to have corrected and settled in until the next change.

Please can I ask people that are using any steel set whether they have to do just an ad hoc bolus to counteract highs following a set change?

 

[azure]

Hi @donnellysdogs I use steel sets (thanks to your help) but I don't have this problem usually. I leave my old site in for a couple of hours. I also try to change sets before a meal so I can bolus soon after insertion. My DSN recommended that when I first started pumping as she said the bolus would help push any trapped flesh through and get the site established berter.

 

[donnellysdogs]

On Monday. I set changed and bolused for breakfast. 3.1 units and never ate breakfast in the end. So I had 3.1 units for not eating, and another correction and even the corrections not work. Jumped up to 17 still with extra corrections thru pump before doing injections.

Happened on 3 out of 3 set changes.

I couldn't eat as my levels would go even higher! This is what happened when I ended up in A&E for the first time ever.

Hospital solution:
Wait to see what happens and correct... or: (why should I have to accept high levels and swings?)

Or : figure out for myself a bolus to give on cannula change.... I don't know that every cannula will fail initially-it puts me in danger if I need to drive or do anything if the set is working immediately; or do I use the pump? Use injection? When should I put through a pre empting bolus??

I was hunky dory on pump for 5 years and all of a sudden the Insight rapid d's kep failing. Came off pump. Handed Insight back.

This is 2nd attempt with my old back up pump which has been replaced back in August when we were trying to find out causes of troubles.

Again today after set channge highs yesterday and leaving set in levels came back to normal and have remained perfect again!!

I dread again tomorrow with set change again.

I know @MushyPeaBrain has probs similar to mine on occasions.

As I am so limited with food etc this is making it horrible around food times, need to drive, etc. I really am at my wits end...

 

[azure]

I sometimes use my insulin pen when I'm dealing with a not so good set - you know, the ones that kind of work but not very well? Having that pen insulin on board can stop highs and give the set a chance to settle and/or me a little longer before I have to change to a new set and give up on that one.

So I think what I would do is leave the set (if it's likely to settle in and start working, that is) and use a pen to correct but only when BS creeps up, not to,pre-empt.

Do you think it could be the area where you're inserting your sets? I used my tummy when I first had a pump. I used it fine for 4 or 5 years, and then it suddenly went **** and I was constantly changing sets and waking with highs. Moving to a new body area solved that very well.

I know you may be limited in what areas you can use, but I now use my bum and thighs. I'm currently using my bum but can feel the site areas 'wearing out' so will soon move to my thighs.

If you think it's the Rapid Ds themselves, could you try a different brand? I now have a Vibe and use Animas equivalent of Rapid D's.

 

[donnellysdogs]

Have asked to see rep and tenderlinks despite having chronic phobia about the sideway sets.

Are they ok for thin people?

 

[donnellysdogs]

I used my bum for prob 90% of time in 30 + years. Nothing wrong with it. I inject in my legs then. I have put a maximum of 12 sets in stomach.. and this is where the D's are now.

Initially I though could be my sites so changed from bum cheeks. Injections in bum and legs etc still work well there. So I'm using stomach which should have no problems at all.. i get no lumps etc any where on any of my sites..

I am going to suggest to my pump educator that perhaps I could try different brand (they no longer deal with DANA tho which would have been great with 4.5 sets) or could it be the insulin???

Glad to never w have realised the exact timings etc of probs.

Trouble is one day even with 6.8 and no food levels went to 17+.

Yest with 2.7 (2 by pen) I still peaked at 13 (much reduced)...

How much to estimate how high I am going to go?

If first bolus fail on pump (as they have been) when I actually eat my scrappy bit of food in the evening is it going to fail on that 1st bolus?

This are the thiughts going through my brain... what happens if I don't do that non working first bolus? Is it just going to then occlude from just basals as it was back in August?

My team just use emails for communications once a day so not get opportunity to discuss as such..

 

[azure]

Have asked to see rep and tenderlinks despite having chronic phobia about the sideway sets.

Are they ok for thin people?

I used Tenderlinks - they were fine and I'm slim I used 13mm length cannula in my thighs and 17mm in my bum. Inserting them is ok once you get the knack and the right angle. They're a neat little set and don't have a 'dangly bit' like the Rapid Ds.

 

[azure]

I would correct by pen in tiny amounts so you can add more corrections according to your rise. Obviously watch that you don't stack insulin, but I would correct in tiny amounts by pen (I have a half unit pen) and as necessary.

You mentioned just using the pump for basal. My consultant has a patient who does that - the pump delivers basal and then she injects her boluses with her pen. I actually tried this recently in an attempt to prolong how long my body areas lasted. It worked well, but a half unit pen is definitely advisable.

But then, that doesn't solve your set problem. I wonder whether your tummy is a bad area? I planned to go back to using my tummy after a year or two, but it just doesn't work any more. It was more than 7 years ago, I stopped using it and I've tried it a number of times since, but just go high like the insulin isn't being absorbed. There are no lumps or weird bits in my tummy - it looks fine but just doesn't work. I wonder if it's due to not having enough fat because my arms don't work either.

If you get the Tenderlinks, you could maybe try your thigh? That's my favourite place and probably the area that works best for me.

 

[dancer]

Have you tried a temporary basal along with the injection?

It looks like the usual trial and error situation which, I know, can be very scary.

 

[tim2000s]

Hi @donnellysdogs , I wonder if it's simply that after everything your body has gone through, each new set is resulting in an exacerbated immune response. If you consider that there is a fairly well documented (even if anecdotal) evidence set that demonstrates that quite a lot of people suffer with higher than normal blood glucose levels after set changes, it sounds as though you are seeing an extreme version of that. Especially as everything settles down afterwards.

It may be that using a different set type will make this less of a problem.

 

[donnellysdogs]

I'm hoping a change will help.
My stomach is practically a virgin area of usage.

What happened in August when I was unable to eat in mornings was this:

Put set in stomach, think ok and gradually by 3pm onward I would get occlusions.. thats why I am just wondering if to do a blank bolus with the pump say for 2 units. So far the pump correction boluses have done nothing- only the pens as far as levels are concerned but it will kick start the basal running - otherwise I'm just going to be running with no basal at all and chronic DP & WP.

If I do it at night when I eat
my teaplate of food.. I could effectively bolus for my food on the pump BUT also remember the amount and to do a correction up to that bolus for the tea over say 4 hours.

However, this just makes me think what an efgort to just manage living.

I don't want perfection. Just normal bloods.
Even at this moment... I had brnch today which was my highest level.. went to 7.8 and back down nicely to 5's so I can basal test tonight.

Also the trouble is with all of this at the moment is:

Yesterday with high levels I couldn't eat much. Today I need to basal test. So my food today has been 100g of yogurt. Yest evening when my levels finally came down I had a sloppy homemade teaplate of corned beef hash. And 7 almonds daily. So ut is limitting my already very small poor eating (due to my colon troubles)...

I've just had to change over my tablets for stomach and start new ones tomorrow.. so this may also impact on everything too. I get chronic nausea and stomach pain and horrible BM's so I need to really keep to my eating otgerwise I will go backward with anaemia again etc....

From 5pmish onwards on that first day right through to set change my levels are so good...

Jyst don't know if all this faffing around is worth it. Think I will see how I get on with tenderlinks.. I'm so small that on my tummy I have already rotated on my left side in a week and have to use the right side now. I guess if people have larger waists etc this gives more skin to rotate on. Sadly, my bum used to be a lovely JLo bum but now its barely there at all so think I will get probs as I was back in August using my bum. Legs always bleed with sets but ok 99% of time with needles.

Think I'm just burnt out with struggling with cancer, stomach and diabetes...laughable really tgat cancer can become the least significant thing!!

Just got to wait for rep to contact me tomorrow to arrange "training" with new sets and I guess the Rep looking at all my details of problems.

I not had any contact from hospital at all today so far.

I just want some quality of life with levels that are acceptable at under 7.8....
Thats always been my thinking but now I just have 50% and that just not good enough for me....

 

[donnellysdogs]

Have you tried a temporary basal along with the injection?

It looks like the usual trial and error situation which, I know, can be very scary.

No I haven't. Its just the rise starts to occur abiut 1hr later and hits at 4hrs later... so would a temp basal attack that prob?

Tge 4 hours before waking I pump through 40% of my total daily dose. I'm thinking it would have to be started an hiur or two before my aet change to be effective but this wouldn't resolve the issue of that new set not working initially until my skin settles?

I can give it a go... if I did for two hours when new set in with pen bolus it may get my body accepting the set quicker?

Think I read somewhere @tim2000s about a rare thing hapoening with new sets like you describe. Must be in John Walsh book...will try to find what is recommended....

 

[donnellysdogs]

&Azure I wouldn't mind the pump just to give basal but it can't do that after a set change... only eating food enough for a hamster once a day and a bolus by pen would be no prob at all.. just that after 5pmish in that first day bolus's are ok.

After almost lising my licence 6 years ago. I admit I am absolutely petrified of driving and having any unknown bolus in me.
So on too of planning or cancelling things when my stomach is ok I would also have to knock a period out for unknown bolys every other day....at least until I could establish a routine for myself.

Perhaps 4am shots every day aren't so bad? At least I know that insulin is out if me and what I need.....

 

[azure]

@donnellysdogs It must be horrible trying to basal test when you're already restricted in what you eat. The only idea I have is simply don't basal test during the day. When I was pregnant, I had to change my basal numerous times and my ratios too. Obviously I wasn't going to not eat, so I just tweaked both the basal and the ratios until I got good numbers. I ddint worry if my bolus was partly doing the basal's job or anything. All I cared about was getting my BS good.

Regarding the sets bleeding in your thighs - perhaps you could try a Tenderlink there? I've only ever used the steel sets in my bum. I pinch up my thigh, manually insert the Tenderlink, and it's fine. I don't feel it, it doesn't bleed and it works well. I'm small like you and I find the thighs much easier to get plenty of sites on than the tummy.

Not saying you should do that if you don't want to, but it might be worth a try.

*I had another thought - could you insert the new set while the old set, with pump attached, is still working? So have an overlap? That way the new set would settle in to your skin for some hours before you switch the pump across to that new site.

 

[donnellysdogs]

Thanks for things to try everyone!!

Tomorrow is changeover.

I like idea of putting in a new set and letting it settle but how would that be done? Would I just prime it out of my body as per ysual and put it in and cap it off for 4 hours? And just reconnect back to the old one?

I haven't got any of the caps currently but can phone them tomorrow and order.

Is that tge way I would do it?

Tomorrow, as got no caps I will wait till levels start to climb and then do a double bolus. A duff one with set and one that works with pump. See what will happen.

Just wondering whether to do this at say 1pm instead of 8.30am so that when the set change happens my body isn't fighting with the waking phenomenon that occurs with me so badly.

If I do at 1.30 ish hopefully the climb would be less. Just may be facing highs when I need to eat at tea time though!!

I never used to basal test tgat iffen either to be honest. Only really three times a year. When clicks changed and July when I always used to have bad hypo's. i'm used to just tweaking. However the new hospital are wanting 4 stabs a day and my libre results and some basal testing. They are really treating me as if I am well, just a newbie to pumping.

They have had results sent to them but they weren't the ones to identify the link to cannula. They got details why I gave up pumps twice before.

I haven't even got to the think about the CGM yet that I was allocated 3 months funding for! Thank goodness for the libre!!

All levels today been superb again.. 7.7 high and a 4.3 5 hours after my 100g yogurt!!-lol.
Apart from eating they've stagnated in the 5's all day. I couldn't wish for better results.

I sound so damning really about hospital knowledge and treating me like a newbie.. they are caring, they are batter than last hospital. I guess I just wanted their help with this problem and better suggestions than their just being vague and not even suggesting tenderlink. I suggested it by email last night.

I have had more options and help suggested to me by experienced people and for that I am so, so grateful.

Just going to need to ask my hubby to pick up
a bag of courage for me at the shops to give tenderlinks ago if I can get the Rep to train me... another official line that has to be dotted and crossed yet!!

Thank you all so much for coming to my rescue with some ideas... I am so grateful.

 

[azure]

I think you'd have to experiment with what worked best for set overlaps and letting a new set settle. I just meant insert it and cap it off, putting the pump back into your old site. The new site would then hopefully settle in ie skin irritation would settle. I'd then leave the new set for a few hours before swapping the pump over to it and using it as normal. If I did that, I'd also leave the old set in a couple of hours, as advised by my DSN.

Don't let your team stress you. Mine have learnt that I'm grateful for their advice but will do what I think best as its my diabetes and my health

 

[iHs]

Just remember to prime a new set first before capping it otherwise blood might try to come up the cannula or steel needle and possibly block it until insulin pushes it through again.

 

[donnellysdogs]

Just remember to prime a new set first before capping it otherwise blood might try to come up the cannula or steel needle and possibly block it until insulin pushes it through again.

So if steel cannula and it primed before it goes in body.. still bolus something before capping?



This is no joke.. just done.. with injections up until a period of 2 hours out and I forgot jabs.
1 hr ago I was this.. with a recommended 1.7 that I doubled as I forgot pen


Had to do another set change at 3.30pm after 1pm one as it was so painful... this is in right sude of stomach.
What I did was leave old one in today and hooked up to new and did a 1 unit supposed bolus with pump but also did with pen. Was 9.7 at 5.05pm and by 5.56 17.0. When I whacked through the supposedly 3.4 units cos of pen forget.
Now 21.3 and just gonna shove in 5 units by pen...

Really questioning if its worth it.

Will be normal tomorrow but bouncing and feeling **** is a joke.

 

[azure]

I can't understand why it's doing that : (

Do think about trying a new body area. The only time that anything similar happened to me was when I tried my arms out of desperation. My sugars were mad and kept going high but then seemed to be ok - before going high again overnight.

 

[donnellysdogs]

Didn't have the 27carbs either. Depite not eating anything since yest 100g yogurt at lunchtime. I had thought about having cauli cheese when I got in and bolysed for it and can't face eating it and knowing I'll make myself worse bg wise.
Its just purely set change over day. Tomorrow will be perfect again...
this happens in bum that I thought may need a break from 30 years stabbing... skun still perfect but exactly same happens tgere.

Got libre in right arm. Don't think I should inject near that and left arm not usable. Injections fine on legs -anywhere, although sometimes bruise. Sets always bleed and have had a real gusher of blood trickle down to ankle a few years ago.. its only place where blood can and has gone back up the tube. Legs are very thin now. Used to have a lot of muscle in them but all that just vanished and justl left with not much more than matchsticks now. Size 8 jeans on them hang off the too of my legs...

Going to try the sideway sets next.

Bolused 5 units extra!!

As mych as not liking 4am double jabs of insulin each and everyday. This is killing me..