rising blood sugars; hours after a correction dose

[chromeazone]

Hi,
I've been on an insulin pump for over 4 years... (Novorapid) and have a blood sensor linked to the pump too.
Things are getting a bit weird; over the last year or so my blood sugars have been rising (before and after meals) even after giving myself correction dosages (worked out by the pump) a few hours before hand... the pump obviously takes the active insulin on board but the slowness on reducing the blood sugars has often resulted in rapidly decreasing blood rates when a second correction dose seems absolutley necessary (after 4 to 5 hours of the first correction dose; I've just given myself a correction dosage of 5.2ml 3 1/2 hours after a previous correction dose of 1.7ml)...
I've had a radio-active food test to ensure that my food is being digested as the 'normal' rate; that's okay. I've been on a refresher DAFNE course; no probs there (apaprt from some silly miscalculations occassionally), my hypo awareness is not great but I certainly know when my sugars are rising.
Has anyone else had the same problem, or similar, and has had some success in trying to reduce this lagging in getting the blood sugars to come down? Could it be the type pf insulin? could it be I'm becoming immune to my insulin? could it be poor insulin absorbtion in my middle aged midriff? could the pump need dosage ratios amending?
any help or constructive comment would be helpful...
thanks...

 

[BobCornelius]

I don't pump ( yet ), but I would be looking at having your pump software / function looked at? Bit of an MOT/service, to make sure it is doing what it should?



Bob

 

[phoenix]

I think that you have to ask why you need to correct.

Is it because you didn't give enough bolus in the first place?
Is it because your levels are rising between meals ie your basal isn't correct?.
If this is happening frequently it might be that your various rates have changed. Most of us on pumps have to change them from time to time.

Personally I would check my basal rate first.
Then look at carb factors and correction factors.
There are some worksheets from John Walsh that can help with you work them out.

http://www.diabetesnet.com/pi5

You also mention the possibility of absorption issues, have you tried using another site? I have a pump 'checkup' every six months and my sites are noted. The nurse always emphasises the need to vary and rotate sites.

 

[donnellysdogs]

Have you done recent basal testings for these periods of time?
My thoughts are that your corrections may be having to work against basal rates that are too low..

Other thoughts, is your correction factor given, the same as your 2nd? Maybe for example that say at 3pm you give a correction... And your factor rate may be 1 to 3bg.
Then when you give your 2nd at a different time your correction factor may be 1 to 2.6 so you getting wrong correction factors used. The thing is, you should be aiming to get down to target level at 5 hours... Not 3.5hrs.. Your pump will recommend more according to your acting time and offset times... These will also impact on when your pump thinks you need more, even when possibly you would have come down after 5hrs....

Think you need to do basal tests for times of highs..
Do correction tests at a bg level of 10. Allow first correction to run for full 5 hours.
You will be able to see during the first 5 hours just how long your insulin takes to work, and how long it lasts if your basals are tested first and are good.

If I get my basals right first, I will eat 2 custard creams without a bolus. I know without a bolus and if I am at home, then my levels will go up to 9/10ish within about 50 mins.... I then do a correction and see what happens, how quick, and how long it takes to get back to target level. If I come down to target level before 5 hours... Then I know for sure that at 5 hours I will be far too low..

 

[chromeazone]

Thanks to all your amazing replies... I suddenly realise how little I know about my Diabetes control after taking so much for granted over so many years.
After going on a DAFNE course I think my assumptions on charbohydrates are reasonable but whilst abroad these suffer a bit but not to the point where I need to run 2 correction doses.
I had had enough of the high blood sugars last night and have become so frustrated that I decided to change the catheter and site that it was in and within 2 hours the blood sugar levels started to level out. Bolus and Basal seem to activate within 1/2 an hour today so I'm dfeeling so much better and I will give my entire stomach area a huge break from 'injections'
I will take all the replies seriously and will contact my Diabetic Specialist Nurse at the Hospital to ask if tests on the pump can be made (or Medtronic) and will ask for tests to be done on my 'injection' sites, together with asking for more advice and training on insulin control...
Many thanks to all your replies...
It helps to know that there are other people out in the workld that can help me through their own experiences...
Best regards and good helath to us all...

 

[donnellysdogs]

Sites can be a huge factor to levels and corrections working (or not)...
I know my right bum cheek will not be so good as my left... Which incidentally.. I've used my left bum cheek for majority of sets and injections for nigh on 30 years, but it remains good and absorption is so much better there than anywhere else..
If, I get to a point where I have to do more than one correction I will change everything.. Tube and set and site...

 

[chromeazone]

I hadn't come accross this in my 37 years of being diabetic so it was a bit of a rude awakening...
I had asked the hospital if the catheter can be used on the bum (it's a question of comfort on sitting and whether there is a little bulge under trousers etc...) but I think more sites might be very useful for me rather than becoming reliant on either side of the belly button...
thanks, donnellysdogs; good advice on changing everything if 2nd dose is required...

 

[iHs]

Hi

The only thing with changing sites on body for infusion sets is that it might mean a new basal rate being set up and possibly a new insulin to carb ratio as well. I appear to have areas where infusion sets no longer work very well and it does get a bit worrying to say the least....

 

[donnellysdogs]

Agree with iHs.. I'm trying to decide now whether to set up a different rate for right cheek of my bum.. And to raise my bolus's by 30% for it..

 

[chromeazone]

I'm amazed that there's such a difference and quite frustrated that when I talked with my Diabetes Specialist there was no mention of these differences... I have a bit more investigating to be done by the sounds of it... thanks for advising me of your findings... Who first made you aware of the differences in dose in relationship to the infusion sites?

 

[phoenix]

Here's a pic of possible sites
http://www.springnow.com/infusion-site-guide.html
Personally, I don't use an inserter and am not as flexible as I once was so couldn't manage to insert as far round as the man in the picture has.
I probably get the fastest/best absorption in my thighs however I haven't found it necessary to change rates for site. I rotate thighs, hips and as far round on my bum as I can get . Occasionally I use my stomach but a bit in trepidation as if It's at all warm I get an allergic reaction from the adhesive which produces itching and red welts so I end up having to change anyway. Have never used arms though read of people that do .I think a lot of people who use tubeless pumps like the arms as a site.


Have you seen the John Walsh book Pumping insulin? I found that invaluable at the start and still refer to it from time to time.

 

[chromeazone]

Thanks, Phonenix, for update,
I hadn't realised that there was so much info...
I will have a look at the John Walsh book; I've never referred to any other literature apart from that issued by the Hospital / pump supplier (which is a little naieve of me)...
Best regards and many thanks for input...

 

[Oblomov]

Just had to post. T1 for 40 years, been on a minimed pump for last 8. Am having exactly same, so reading with interest.

 

[WilliamIrvine]

Having read all these details etc about pumps I am really tempted to inquire about 1. I do believe though that NHS Greater Glasgow and Clyde in their wise wisdom aren't supplying at the moment. Maybe a small e-mail to my MP might do the trick. However will e-mail my consultant when she returns from holiday <how dare she take time off> and start the ball rolling.