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T1 Pumper with unstoppable spikes in BG

pumper1969

pumper1969

Member
Hi - I'm looking for advice on how to deal with this? I have been on my pump for 18 years, T1 for 45 years, well controlled and have a continuous glucose monitor which is a great help. My issue is that occasionally my BG goes up on a steep trajectory, and no matter what I do (extra bolus of insulin, change infusion site, etc) it just keeps going. Yesterday I was between 5 and 8 all day, then went up to 12, did a corrective bolus and changed the infusion site, but it kept going up for 3 hours to 24, before coming back down to 4.5 during the night. It's almost like my body is saying "I'm going up now, whatever you do", and then gets to the top, and decides to come down "whatever I try to do". Is this pooling? And if so, what do I do to treat it!? Thanks
 
pumper1969 said:
Hi - I'm looking for advice on how to deal with this? I have been on my pump for 18 years, T1 for 45 years, well controlled and have a continuous glucose monitor which is a great help. My issue is that occasionally my BG goes up on a steep trajectory, and no matter what I do (extra bolus of insulin, change infusion site, etc) it just keeps going. Yesterday I was between 5 and 8 all day, then went up to 12, did a corrective bolus and changed the infusion site, but it kept going up for 3 hours to 24, before coming back down to 4.5 during the night. It's almost like my body is saying "I'm going up now, whatever you do", and then gets to the top, and decides to come down "whatever I try to do". Is this pooling? And if so, what do I do to treat it!? Thanks
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Pumper, I'm neither T1, nor pumper, so have no specific wisdom to offer you, but how often is "occasionally"? Is it roughly, once a week, once a month, or whatever? Just on average.

How does the timing relate to set changes? Is your cannula always on the same site, or does this happen on various places on your body? Do you rotate sites?

Does this happen after any particular sort of food, or drink? Exercise, or a sedentary period?

I'm good on questions; less great on answers. :)
 
I'm not sure how much insulin you take at once. But pumps can cause what we call tunneling, which means the insulin just stays under the skin and doesn't absorb. Smaller doses, say not more than 2-3 units at once help stop it. But larger doses can easily cause it.

Also if you have been a T1 for years, there can be a problem with scarring and you end up with bad sites more often, Rotating is key to stopping this but some people seem more prone than others. I know that some pumpers start trying totally new areas when this has happened to them. If this is the issue you might try some of the scar oils to try to correct it if you can.

Plus sometimes you just become more susceptible to certain things happening, so is it certain foods you are eating? I'm not sure how much you know but high fat slows absorption. The higher fat the more of a delay. But if the insulin is kicking in later sometimes, it sounds like you might be dealing with poor absorption sites.
 
Hello @pumper1969

Ideally it would help to know more about your activity around the time of this, so food eaten, exercise ? How long your set had been in place ?

If your dealing with an unexplained high so no recent food intake/exercise event or set change, then i'd check the following, check your infusion site for lumps/leaks/bleeding, look for air in the set or if it had come loose, if all ok then replace both the set and use fresh insulin.

To manage highs do you keep a novorapid pen in the fridge for back up ? It's the easiest and quickest way to bring down a high reading particularly when your in the twenties, also check for ketones, with a lack of insulin in the system becoming unwell with DKA can happen very quickly, as a pumper myself we have to take extra care to manage our highs compared to those on MDI.

Check your sites carefully as Marie has said scarring can cause absorption issues so insulin will pool under the skin so rotating sites is key.
 
Thanks all for your replies. This happens maybe once a month, usually if I've under-bolused so goes up to say 12, but then it just keeps on going rather than coming back down like it normally would with a corrective bolus.

The tunnelling sounds interesting though, because often it happens when I might say be going out for a couple of drinks or some food and I continue to eat/drink (not excessively) having thought I'd bolused the correct amount to a) bring it down and b) for whatever I might eat. So I might give myself 6 units - 2 to bring it down to the correct level, and 4 for what I'm about to eat. Which usually works. But if it doesn't absorb properly (tunnelling? Is that the same as pooling?), I guess what I then eat will continue to raise my BG without the insulin to go with it.

I don't think it's scarring, I've had a pump for 18 years, but I rotate every 48 hours from left stomach, left leg, right leg, right stomach....and so on. So it never stays in the same place very long. And when it happens, like yesterday, I move the site immediately to rule out a poor infusions site/poor absorption. Also I use Novorapid in the pump anyway so its quick acting.

And regardless of what I'm eating/doing, the key point is that ALL the insulin I bolus EVENTUALLY does it's job - so it's not that the insulin doesn't go in at all, it's the length of time it takes to act which is very different to a normal reaction. So yesterday my Freestyle Libra graph results look like a mountain!! It just goes up, and up, and up in a very straight line, and then when it hit 24 yesterday, it decided it was finally going to take notice of all the insulin I had bolused over a 2-3 hour period - and then came down in an equally straight line (regardless of what I then ate over those 2-3 hours).

I think this could this be tunnelling then - and maybe I should not eat/drink anything at all til I see it start to come down?
 
Also Juicyj and Marie 2, I did used to get air gaps in my tube which did cause this, but now I'm on the sealed insulin cartridges so wouldn't have thought there would be any air gaps?
 
Hello @pumper1969

If it’s happening on a night after a period of eating and drinking then I’d relate it to this and not absorption issues, as it’s happening around an unusual event and not happening otherwise. A few things will be at play though, firstly eating more than usual can result in slow carb absorption as can eating more fat/protein. I also find when I go high so above 12 I can hit a wall of insulin resistance and have to take more quick acting than usual to remedy this. I had a high BG event during the night, I ate a steak last night, was in range perfectly before bed and went up and up waking high this morning, I always seem to get this when eating more protein/fat than usual.
 
Juicyj what you call "a wall of insulin resistance" is the perfect description for it. It goes on and on, but also when I'm continuing to eat/drink, even though what would normally be small quantities - so not exactly helping myself!! I like the tip of smaller doses, and maybe just have zero carbs until it starts to peak and come down then at least I know the insulin is working again.

Not always easy if I'm out for a pint or two!
 
Yes, for me once I am too too high it takes a lot more to get it to come down and it takes a lot longer than just a small correction. So if you are still adding to the problem that could really explain it.

Be aware that scarring just happens to some people whether they have always rotated well. We are putting a foreign object in our tissue and when you do that the body starts to react. Cgm’s don’t cause it as easily because it is a thinner cannula, but insulin coming from a thicker cannula can cause more of a reaction. So over time for some people you have built up scarring even with good rotation. But some people get scarring from MDI too.

I have some specific areas that don’t seem to absorb as well.
 
I use all over my abdomen, but I have pods so for me if I ever need to I can switch to some more novel areas, which some people do when they have issues like the arms and legs are common.

But when I was on MDI I had never been told about moving about, for years I didn’t know so I commonly used the same smaller area. So I have a 4-6 inch area below the belly button that’s not good. I also seem to have a smaller area to the right of my belly button. My bad sites might all be linked to MDI areas in the past as my upper and sides of my abdomen work well.
 
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