Where do I start with crazy BG?

[MushyPeaBrain]

So I'm starting to have some real issues with control and I've no idea where to start to regain better BG. My BG suddenly went erratic a few months ago and I wasn't sure what it was. At one point I identified issues caused by faulty sets and removed all of these batches. Now I always keep 2 different batches so I can rule that out. Everything seemed to settle and then again they went crazy. Changed sets, tubing, etc and when injections brought down high BG I changed vial. However I'm starting to suspect there's more to this. So on top of all this with stress I gained weight. Not sure how much as I don;t weigh myself but I've probably gone up a dress size - so from 10 to 12. I know this would effect my basal and bolus needs. The weight gain made my painful sets much more comfy. However I can't seem to get a grip on my insulin needs. I'm running huge temp basal (like +40% with one set and then +120% with another. I'm also bolusing much, much more. I literally seemed to have tripled my insulin needs. I have had to take to injecting to bring high BG down as the pump will maintain basal but doesn't tough BG over 7 with any amount of bolus. I'm not ill but I am feeling run down from the stress of this. I could do with some help please on where to start to regain my good control.

Is this all down to the weight gain or something more?

 

[tim2000s]

While I'm not female, I've gained about ten pound sand not seen similar issues. I'm wondering whether you are seeing thyroid issues?

 

[ewelina]

Thyroid can be an issue as Tim said. Also, is your lifestyle a bit different now, over Chrismtas period? I'm on school holidays now, and Ive noticed that I need much more insulin. Today I struggled to bring my levels below 8 whole day. 20 minutes exercise with youtube solved the problem Not being active, as much as usual, will change your insulin needs

 

[MushyPeaBrain]

Well things are different over Christmas but this has been going on well before that. Would I have any symptoms of thyroid? I gained the weight because I was comfort eating but I am surprised it's had such an effect. Current set is a good example of the weirdness. Changed yesterday and BG held at 5 after lunch so looked good. After dinner they shot up to 10 (I never used to go above 9 much at all) and I put on temp basal of +150 and correction bolus. They appeared to hold at 10 then started rising further 2 hours plus after food. I kept bolusing and eventually got them back to 10 but couldn't get below. Was 1am by now and I was tired so ended up injecting. That brought it straight down and went hypo! This set is like many of my others now so not worth changing site because bolus not doing much is the norm.

This morning woke up high at 9 so tried bolusing to correct but over an hour and no change. I don't eat unless BG is 5 or lower so no breakfast for me.

 

[noblehead]

Some complex issues going on there @MushyPeaBrain, running a TBR between 40-120% depending on sets just doesn't seems right, can I ask if you've mentioned this to your pump DSN/Consultant?

 

[MushyPeaBrain]

I would have mentioned to DSN but they cancelled last appointment and now not seeing until first week of Feb. one DSN is off on long term sick so the other is struggling and hard to get hold of. Mind you they've never been much help with anything pump related in the past. They can show you how to use it and that's it. Doctor changes every appointment too so clinics almost pointless these days.

 

[noblehead]

@MushyPeaBrain, given the situation you now find yourself in I'd be on the phone next week and pushing for a appointment asap with the diabetes consultant, you shouldn't have to be running TBR's all the time and having to inject just to keep your bg levels down, there's something not right and it needs to be investigated.

 

[azure]

Definitely speak to your team for advice.

I don't know if it's relevant to you at all, but I had a similar thing happen a few years ago. I seemed to be fighting a losing battle with my sugars and constantly correcting and using temp basals. I honestly thought something had gone horribly wrong as I normally have very good control.

Finally, I identified the cause - I'd used only my tummy for sites for the 4 or 5 years I'd been using the pump, and somehow it wouldn't work any more. I swapped to my bum and after a few days of perfecting which set to use, my sugars went back to normal.

Do you use different body areas? Have you tried a different kind of set?

 

[CarbsRok]

Sounds to me as if you need to do a basic basal test. No idea what age you are so is it a hormonal thing for instance, as others have mentioned could be thyroid.
Comfort eating certainly doesn't help either
It could just be the fact that your body needs have changed since you got older thus your basal is on the move a lot more than you realised and all the alleged bad batches of cannulas are in fact your basal changes and nothing to do with the cannulas at all.

 

[MushyPeaBrain]

@azure I injected my tummy for 30 years so can't use it at all due to damage. I started pumping 5 years ago and use hips all the way to back and then my front between boobs and waist line. I rotate very carefully and so each site is not used again for about 6 weeks. I considered site fatigue before and mentioned at my clinic appt but they felt everywhere and said they saw no signs of site issues or scar damage so it wasn't that. I am partially sighted and have lots of moles so it's hard for me to do any other sites. My legs are too thin and my arms use a libre and are quite thin too. I did try inset 30 but it caused huge red lumps. I also tried contact detach but they leaked insulin at site and I had huge high BG with them. My DSN said I need to stick with the insets.

@CarbsRok funny you should mention age as I am 39 in Feb and I have certainly noticed my monthly cycle affects my BG much more than it used to. I asked about hormonal affects at my clinic and the doctor said it doesn't affect women that she is aware of. Would you say this is true? The bad batches were def that as they caused occlusion alarms and when I gave some of the sets to a friend also on the vibe they gave her occlusions too.

I've looked up thyroid and it could be that as I feel like I'm becoming insulin resistant plus I'm more tired than I used to be - although had put that down to getting older and more erratic BG. I'm going to ask to have it tested.

 

[azure]

It sounds like you've tried quite a few things @MushyPeaBrain I don't know what else to suggest : (

I can't use my tummy any more as the insulin just won't absorb. It doesn't feel any different, but it just won't work. I now use my bum and thighs (quite slim and muscly, but they work ok)

The only other thing I can think of is to try a different length cannula.

I know how frustrating and upsetting it is to have problems like this. I know I'm not much help, but I do sympathise enormously. I really hope you find something that works for you.

 

[Gaz-M]

with regards to the thyriod function, when mine was overactive and before I had the radio iodene tablet my bloods sugar and weight was terrible, down from 10.5 stone to 8 in a few months, then would have weight come back on but then dissapear again.

Blood sugar was horrendous, mid to high 20,s some days and others mils hypo nearly all day, suffered from ketoacidosis 3 times so starved myself but still took insulin in same doses and drank water like it was going out of fashion. I was also constantly tired and spent alot of my day off from work in bed most the time.

Hope you get the problem, whatever it is sorted out asap

 

[CarbsRok]

funny you should mention age as I am 39 in Feb and I have certainly noticed my monthly cycle affects my BG much more than it used to. I asked about hormonal affects at my clinic and the doctor said it doesn't affect women that she is aware of. Would you say this is true? The bad batches were def that as they caused occlusion alarms and when I gave some of the sets to a friend also on the vibe they gave her occlusions too.

What planet is that doctor on? That is surely basic medical knowledge that hormones affect blood sugars. Are you starting the process of the menopause, Some people start earlier than others.
The comfort detach which is an angled set is very good for skinny people. There is no inserter with it you just push it in at what ever speed and angle you want.

 

[tigger]

Someone told me they had to stop pumping because of the menopause as it wrecked her site absorption and she was a long term pumper. Drs refused to believe this initially but she is an academic and convinced in the end.

 

[MushyPeaBrain]

I really hope I don't have to stop pumping. My diabetic clinic have been totally unhelpful with any pump problems in the past. I'm basically fending for myself.

@CarbsRok I did want to try the inset 30s again but the last 2 left me with such large lumps that I still can't use that area. I don't want to lose any more real estate - any idea why that happened?

Currently injecting for meals and using pump for basal but with large temp basals that vary

 

[CarbsRok]

I really hope I don't have to stop pumping. My diabetic clinic have been totally unhelpful with any pump problems in the past. I'm basically fending for myself.

@CarbsRok I did want to try the inset 30s again but the last 2 left me with such large lumps that I still can't use that area. I don't want to lose any more real estate - any idea why that happened?

Currently injecting for meals and using pump for basal but with large temp basals that vary

I didn't say use the inset 30 I said try the comfort cannula. Which you insert yourself. The 30 goes off like a torpedo. They certainly don't leave huge lumps or bumps though so suspect you didn't follow the instructions carefully

Bottom line is either your basal is well out and you need to basal test or you are using the wrong cannula for your needs. As you say you need large varying temp basals then a basal test is the obvious thing to try first.

 

[MushyPeaBrain]

I didn't say use the inset 30 I said try the comfort cannula. Which you insert yourself. The 30 goes off like a torpedo. They certainly don't leave huge lumps or bumps though so suspect you didn't follow the instructions carefully

Bottom line is either your basal is well out and you need to basal test or you are using the wrong cannula for your needs. As you say you need large varying temp basals then a basal test is the obvious thing to try first.

I'm not sure I would be able to insert a needle myself due to my partial sight. I am blind in one eye and reduced in the other which also effects my perception. I would find it hard to see a fine needle and also to see the correct angle. My DSN said I should stick with sets with inserters or straight sets which of course is limiting. I wondered if I'd not got the inset 30 in deep enough although I was very careful to watch youtube videos and follow the instructions to the letter.

 

[CarbsRok]

Bottom line though is no cannula will work for you unless you do a basal test.

 

[MushyPeaBrain]

Bottom line though is no cannula will work for you unless you do a basal test.

Yes I have wanted to do the basal test but with swinging BG it was hard to know when and where to start. Overnight seems the least affected so I have been trying to do a morning one but wake up either too high or low. Should I do one even if I'm high then?

 

[iHs]

The Comfort set is more or less a Tenderlink. It has a thicker introducer needle than the Inset 30 (I took a 30. apart using some hedge trimmers to cut through the plastic housing so that I could get to the white spring). The 30 does need the spring insertion otherwise the introducer will bend as it is pushed into the skin, whereas the Comfort/Tenderlink doesn't . What helped me was to numb the skin off a bit using a pack of frozen peas over a t shirt for a few mins and then insert the introducer. It got easier the more times that I did it and although the introducer looks long, only about 5/8 ins is actually in the skin, the rest is in the white housing.and as the intoducer is pulled out, the inner cannula is left behind.

Mushy because of yr sight issues, I think you would find the luer Flexlink or Flexlink Plus fairly easy to insert and to attach the tubes whereas the Insets are difficult to use in the backside with attaching the tube clips.