Am I sitting on a time-bomb now?

This has probably been discussed before, but just want to ask…

I hadn’t eaten in 6 hours, and I took a reasonable sized bolus for 18 grams of sugar (chocolate milk) earlier this evening. More than enough to cover it (I usually take a little more than what is needed, and then make up for it with a little snack later, because you can bring your BG up faster than it takes to bring it down. Coming up is just easier than coming down, I think).

So instead of the quick spike and eventual small gradual low that I was expecting, my BG kept climbing. And…I…kept…hitting…it…with…more…insulin. After 5.5 hours my BG was through the roof! And I had taken about 1/3 of my usual TDD, just to cover a little bit of sugar. It just was not coming down! (And yes, I checked it with several different meters just to make sure. Washing my hands and doing all the right stuff!)

After 5.5 hours my BG was still climbing, so I took the pod off. I carefully peeled it away to see if the cannula was still inserted. Yep, cannula was in there. I checked the pod after removing it, with a quick bolus, to see if the pod was still working. Yep, still working, could see insulin being bolused out. So I KNOW there is 1/3 of my TDD sitting under my skin, and it hasn’t budged my BG for 18 little grams.

This was a recently opened bottle of insulin, doesn’t expire until 2018. I have used it before with no problem. And the pod was working for 2 days before it bonked on me.

I expect that the reason it wasn’t working is because of absorption problems when I get into the 3rd day. And I think the short cannula doesn’t work well for me.

But, the insulin is still in there, sitting under my skin. And that feeling kind of sucks. It’s like an insulin time-bomb, and I gotta wait it out.

The amount of insulin I took for 18 grams was crazy! Practically enough for breakfast and lunch. To put it into perspective, I dosed close to a 1:1 insulin to carb ratio. That is nowhere near normal for me!! I’m usually 12.5 to 1. (I know it’s dumb to take that much, but I don’t take kindly to high BG. I want to stop them immediately because I am impatient and have no tolerance for having high BG!!)

I put on a new pod, but I’m waiting for morning until I take anymore insulin. Waiting until I am confident that the previously delivered stuff won’t knock me on my [colorful language]…

Anyone else have something like this happen? Do you just wait it out with an eye on your meter?

Oh, just one more crazy point. My wife had to take a trip for work. She always worries when she’s gone. Before she left, she actually said to me that I should go back to syringes for a few days while she is gone, just to be safe. That sounds so crazy, right?!? Saying you should use syringes to be safe! That’s just not the normal perception of pumps vs. syringes! I guess the point is - guys, listen to your wives. They KNOW stuff! :wink:


I love choc milk, but it is so evil, I believe it has as much sugar in it as coca cola.

6 hours has passed and hopefully you are sorted now,
my guesses…
if in doubt, it’s always best to do a set change, that is my first guess
did your try another new insulin? the insulin fairy is a BIT*H, bolus with a syringe to get it down?

This happens quite frequently. The most likely cause is site failure/degradation. How long had you had the pod inserted? Sites can start to absorb less efficiently for a variety of reasons including insulin becoming denatured at the site, inflammatory reactions , bad sites due to overuse of the area etc…

With a tubed pump it is straightforward to simply put a new set in (if in doubt change it out). I would guess that more than 10% of my sites have to be changed before the scheduled deadline because they are not working as efficiently. Obviously this is easier with a tubed pump.

What happens to the insulin? I don’t really know. I suspect that if the problem is insulin denaturation/clogging of the set it is simply lost. Just check your CGM or take regular fingersticks

One thing to remember is that when your blood sugar goes high, you become insulin resistant. This is the way your cells protect against sugar poisoning, they downregulate glucose uptake. So if your blood sugar is like 300-400 mg/dl you should not expect that a “normal” correction will just bring it down. And this is one of the reasons that if you are high before a meal you should not expect your ratios to work. The ratios are all “tuned” to work around a normal blood sugar.


Yes! As you describe it exactly. It was several hours of constant BG rise to seemingly no effect of bolus/corrections…Then the bomb. I was actually outside mowing at the time, when I noticed a -35 delta from my watch all of a sudden. When I checked BG from the meter it was 100 pts lower from Dexcom (not uncommon for Dexcom to lag–the bigger the delta, the bigger the lag). With an infusion of Mt. Dew, other sweets and glucagon by my side, I was able to keep it at bay in the 40’s for several hours (seemed like an eternity).

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Horrifying, isn’t it?

I think for me the problem was absorption. Next time, I will probably hit it with a syringe instead of continuously doing pump boluses that doesn’t seem to work.

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Definitely a syringe is a good alternative. If my first bolus does not produce some result within 1 hour I go with a syringe. If the dose is over 6u I use a syringe I have grown to know what a potential absorption issue looks like and quick to inject.

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I definitely appreciate that info! I am an old-timer when it comes to having the disease, but I am a relative newbie on the pump! Some lessons are learned the hard way.

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I’m thinking that your site just built up a resistance to absorption. This happened to me many years ago and I kept bolusing through the pump with zero effect on blood sugar. Then, finally, the insulin dam burst and my blood sugar plummeted. Unfortunately I was busy in the dentist chair during the period I might have sensed what was going on. This was before the I used a CGM or a hypo-alert dog. The consequences were severe and I was lucky to survive.

I think as soon as you observe a slowing of the usual effect of insulin lowering BGs, I would switch to syringe corrections and frequent monitoring, especially with fingersticks.

I tried the Omnipod back in 2012 for five months. I had a poor experience and you may read about it here. I recognize that Omnipod use has been successful for many, unfortunately it didn’t work for me and I had several occurrences like you wrote about here.

I think fading sites are hard to make a good timely judgment on. I’ve been tempted to switch out a site and just before I do absorption returns to normal. I think it’s much better to switch out too quickly than too slowly. I know doing it too quickly risks wasting insulin and supplies but I think my health is more important than that.

Lastly, you mention that poor absorption happens about 10% of the time for you. Have you tried some new places on your body? Since I switched to infusion sites on my back this has not happened to me. Good luck – glad you are safe.

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I’ve tried places all over my body! I’ve been making notes of different infusion sites and how well they work. But of course, you know how difficult it is because there are so many other factors, so you never know whether it’s the site or something else completely.

It’s extremely useful to have heard how others have dealt with the same issue. I will definitely be more aware of it now. And I will certainly be hitting the syringe earlier than I did before.

This just happened to me last weekend. And it lasted almost the entire 3 days of the pod. The first day was not too bad, but day 2 and 3 my numbers kept rising over night. My first response is to blame myself and think that I did not carb count correctly. But as soon as I changed pods all was good again.

However, the pod placement was on a very new site that I have used only a couple of times. I don’t think overuse is the issue here - nor was it the chocolate milk, etc.

For whatever reason sometimes absorption is just not the same and the insulin seems to just disappear - no time bomb. This is what makes this disease so difficult to treat.

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I remember having an ‘insulin time bomb’ once back in the days before there were home glucometers, so there was no way even to measure how much impending or actual threat there was of a massive hypoglycemic seizure.

I was an undergraduate and had woken up suddenly to find I was late for my first class at 9:A.M., since it was already 9:15. I hurriedly took my daily insulin dose (it was one dose a day back then, a mix of Clear and NPH), backed up my notebooks, and started off for class, intending to grab a snack for class en route. As my last act before going out the door, I opened the curtains of my room, but much to my amazement, it was pitch dark! Evidently I had fallen asleep after dinner and woken with a start a few hours later, not remembering what time of day it was. Things were made even worse since the university dining halls were already closed for the day, so I had to wander around town half the night, eating as much as I could find.