Hello, I've been a diabetic for 27 years but just started pumping with a Metronic pump about 6 months ago. For the last 3 days I have been stuck around 200-300 before, during, after and long after meals. I have been taking at least 3 extra boluses a day. My blood sugars will not go down and when they do, they go directly back up. What's extra strange is that eating a meal does not increase my blood sugar, it's just staying mostly steady in the 200s. I've been trouble shooting for the last two days. I tried a new port in a new place, new bottle of insulin, new tubing. Could this be bad insulins? Or other pump issues? I'm at a loss of what to do. Prior to these last 3 days, I was well controlled in normal ranges before and after meals. I have not changed my diet or exercise or schedules.
Any trouble shooting ideas would be greatly appreciated.
You seem to place a lot of the potential failure on insulin and your pump. Why do you think your test strips are good? Did you try a different lot of test strips?
Good thought. I did not try different strips or glucose meters, but I really feel high. I also wear a CGM that at least shows me going up, even if the numbers were inaccurate thanks to a bad meter or strips.
I tried a third new bottle of insulin last night and that seems to have taken care of it. I've never had 2 new 'bad' bottles of insulin in a row before. I don't know that I've ever had a bad new bottle of insulin. I just wasn't expecting it. I guess I figured out what it was.
Could you just need an increase in basal? The day before yesterday I woke up at 297 (after going to bed at 115). I changed out my set and insulin (which was due, anyway) and decreased the amount of bolus insulin my pump recommended because it was massive, and even so I went low after breakfast, and thus my before lunch reading was fine. Before dinner I was 247, and after dinner I was 353. I corrected, but yesterday morning I was still 313, so I changed out my site and insulin again, and even so I was 311 after breakfast. By lunch I managed to get down in range, but after lunch I was again 342, before dinner I was still 268, and after dinnner I was back up to 349. I wasn't convinced I'd have two bad sites in a row (especially because I use metal sets which can't kink), so before changing sites again I upped all my basal rates by 0.1 units per hour. This morning I woke up at 124 and have been no higher than 180 since. I forget sometimes how much of an impact a change of just 0.1 units per hour can make!
One of the pumping rules is to use a syringe to correct if BG is over 250 or a correction bolus does not work...and always change a infusion set if a correction does not work.If your BG still does not drop after the correction with a syringe, change insulin...
A couple of things. First, try a different bottle of insulin. If it is the insulin chances are you will have the same action in bottles of insulin obtained from the same source at the same time. This time of year my mind always goes right to bad insulin. However, i doubt the issue of a painful site has much to do with insulin. If you think about it when insulin goes bad its action goes bad the elements of insulin do not usually start to irritate etc.
My second thought would be if the site is bad. If the site is hurting I'd pull it in a heart beat. Sites that hurt make for poor absorption but also can lead to infection. If it hurts get it out immediately is my advice.
Finally I do like Brain's idea. I seldom think of bad test strips but yeah Brian has a point.
I think of frozen insulin when I think I have bad product. This is more common with mail order, but can also happen with store bough. There is no test, so it is really a test and make a decision. If you have concerns take it back or call the mail order company. bad insulin will mess you up (Old Indiana saying). Not really, it is my saying however.
I had one good day then went back to being high so I raised my basal rates significantly (.2-.5 more per hour at different times) and that has really helped, although I am still high at least twice a day. I still wonder if something is wrong with my insulin, but I couldn't get my doctor to write me another prescription. I do get it mail order and it was left outside wrapped in cold packs in freezing conditions.
I'm not sick, I feel fine. I've never heard that you're supposed to use a syringe over 250, but I did try that too. The insulin seems to start working faster, but I still went right back up.
My pump has given me lots of "No Delivery" errors recently, but only when I'm starting a new reservoir. I'm hoping that doesn't mean something is wrong or not working, but it does make me worry about how well it's delivering insulin after those errors are taken care of. I don't really think the pump is to blame. It's only 6 months old.
What about where you are placing your infusion sets. Have you tried an area where you have never been before, or at least an area that hasn't been used much in the last 30 days?
All my areas are still new. I never once took a shot in my abdomen, so everywhere is scar tissue free. I used my thighs exclusively for about 20 years.
Well, I would still encourage a new area just to eliminate as many variables as possible.
Are all of your insulin vials from the same delivery? Are they the same lot number?
Also, do you have a sample of a different type of infusion set to try?
Have you changed the pump battery?
If you are consistently running high, you might need to try an intramuscular shot of insulin to see if that will correct you within range, then see what happens with a new set, new insulin, new battery, new tubing etc.
