Blood sugar >500 (cue to cry)

My blood sugars >300 almost always mean my pump is blocked. This is a problem I have continuously been encountering over the last 3 months. Despite a healthy diet and a little more continuous exercise, the blocks create the most frustrating obstacles for keeping my readings in control.

I'm not sure what I'm doing wrong. Over the summer, I maintained an average blood glucose of about 130. The sites were working great. I do have to admit that I used only my stomach, but it was working, so I didn't think about changing my ways.However, right when the semester started, I started noticing high blood sugars. I'd look at my tubing and sometimes there was a kink or the catheter, when taking it out, was dry, as if no insulin was going in for some time. Realizing maybe I was overusing my stomach and probably developing scar tissue by now, thus making my sites less effective, I tried using my thighs again (for the first time in a long time). It worked good for two weeks-then again, blocks. There were times I have gone through three sets all in one day because of getting blocked. Luckily, they have come to a pause, but the blocks do show up every now and then.

Perhaps one of the worst cases was today-changing my site before dinner, I decided I will use my back (upper buttocks) for the first time since a VERY long time. In the past, this site has provided me mixed results, but since it is rarely used, I figured it might work this time. Giving myself the proper dose for dinner, I went about my ways but started feeling sick-and that's when I figured my blood sugar is probably not faring well. Checking it confirmed that I was right: 526. My blood sugar has not been so high in ages. Freaking out, I immediately took out my old site, injected my correction with syringes and then proceeded to change my site. I also did about 30 minutes of exercise afterward. Within an hour, my reading came down to 206.

I have posted my problems with sites on a diabetes forum and people have told me it's probably something to do with the way I change my sets. I am not new to the insulin pump-I've been using it for almost 8-9 years now (with a gap in between)-first the Deltec Cosmo, now the Minimed. I have had these problems before (which led me to temporarily going back to syringes till I was eligible to receive a new pump following Cosmo discontinuing the Deltec model). I figured it had to do with the reason Deltec was discontinued. Don't know. I'm considering calling up Minimed and getting a trainer to go over with me again the way I change my sites and the such.

This whole site issue raised my A1C by 1% :(. Hoping it gets fixed soon.

Which sort of set are you using? I haven't been pumping for as long but switched to the Silhouette sets pretty early on, after sweating a Quick-set off. I like the Silhouettes better as the manual insertion seems to "stick". I use the area above my hips when I want to give my abdomen a break and, so far, haven't had too many site problems. It sounds like you did a really good job fixing it. I know a lot of people follow the medical plan to not exercise highs away but I find that it helps get my BG down faster if I do something moderate like walk the dog or something lke that.

I would say definitely see if Medtronic can have a trainer review your technique with you. In the meantime: Have you attempted to re-prime to see if the insulin is or isn't moving through the tubing? With the Medtronic (Paradigm Revel 523 is what I am using) disconnected from your site, go to the "Reservoir + Set" menu, then to "Fill Cannula." Then have it send at least 2 units through. If the drops of insulin come through the end of the tubing, a clog in the tubing or reservoir should not be the problem and might be indicative of a site issue - your cannulas may be getting kinked due to hitting muscle or scar tissue.

I use the Quicksets (6mm) and this is what I do to start troubleshooting high BGs when corrections aren't effective. If the insulin is flowing through the tubing OK, I'll pull the set and do a new one.

I did change the set to the Silhoutte where I had met with success all summer till the blocks started happening again. I think the main problem is me hitting muscle or scar tissue, but to check tubing I usually use .5 units and not 2 to fill canula-I will try that next time as sometimes using .5 it's hard to tell if the insulin isn't coming through or not.

Yes, I tried using .5 units before, and with that amount it really is difficult to tell for sure. I figure using the larger amounts make it more definitive :) Good luck! I used to do fake quick boluses until I realized that messes with the Insulin on Board number.

I can imagine that a low basal rate leads to a reduction of flow in the set. This makes it more likely that insulin can form more complex structures that will block the catheder. It can make a difference to change from one brand of insulin to another e.g. to change from Apidra to NovoLog.

Another point might be a high frequency of reusing sites. If you have used the stomach only then the skin might have developed deposits of fatty tissue. These deposits are known to cause absorbtion problems. Despite of not using the sites for a while I have no idea at hand to help the skin to recover. But dilligent site rotation gets more and more important the longer you are pumping.