Correcting Highs vs Changing site

Hi all

I try and strike a balance between waiting too long to change a failed site when I'm high, and wasting supplies by changing when the site might not be the problem. I realized I might have a misconception that it's all or nothing, that is that either insulin is getting in or it isn't. Here's an example.

This morning I got up at 134 which is high for me. I ate my usual breakfast, bolusing my usual amount with an added correction. After breakfast I was 184! I eat the same breakfast M-F and am almost always within 20 points up or down. I thought "site?" but decided to try correcting first (I just changed my site yesterday).

I corrected and by time for lunch I was 99 so I figured all was well with the site and bolused for my lunch (I have a bit more variation with lunch but nothing justifying the result...218! So maybe all is NOT well. So I realized the question I have is are there circumstances under which the site is letting in some insulin, but not all? Or perhaps the insulin is not being absorbed well?

Thanks Diabuddies!

I can have some variability between infusion sets so I never change one unless my BG continues to climb after a correction or I cannot keep it on target with small corrections. If it will not stop climbing I will correct with a syringe this gives me a good idea whats happening with the infusion set.

Everyday is a new day, and there is always some mystery.

You got that right! Thanks, John.

I hardly ever change one either. I think a lot of times it's like "rusty pipes" and some aggressive CB seems to clean them out? I always feel like I have to make sure it doesn't work that would take a couple of days and they start working normally by the time things settle down?

I can't help, I am having a similar problem today :/ I guess Gremlins lol

Thanks, guys. I hope yours settles down, Kelly.

Yeah, I think if I get results from corrections, I'm inclined to hang in with it. I was just curious if I was thinking about it wrong.

Do you regularly check your tubing for sneaky air bubbles? Depending on your basal rate, even a tiny bit of air in your tubing can translate into 30+ minutes of "lost" insulin, where you're getting air through your set instead of insulin and the pump doesn't know the difference. If I spot a bubble that is bigger than 2mm long, I'll "flush" it from the tubing right then/there... but I do it using the "prime tubing/cannula" feature on the pump instead of "bolus" so the pump doesn't record it as a dose that gets added into my active insulin.

You do end up wasting some insulin doing that, but it's better than pumping air and then being high.

I usually prime my pump w/ the "out" on top, and tap it to get the bubbles out there which seems to prime them out? I hardly ever see bubbles.

Thanks, abcpav. I just checked my tubing and don't see any bubbles, but that is something I can add to my repetoire of things to look for! I'm pretty diligent about pinging bubbles out of my cartridge when I fill it.

Yes, sites can be partially working but not completely.

For me, if a site fails completely I shoot up to 400-600+ within a few hours (even if I don't eat) and have ketones and absolutely know something is wrong. In a way I wish all sites were all or nothing because this would make knowing very simple!

When a site is partially working, it gets a lot trickier ... The other day I was stuck between 200-250 most of the day despite correcting every few hours, upping my basal rate, upping my boluses. I finally tested ketones and when I saw they were moderate I changed my site and found it bloody and bent. Clearly some insulin was getting through, as I had it in for 24 hours and my blood sugar was partially controlled, just not very well!

I tend to not change sites unless one is clearly bad (BG of 350+ that is not coming down with corrections, and/or lesser high BG that is not coming down in combination with ketones), and this may not be a good thing but I think sometimes sets just don't have the greatest absorption.

Thanks, Jen. I agree that it's a lot trickier when a site is partially working. I actually will go ahead and change the site if I get stuck between 100 and 250; when I'm unsure is when I come down into target and go back up again! But I think it depends also on what our insurance coverage is, and how close to running out of supplies we are!

I think sometimes the insulin just doesn't absorb as well, so the slow basal delivery works well but the larger boluses don't absorb quite so effectively.

I also think the level at which we let our BG rise to probably depends on our level of control. I would think the tighter your control, the sooner you might think something is up if things don't seem the way they normally are. If I test after a meal and I'm suddenly 500 (which has happened before) I'll change my site right away, but I can get hit with a few 200s for no reason even when my site is working just fine (i.e., today after a 17g lunch I was 211 for some reason), so I tend to wait it out to see if it resolves before changing the site.

That makes sense, Jen. For me low 200s are not common, but not a cause for freak out. But get above 250, I'm sure there must be a reason and 300 I would instantly change my site. I talk often about the "luck of the draw" - that we all have different levels of control even when we try our best. I guess I'm in the middle. When I hear people who are freaking out because they're 140 I'm like, huh?? It's all relative.

Hey Zoe -

I had one of those almost not working sites on Thanksgiving (and the following day). I didn't even realize it might be a site problem because a feast day is tough to calculate even when we're careful. It was only the next day when I kept going to 190-201 did I have an inkling of what's going on.

I get a lot of what I call B- sites where I run 20-30 points higher than expected for the last day of my three day cycle. As Roseanna Dana Anna would say - It's one thing or another but it's always diabetes.

Maurie

Yep! I just went over 200 again after dinner so I gave up and changed my site. I've already ordered new supplies and still have some left, so why not! For me it doesn't seem correlated with the last day (I can even go into the fourth day), but just random. I like that, "B sites". It's just not worth all the spiking and correcting!

Actually, often when I remove one of these B sites, I find bubbles not in the tubing, but in the cannula. I guess the solution is just to be extra diligent about "pinging" the bubbles in the cartridge before inserting.

Like me, Zoe LOL. I agree, it's all relative. I changed my site twice when I was having those gremlins earlier this week, corrected by syringe... nothing helped. Now I'm back to whatever normal is. No rhyme or reason.

This could be so many things...air bubbles, weak insulin, a bad site, etc. Sometimes, I'll start climbing and it seems like my site is bad, but then I'll go to do a correction and WHAM! I end up low. Which makes me wonder if small clogs build up within the canula and they are pushed out by the correction.

Also, my sites vary in terms of absorption and control. Some places seem to work better than others.

That makes sense, the correction pushing out a small clog in the canula. Sometimes things are obvious and sometimes not so much and then it's a judgement call - really intuition. I generally think of managing D as a very "left-brained" enterprise: lots of figuring, computing, assessing variables, etc. But there is also a very right-brained aspect: that whole intuition and "what feels right" thing. Lucky for me, I have both a strong left-brained side (logical) and a strong right-brained side (intuitive). The key is knowing which to use! (That probably didn't make sense to anyone but me, but that's ok!)

Btw I changed my set finally last night and seemed back to normal after dinner. I tested when I got into bed to read awhile and was a happy 81.(I like to test a bit before I intend to sleep in case I need correcting) Then I read awhile, turned off the light, felt funny, got back up and I was 35. Yikes! My cat who'd settled into her place on the pillow was not happy when I got back up to read until it was safe to sleep. Geezz...but I also mentioned in another post that I'm working at breaking down my ISF to less insulin at night and I think that was a clear message to go another couple steps! Are we having fun yet?

For BG up to about 200 I just correct & test an hour later to make sure BG is going down, if it's still under 200 I may do an extra correction,over 200 if it's not going down with the correction I will correct by syringe & change my set without having to rush it. I think in the last few years the only times I've been over 250 is because of an obviously badly inserted infusion set or a missed meal bolus.

I do think absorption can depend on where on your body the set is inserted, for me certain places start off slow for a few hours & then settle down. In fact for me days 3 & 4 of a set often give much better BGs than days 1 & 2.

Interesting, Annabella. I think that may be the case for me as well, but when I have problems in the first day or two I just think it might be the set.

I think I might also have a line beyond which it's the set, and I think that might be 250 as well, but I know it's not possible to make cut and dry statements. Thanks. Good info!