I recently started using the metal sets (comfort detach for Animas). I have been very happy because they are far easier to put in than I imagined and I no longer have to worry about set problems such as the frequent kinked canulas I was getting with the plastic sets.
I thought...I was doing just fine yesterday (having solved - I thought - my new DP problem) when suddenly after lunch I went from 117 to 256. I was due to change my set so I did so, corrected and started to come back down - 152 before dinner when suddenly after dinner I'm at 377 - what! I did have a high carb meal, but I took a shot correction. Then I woke up at 316. I changed my set again because it was just so high. Again, it started to come down - 211 before breakfast and 147 after (with of course corrections). Then back up to 238 before lunch and with corrections and a low carb lunch back up to 328 after lunch! My site was a tad painful, just a continual nagging mild pain so I checked it again. No blood (at any of the changes) but a drop of insulin at the bottom of the canula. I corrected again and just tested at 6:30PM and...it is 437!!! 437??? It's like I'm not getting any insulin at all! I just did a huge correction shot with a syringe. What the heck is going on??? Is there anything that could cause problems with metal sets? If I change it again I'll use a plastic one just to vary something. I thought of illness, I feel a bit allergy-ish, but it's raining which tends to bring out allergy stuff. I feel dragged out, but with blood sugars in the 300s and 400s that's to be expected. Yikes! Any ideas? I'll have to see what the shot does.
Yeah, 437 is where I'd bang some IV juice to get it down quicker (although perhaps super dangerous...) but, if you already corrected, I guess I'd hold out. I'm not sure what to make of the set issues but maybe try another one, in your best spot and, if it doesn't work, move on to plan B. I don't really have site problems too much so I'm of little use but I hope you can get it ironed out!
Have you checked for ketones? Have you been drinking plenty of water to stay hydrated? I know you know this stuff but being so high can turn your brain to mush for a while.
I was taught that the you should correct using 20% of your total daily dose if you're over 250 and have ketones. For me that would be a 5 unit correction which is a double whopper.
When you changed your site, did you change the reservoir and do a full rewind? If not, that might be a source of your problem.
Thanks, Maurie. No, I don't have ketone testers (because they just keep expiring). I have been drinking water, but need to drink more.
I actually took much more than that - 11 units based on my ISF of 27.Yikes! Yes, I did a full rewind. I was about to use the same cartridge as I still had plenty of insulin, but thought I should make everything new. If this doesn't start coming down I may get a new batch of cartridges and insets - everything.
Zoe - I hate when that happens. I have a few random thoughts but most of them are not timely. I hope you feel better soon.
Were you getting to the end of a bottle of insulin? I think the vial you're using can be unrefrigerated for 28 days. Were you pushing that limit? Did you wash your hands and test again after the 437? If you have to change again, I'd use an infusion set from a fresh box, preferably from fresh lot.
I've only used a handful of Contact Detach sets and I can't use them for more than 48 hours or they start getting painful. I suspect that pain = inflammation and impaired absorption. I think the package inserts say change at 48 hours. Do you generally use them longer?
Smell for insulin where the infusion set attaches to the cartridge.
Thanks, Terry. Yes, I am close to the end of a bottle, but it has been refrigerated the whole time, and due to the DP problem I've had it's only been 2 weeks in use.
I've used CD before for 3-4 days with no problem. The one I have now is new today and it is starting to hurt again, just like the last one. Is there some way CDs can repeatedly cause inflammation??
I'm going to change to a totally different set from a fresh lot now. This is getting scary.
I don't understand why the shot I did hasn't brought it down (it's been 3 hours) maybe it's just the idea that once it gets that high it's just harder to get down.
I just removed the set to change it and it was soaked with insulin underneath. What?? Definitely no absorption!
One more probably unrelated symptoms is my chest area is itchy! No rash and the set was in my stomach.
I don't use a pump so I don't know if I can help.. did you change the site area too? Maybe there is scar tissue in that area, but it definitely sounds like a pump/etc malfunction to me. Just drink tons of water and go for a walk, it will come down soon I'm sure. Take another small injection maybe if not, but call your doctor first for advice. Hope it comes down soon!
Ugh, I have been having similar problems except with plastic sets - BUT I've had the same thing happen with metal sets where insulin leaks (and they bleed sometimes) and they do not absorb properly at all. It's one of the main reasons I have stuck with plastic infusion sets for so long even though I'm sure I'm allergic to the cannula and adhesive, although I've been having more issues the past few weeks so may give metal sets another try. I don't know what causes it, but lately any time a site is remotely irritated or painful for me I've been changing it (I already change them every two days).
Is it possible the sets are hitting muscle? In that case they wouldn't kink, being metal, but it could still affect insulin absorption.
The other thought is that your insulin has gone bad somehow, maybe overheating? Especially if a shot isn't helping to bring it down.
Good luck figuring it out! I woke up this morning at 13.3 (239 mg/dl) when I was normal the previous two mornings, and then was 23.1 (416 mg/dl) after breakfast and ended up changing my site. Some of my control issues lately are due to me, and some are just due to me not getting insulin properly. I never have ketones so I'm getting some insulin, but my sites seem to be leaking and/or not absorbing well a lot lately.
Interestingly, I think you said you use Apidra? I'm using Apidra as well ... I wonder if something is up with batches lately?
Thanks, Jen, very helpful. That's what I was curious about: what problems could happen with metal sets. I didn't know they could leak which is definitely what happened! I changed to a plastic set an hour and a 1/4 ago and finally saw 355 - I never knew I would be happy to see 300s!! I was starting to think ER. And the hospital in my small town is a pretty iffy place, so that thought was not reassuring! Hopefully it will continue to come down.
I don't know if the insulin is bad; definitely no overheating as it has been refrigerated the whole time. But I'm getting low so I will get more tomorrow.
Sorry you're having problems too. I hope to hell it's not Apidra. I love the free Apidra all year. It would be interesting if they are giving deals because they are going out of business or something....kidding!!
Interestingly - I recently was randomly looking at my insulin after picking it up from the pharmacy and noticed that it said NOT to refrigerate the insulin after opening it. I'm not sure why, but maybe it makes it degrade faster once opened or something ...
I didn't know metal sites could go "bad" either, until it happened. When I was using them I found about 50% of them leaked or bled and I had a lot of extreme highs.
Lately the same has been happening with my Comfort sets, where the cannula looks fine but they leak or bleed. I posted another post about this asking if it could be a progression of my allergy issues (previously sites just got really red/itchy/hives and stopped working well after two days), and people replied saying it could be ... I also talked to a doctor a few years ago complaining about how my allergies were driving me insane (I was breaking out in hives just from friction and fabric my skin didn't like!) and she said someones when allergies are acting up the body can get super sensitive and start reacting to everything, even things you're not technically allergic to.
So my theory is that my allergies are to blame for most of this. I wonder what kind of metal the metal sets are made of? I know people can be allergic to things like earrings and necklaces, I wonder if it could apply to the sets, too?
Glad to hear you are coming down. I just tested at 160, which is great after three corrections (I'd been stuck around 200 all day ever since my post-breakfast 400 reading). I hope your blood sugar continues to improve and to stay down!!!
Last week I was having similar problems. It turned out to be something new - after nine years pumping. The tube leading out of the cartridge had broken, at the top of the Luer lock assembly. Not completely, but enough that no insulin was making it through. It was unusual enough that it took me a day or so to figure it out. It's worth checking.
I've also had trouble with 90 degree sets and auto inserters. The inserter bends the cannula so it just lays flat under the tape next to the skin and no insulin gets delivered. I've only had that happen with Teflon cannulas, though.
I know on the rare occasions that something goes wrong and my bg goes over 400, I have to take a scary LOT of insulin. Be careful, and good luck. We all know how miserable and unnerving these events are. (Forty four years with Type 1, and it still gets the best of me some days!)
oh, sorry... well, as long as you're on some insulin and you don't have an infection you probably won't go into dka. If you catch it early they can sometimes just put you on iv fluids/insulin for a bit and not need drastic measures etc. I would go tomorrow and get new ketone strips just so you can test to make sure you don't have ketones. There is a meter that has bg and ketone testing. I bought one and I'm going to ask my endo to rx some strips for that one so I can have them just in case I need to test again for that.. hopefully not! keep us posted, you have plenty of help here :)
Thanks, all. I'm still in the 300s but going to take another shot soon. I know myself, that sometimes when I have to take multiple corrections all of a sudden it "takes" and I go low (even though I do, of course, keep track of IOB whether with the pump or on shots). But something is going to have to give.
good luck Zoe, that happens to me too... I'm working on an after dinner high, nothing like yours, just took another two units and more water.. I will prolly come crashing down too at some point...
Interesting, Jen. I just looked at my vial and it says: "Unopened vials should be refrigerated at 36-46 F.(2-8C) Opened vials whether or not refrigerated, must be used within 28 days. If refrigeration is not possible, the open vial in use can be kept unrefrigerated for up to 28 days away from direct heat and light as long as the temperature is not greater than 77 F (25C)."
I just "wasted" five units from my pump and took a 5 unit shot. (I'm getting tired and it makes it safer to keep track of the IOB). If I'm still in the 300s tomorrow I'll probably go to the ER, though knowing that place I'll probably have to explain what a pump is, define DKA and put in my own IV.
I rarely let D bother me too much, but this is one of those times.
