OMG - guys you are not going to believe this. I spoke with the tech for a bit and then he had the nurse call me and I spoke with her at great length. I explained to her that the one variable I'd been unable to change is using a brand new insulin vial as I am in the middle of the GREAT MEDICARE BATTLE. We then went over everything I've done since Monday when this started and reading out all the records from my pump history. I believe we spoke for about an hour. She then told me a combination of things she thought might be causing the problem, which didn't seem to account to it for me. We were nearly done with our conversation when she said: "What is the expiration date on the Apidra bottle?" I hadn't even looked! It was....11/1/13. The insulin was expired!!!! That was it, so simple.
My numbers have been coming down (though still high) and my ketones decreased from 'large' to "moderate" but the numbers have come down previously in the last three days and popped back up.
I called the pharmacy and they are still trying to fill out a form for medicare ("We don't even know what some of these codes mean"). I told them it was a medical emergency and I was in danger of being hospitalized. (slight exaggeration). They right away called Medicare and figured out how to do it! They are now faxing the form and then it will take "awhile" to hear back. They would sell me a vial but it is $500. I am so angry!
But I also can't believe it was something this obvious and I didn't think of it! Apologies to the person who said, "maybe your insulin is bad" and I said, no, that wasn't it!
yeah but didn't you just have a really really bad low just a few days before this - was bad low with the same outdated vial of insulin? i hope that's the problem, though. does your pump company have a nurse available for you to speak with or was this your doctor's office? Also, find out what pharmacy gave you that vial, when did you get it filled? it should be viable and not expire for at least one year after you fill your Rx, that's how long it lasts without opening it. i doubt you've had it hanging around for a year. they should replace it.
Oddly enough, Sarah, yes, the low was from the same vial. I do definitely hope this accounts for it! It is odd that it expired - thanks for the suggestion; I just checked and I received it on 10/17 and it expired on 11/1, that makes no sense. I'm going to ask about that tomorrow.Now I'm wondering if that is truly the expiration date; it's not clear on the label.. It was the Animas nurse I spoke to, my doctor's office would have no clue. The Animas nurse said "see your doctor if it doesn't improve" and I just laughed.
Meee, I found out that the $500 was quoted for my 3 month supply and that one vial will be "only" $190. I'm optimistic I'd get reimbursed (eventually) but hopefully they will complete the insurance craziness tomorrow and I won't have to lay it out.
ok, that is better, lol. I hope you get it straightened out soon. I am using a recently expired insulin pen which seems fine, still dealing with lows so I guess it is. That is odd about those numbers too.
Wow, Diane, I never even thought of that!! Today I will find out if they have completed the paperwork and if not was going to lay out the $190 and hope I'd get reimbursed. I now have a step in between - beg for insulin at the doctor's! Thank you!
Btw my saga is nearly concluded and I'll let you know the final results of what was going on....if there are any clear results that is!
Zoe, you've been living an interesting saga! I told you that my vials kept quitting on me at 2-3 weeks, and that in the future I'll be getting the pens, which have less insulin and hopefully won't run me in the 300's while I try to figure out what's gone wrong. I don't want to even know what my last A1C is, I mean, I really don't want to know!
With respect to your recent saga/problem--I would think you'd have a case in requiring the pharmacy to replace the out-of-date vial of insulin that they sold you.
Thanks, Trudy. It's actually not yet clear that the insulin is out of date OR whether that or bad cartridges were the source of the problem; I'm still researching it. My numbers are still running high but nothing like before! I'll post my conclusions soon (though most people probably have stopped reading the thread!)
I have never used Apidra but a while ago there was a discussion on the Insulin Pumpers Mailing List about the use of Apidra in pumps. Some people had problems with the Apidra gelling up & blocking the tubing or infusion set, others said it worked fine. (www.insulin-pumpers.org).
Maybe your pharmacy doesn't dispense a lot of A[pidra & you got a vial that had been sitting st the back of their fridge for some time. When I get new insulin the expiration date is usually a couple of years in the future. Check when you pick up a prescription & ask for another vial if it expires in a few months.
Thanks, Annabella, good advice. The expiration date on the vial is unclear and one of my errands today is to stop by and clarify things. I'm FINALLY getting my new insulin today so thanks for the reminder to check the date on that as well. Also to keep in mind if I have further problems to consider switching insulin brand.
So finally today, after four days of often extreme highs (culminating in a 25 that broke my record for lows!) my blood sugar has been normal all day! Yay!!!!!!
So here is what I think: I'd say the main cause was a vial of Apidra insulin with, for some reason, reduced efficacy. It was not expired (I'd mistakenly thought it was earlier). It had been in the refrigerator in use for just 3 weeks and it looked fine. Though some people talk about problems with Apidra in a pump, I have used it for 4 years, so it had to be that particular vial only. You might notice in Jen's current thread she has had a similar problem with a vial of Apidra bought in the same month. Interesting.
I think another issue I was having was sporadic leakage from a particular lot of cartridges, but think this was the lesser problem.
New lot of cartridges, new insulin (finally after the Great Medicare Battle), and I'm a new woman. This has been a busy and crazy week for me in several ways and I'm glad it's over! Just wanted to share the probable reasons behind my experience to anyone interested.
It would be nice to have a way to test the strength of insulin. Maybe something like a test strip that turned color to let us independently verify whether insulin is good or not.
Have you talked with Sanofi about this particular vial?
So glad you got it figured out! I really do wonder if they had a bad batch of Apidra. My blood sugars have been great all day, other than creeping up this evening due to (yet another) irritated set. (I posted about it in my threat.) But I moved the set (love the metal sets for that) and my blood sugar is great again. What is your technique for sticking down sets with Band-Aids? I used Skin Tac on this one after moving it, but I'm pretty sure that's causing me horrible irritation (although I don't know now, because the site that just got irritated and appeared to be dying did not have Skin Tac on it), so I'd like to use something else to hold sets down when they become unstuck.
I ,too, am intolerant of long periods where I am high, two things I do 1 Injection or 2 CORRECT on the pump,Up the basal and and tone it down or totally return to normal basal rate when BG begins to drop. NEVER both. That will crash you way too quickly and set a pattern of aggressively ferocious lows.. God bless, Brunetta
Welcome back to a world where blood glucose readings make enough sense so that when a bad number shows up you have an idea of what caused it and can fix it and move on.
It's an amazingly modest definition of utopia but perhaps a realizable one for good stretches.
