266 at 1:30am and large ketones. Correction given and a ton of water. Got rid of the ketones and sugar down to 138 by 5:00. I am mystefied. I was 125 going to bed at 10:30. My set was fine and no leaks. My pump (MM) delivered basal and correction bolus. I kept eyeballing the decreasing units available. I eat at least 140 carbs a day so it isn’t starvation. I am moderately active, but nothing strenuous. I usually walk for a mile after supper (suspended pump for part of the walk) and just do the usual housework and playing with the grandkiddos. Anyone have any ideas?
I am a little compulsive about checking for them since that is how I was dx. Full blown DKA with 1141 BG. The ER medical staff was suprised I made it. Praise be to God.
I’m glad it all worked out and that you were able to bring your blood sugar down in just a few hours. It sounds like it might have been a very large bubble (or bubbles) in your tubing. Everything is working but you still don’t get any insulin.
Maurie
Thanks. I had’t thought of a bubble.
Congrats on reacting effectively in a critical situation. High BGs at 1:30 a.m. can impair clear thinking. I’m glad things turned out well.
There are so many things that can drive an unexpected high BG. It could be an air gap in the infusion set, like Maurie mentioned. Or a “silent occlusion,” an insulin interruption or slowdown that fails to trigger an audible pump alarm.
How long has it been since your last site change? I don’t like to exceed three days because I’ve noticed that absorption can deteriorate going past day three. Is your current insulin vial older than 28 days? That’s another parameter to watch out for, especially if you don’t use 1000 units in 28 days.
Did you give the 1:30 a.m. correction via the pump or as an injection? I like to use a syringe since I want to be certain that this corrective dose is delivered. I’ve been in situations that I used the pump to deliver a correction that never happened. It’s probably a good policy to separately inject if over 240 mg/dl.
Sometimes you just can’t pinpoint the exact cause. The important thing is the react appropriately and in a timely manner. You handled it like a pro!
I have the sure-t infusion set and change every other day. I had just changed it the previous morning. I did use the pump for correction and probably should have used a syringe. Thank you for your input. I did get ahold of my endo’s nurse this afternoon. She came to the conclusion that it was just one of those times that goes unexplained. She thought it might be a liver dumping glucose and suggested that I have a little carb in the form of crackers with my nightly almonds for a bedtime snack.
A liver dump could certainly explain an expected high blood sugar but large ketones would imply an absolute lack of insulin. Now your ketone strips might have given you a false reading but if they didn’t something else seems to have been going on.
Hi Yeagen, I’m glad your bg came down eventually, that is scary. If you think you have an air bubble try priming your tubing to get it out. When I have extended high bg now that won’t come down after corrections and increased basal rates, I assume there is an occlusion and change my set. Most of the time the cannula was bent, not enough to cause my pump to give an occlusion alert but enough to stop me from getting enough insulin & to cause high bg etc.- I was getting some, but not enough. Another thing I do now is to do a correction with my pen to see if that works too, which it usually does even when the pump corrections aren’t- that is another sign of poor absorption and a possible bent cannula with the plastic cannulas.
Thank you, meeee, still_young_at_heart, and terry4, I REALLY appreciate you getting back with me. You all had some good suggestions for the next time this happens IF it does. I am going to be hopeful and think that it won’t. It is comforting to know there are people out there who really understand although I don’t wish D on anyone. Sometimes it is just overwhelming. Today is a new day though and it is going to be a good one.
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