Medtronic Site Change

Diabetes Technology Insulin Pumps
1

Changed my site today on my Medtronic Minimed. Couple hours after changing it I started feeling nauseous & sick and checked my blood sugar to find it had risen to 469. Took insulin and waited 30 minutes and checked it again and instead of it coming down it had rose to 519. So I changed my site again and it's been about an hour and it still isn't coming down...

Have any of you guys, experienced this? And if so what have you done to get it down? I've tried water, I've tried changing my site. And it's still hanging out at 519.

I feel like POO :(

2

Hey Jessica -

Have you checked for ketones? I was taught that with any blood sugar over 250 accompanied by ketones the correction should be the greater of the calculated correction or 20% of your total daily dose.

If you have ketones and the blood sugar doesn't start to come down soon, you should take your next correction with a syringe or pen and seriously consider going to an emergency room.

Maurie

3

I would probably have a shot or even do something like have a shot in my leg and walk the dog to get it going to see if I could make it work. One thing for site changes that I read on FB was to turn up your basal to "cover" the insertion trauma interfering w/ insulin absorption. If I see it start to take off higher after a site change, I'll crank it up to 200% to cover it until I see it come down.

4

I would take a shot... An injection should lower your bg and if not, then it may be your insulin is degraded. If the injection works then make sure your pump is operating correctly, disconnect and do a fill cannula to see if insulin is coming out of the set.

I find that when my bg climbs high like that it takes a lot more insulin to resolve it than the pump says to bolus.

And ditto what Maurie said, do check for ketones.

5

Thanks Guys, I've checked for Ketones but I don't have any which is really good!! I've been working a little over 3 hours to get it down and last I checked it it had made its way down to 452 so we are making some process, SLOWLY but least it's starting to come down. I've drank 3 bottles of water, I hate days like this but it's a part of living with Diabetes we have our good days and we have our bad days!!!

6

Hi Jessica,
it's common for us to think that a correction based on BG X is going to start making BG go down within 15-20 minutes.
But if you had a bad infusion site, and high BG, you are lacking the basal insulin that you usually have in your system. So your BG at 469 is likely still RISING. So 20 minutes later, it was 519 instead of 580, for example because the correction slowed down the rise. Now that I have CGMS, it's obvious to me when this happens.
Also, at that high level, the amount of inaccuracy in the meter BG is high, and 469 might have really been 490, and 519 could have been 500.

So when that high, ALWAYS inject with syringe/pen to eliminate the pump infusion site being a possible factor in a continued rise. After correction with syringe, and I don't see a drop in 30 minutes, I do an additional correction by syringe, based on conclusion that BG was still rising. But with correction by pump, I cannot make the same conclusion.

If it's now staying at 519, it means you gave enough insulin to stop the rise.

When your BG is that high, most diabetics become insulin resistant, and need a much higher ICF factor. But you do need to be careful to not overstack the insulin.

I suggest to keep giving corrections by syringe, and also increasing the basal rate on your pump, maybe to 150%. When you see your numbers come down to the 200-300 range, you know the correction is working, and can stop the temp basal. For whatever reason, I find Temp basals help to reduce highs better than more correction doses. And temp basals reduce the impact of stacking too much correction insulin, as they can be turned off.
I might give 20-40% more correction, for high BGs, then add the increased temp basal to deal with the increased insulin resistance/missed basal.
If you find yourself going down too fast at some point or getting <180 with lots of IOB left, then use a lower temp basal, for example 50%, or consider suspending your pump for maybe 30 minutes (set temp basal 0% for 30 min), based on IOB and how fast it is dropping. You may need to do a snack if it gets <100, and still too much IOB, to avoid going to low. It is good to drink lots of water too ! It won't make your BGs come down faster, but will help the kidneys and reduce your chance of getting dehydrated. You will pee alot, and this is good to help get rid of the sugar spilling into urine.

7

The real danger with this kind of thing (They're right, it's likely a bad site) is that all that insulin is still in your body, and while it's not absorbing now, I had one event where I removed the site and somehow it triggered absorption. I bled after I removed the site, which suggests I had it crammed into somewhere it didn't want to be :D

If you do a manual injection or a site change, leave that one in place for a good long time.
If this doesn't work, look at other problems.
The insulin itself. Any cloudiness?

Check your tubing. Any smell of insulin around where it joins the infusion site or at the reservoir?
Check the infusion site for dampness, and again that very distinct smell of insulin. The insulin may be leaking out.
I've had all these things happen.
You may look under the old site and may notice the cannula crimped under the site and not actually in your body.

As awesome as pumps can be, they do rather raise the likelihood of weird issues happening.

8

So did you get this straitened out and ever figure out what the problem was?

9

just curious, as one who is still trying to get on and stay on the pump, how did you learn to do all this, basal rates, changes, etc..? Is this something that we just pick up as we get adjusted to a pump or did someone teach you how to do basal rates, temp basal rate increases for highs, etc...i read some of this stuff and think, 'how will i ever know how to do this on a pump?' thanks!

10

I learned how to do all of the adjustment stuff through trial and error, through following “question” threads online and, I guess through common sense. I don’t get wrapped up in numbers being “good” or “bad” but try to think of them in relation to goals. I am generally dismissive of stuff like stress or bad sites or other stuff that plague people. If my BG is up, I can take insulin or exercise to get it down. If it’s low, eating is the option. My pump keeps track of things and, with the pie-chart reports, can give me useful clues about areas I can fix. I don’t get tos from my doc. I did get a few tips from the SalesNurse when I got my pump but she didn’t last long.

11

I did finally get my incredibly high blood sugar down. And afterwards after all the insulin that I had taken finally done what it wanted to do. I had a complicated night of trying to keep my blood sugars up while sleeping. I actually had to take my pump off and set an alarm for every hour to watch it. I wound up sleeping with NO PUMP all night, and still waking up with my blood sugar 139 with no basal throughout the night.

The next day was rough too, no matter what I ate I couldn't manage to keep it above 70. After 2 days everything finally settled down the way it was suppose to be. Luckily since then my numbers have been GREAT!

I have NOT figured out what was the cause of this rough couple of days. The only thing I can think of is my pump wasn't giving me insulin like I thought it was, and I didn't get a warning or alert about it.

12

My pump training from my pump wasn't very INFORMATIVE!!! And my doctors have never really seemed like they knew what they were doing when it came to pumps. Heck the one I'm going to now the doctor can't do anything with my pump. She has to get a nurse to do all the basal changes. (but refuses to let me do it myself)

I don't quite understand the basal changes for when my blood sugars are high. I know a lot of people told me when its high I need to do 100% basal while it's running high. I've never been taught how to do that.

13

thanks. Yeah, i read some of this stuff....folks doing temp basal rates, etc...and I'm so new at this, I too have no idea how this all works. It feels, honestly, overwhelming sometimes...makes me always fall back to MDI, which does not and will not work for me. So, I guess I'll just start out slow, read and learn and adjust. :)

14

Bumping up your temp when trying to bring down a high can be thought of in 2 ways.

Either, high blood sugars tend to make you insulin resistant so that you not only have to take a correction but have to adjust your basal until you're closer to range.

Or, the increased temporary basal is an additional basal designed to help bring down your readings. We're all taught that if you drop more than 30 points while fasting you're basal is too high. The converse is if you make your basal a bit too high you can drop an extra 30 points.

It doesn't make much sense to use temporary basal rates when high until your basic basal, carb ratio and correction ratios are pretty well zeroed in. It's a bit of sauce not the main dish.

Maurie