Oh dear blood sugar 26.5mmol 477mg/dl Blood Ketones 2.2 pump fail

Diabetes Technology Insulin Pumps
1

Oh dear,

Another diabetic fail to add to the list.

Test two hours after lunch 5.2mmol/93.6mg/dl pretty happy with that. I get back to work, get home a couple of hours late which takes an hour or so. Rush into town to buy my young Nephew some lego for his birthday, pop in to his birthday party to show my face.

No cake. No Jelly. No ice cream.

Notice that I'm feeling a little sick, perhaps a bit more cantankerous in the presence of 15 screaming, hyped up children then I would usually be. Make my excuses to leave, get in the car, test. My sugar is 26.5mmol! Hold up, I've not eaten during the last 3 hours and my levels where fine on my last test.

Quickly drive home (5 minute drive), immediately drop trousers upon entering the house in front of startled girlfriend to find the infusion site on my leg has unclipped! Doh.

Test blood ketones, 2.2. Smack a large 12 unit bolus into my arm with a syringe. Promptly vomit and here I am.

I can only of been disconnected for three to four hours max.

Seriously starting to think that I may return to MDI. The site failures, risk of scar tissue, increased risk of DKA etc is a real concern of mine.

I feel that with the knowledge I've gained the last few years, split lantus and novorapid I may be able to achieve the same results with less hassle and less risk.

A definite anti pump day for me!

Barf!

Here is to a miserable evening of extra testing, perhaps a little more vomit, a probable low, then a little rebound high. Then a correction.. Then finally sleep at 2am hahah. Oh diabetes how do I love thee, let me count the ways.

2

I just got a thing from Medtronic about some infusion sets (Silhouettes are what I use...)having issues breaking the tube off where it plugs in.

3

I hate nights like that. Hope you feel better soon!

4

Managed to miss any lows or rebounds and woke up at 90. So can't complain :)

5

I've had that a couple of times with sets I use. It's usually after the tubing being a few days old and when the infusion set is on my thigh and I'm wearing jeans.

Starting to think it might be the jeans stressing the infusion site as it never happens when I'm using my stomach.

6

Yes you can complain. Why do pumps have to operate in such a brittle manner? It wouldn't seem that hard to detect becoming unclipped or some level of occlusion and raise an alarm.

7

I do get an occlusion alarm and it is a useful feature, it always alerts to blood in the cannula or kinks, but does not alert to unclipping or damage to the tubing.

I'm at loss as to how it unclipped as it's a two step process.

I'll get in the habit of checking the site when I test my BS. Thing is I like to keep everything tucked away when I'm at work and getting to the infusion site usually takes a fair amount of disrobing and a visit to the bathroom stalls.

In all seriousness, I'd say this is the 5/6 time I've had this issue over two years. This one being the most serious due to the length of time I was detached.

I also log failed infusion sites, e.g. bent cannula, absorption issues and these have a 1 in 10 failure rate with me as well.

Tried a number of differing sets and still not found a completely reliable one.

I am starting to see where Holger is coming from with his preference and rationale for MDI over pumping.

8

Maybe another option is a mixed strategy where you take your basal by injection and use the pump for meal and correction bolus. That would give you much of the freedom of the pump and hopefully reduce the risks from a pump failure leaving you totally high and dry (in an insulin sense).

9

I get blood around sites, in the little doodad the tubing clips into, all the time. What sort of sets are you using? I'm hesitant to recommend Silhouettes given the recent tube situation but I have had very few issues with them.

10

Hmmm, since we have all plastic parts in the connection between the set and the tubing, I don't see how to easily come up with a detection method. The pump doesn't see an occlusion in this instance, since the insulin is flowing (just not actually delivered to the PWD).

11

Sorry to hear about this ugly day for you.

Is there a different set you could use that has a slightly different clipping mechanism?

While I am also struggling with scar tissue after 15+ years of pumping, scar tissue can develop on MDI as well.

12

Hi Acidrock,

I currently switch between AccuCheck Flexlink and Rapid D sets.

Anyway I have a cunning plan!

https://www.youtube.com/watch?v=Gp5St7hORyw

Tape. I'm going to tape on the infusion set and also a few inches above the tubing which will hopefully minimise movement and pulling forces on the set.

Failing that.. A pump vacation.

13

LOL! Nicely played!

14

If the pump can detect the pressure increase due to occlusion then I don't understand why it can't detect the pressure drop with a disconnect. And I have to believe there are other innovative ways that haven't even been tried. How about shooting a ultrasound chirp down the insulin line and measuring return. That could probably detect both an occlusion and a disconnect. I'm just saying. I think it is important, these problems are a major risk associated with pump use.

15

In my experience the pressure has to increase a LOT for the occlusion alarm to go off, even when it's set to low. My guess is that the difference in pressure between injecting into the body veruss into air (or fabric, etc.) may not be a big enough difference for it to detect... Or maybe it's just a feature no one has suggested.

16

Hugs, oh how I know the feeling. SO scary!