Pumping: made a mistake: how did you handle it?

so none of us PWD are perfect about our self-care. so i was wondering what some of your “mistakes” have been and how you have handled the situation(s).

this morning i pre-boluses for breakfast. my fasting BG was 85. i decided to take a quick shower before eating my usual breakfast. so i went into the bathroom to undress and i detached my pump. sounds innocent enough, right…however, what i did not consider was if my bolus had finished being delivered. when i looked down at my pump (which i had layed upon a bathroom shelf, i realized that insulin was dripping out of the infusion tubing. Oh crap! i had no idea how much insulin had been delivered and how much had dripped onto the shelf. and now i was supposed to shower and then eat my breakfast. OMG. what was i thinking (or NOT thinking as the case was). and, what was i going to do about my predicament? i decided to go with the flow; eat breakfast as normal and correct later. this tiny mistake really screwed up my day. i waited 5 hours for the “IOB” to get out of my system and just be running on basal insulin (my BGs seemed to have leveled off at 168) i skipped lunch and did a correction. ( an explanation for the lunch “fasting” : i am meeting my girlfriend for an early dinner tonight and did not want to insulin stack. i wanted everything to be basal based bolusing by dinner time) anyway, the correction seems to have worked, as its been 1 and 1/2 hours later and my BGs are coming back into a target range. i hope my BGs remain steady throughout the rest of my evening. once i am done with my dinner, i don’t like to go to sleep with IOB, so at the very most, i might have a cup of tea when i get home from seeing my friend.

what things have you done, consciously or unconsciously, to sabotage a perfect day of great BGs? what have you done to try and correct any mistakes you may have made?

curious and interested, Daisy Mae

I almost made that same mistake a few weeks ago, but it was a correction bolus, rather than a meal bolus.

My worst mistake was more one of taking a bolus, waiting to eat, then realizing how late it was and running out of the house (sans meal). Got halfway to work when the big crash hit – fortunately near a gas station where I could pull off and get something to EAT!

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Oh yeah, I’ve done that one. Several times! Try not to be too hard on yourself - the amount of stuff we have to stay on top of is just ridiculous, and you have to be a math whiz too. Life happens, but there’s little room in the life of a diabetic for anything non-routine, so hectic moments can wreak havoc. My latest brain fart was after a moment of, uh, intimacy. I usually detach my pump to get it out of the way, then afterwards I put it back on and give myself maybe half a unit to compensate. And guess what? I put my pump belt back on, but didn’t plug myself in. So about 3am I woke up all groggy and hot and realized what I’d done. Major oops. Probably my roughest oops was when I had a stomach virus a couple of years ago and had been throwing up for 2 days. I’d managed to stay on top of my BG for the most part. My stomach finally settled down for several hours and I was ravenous. I don’t usually eat cereal, but that sounded so good to me so I gulped down a bowl, about 45g worth, and bolused. And of course the barfing started again. Over the next hour my BG plunged to 45 and scared my poor hubby half to death, he thought he’d have to have his first Glucagon moment! I sipped juice and was OK an hour later, but that sucked and I had a hypo hangover the next day. Another time many years ago I was hiking Zion and got off track somehow, veering about 45 minutes away from my campsite. I’d brought lots of Skittles with me, but not enough for an extra 2 hours. I was on shots in those days, and if I’d had a pump then I would have been able to reduce my basal. That was super scary too, never been so glad to see a campsite! Stuff happens, and it’s good to be able to share these moments so we don’t feel alone.

I took a vacation to Sydney, Australia many years ago and rented a bicycle to do some day-trip touring. I was on a pump then but this was long before the CGM. I left the hotel with a lot of snacks and glucose tabs. I bicycled down to a ferry and rode the ferry across the harbor to the small Pacific coast town of Manly.

For lunch I had a sandwich near a beautiful beach. I continued my costal bicycle cruise until I reached a town and another ferry crossing of a coastal inlet. On the other side my route took me up a sustained climb that probably lasted the better part of an hour. Checking my BG several times, I needed to use a lot of my low supplies.

I finally reached a town with railway commuter service back to Sydney. Things were going along OK BG-wise but my low supplies were just about exhausted. I pulled into an outdoor restaurant that was roasting chickens on spits over an open fire. I ordered a generous meal of chicken, bread, and veggies. I ate it all and gave myself my usual insulin dose. The train was coming soon so I had to hurry off to the station to purchase my ticket and load my bike on the train.

Since I was traveling in the counter-commute direction I occupied a train car by myself with my bicycle. I immediately started to feel low so I did a finger poke. This was only about 30 minutes after eating a large meal. I don’t remember the exact number but it was something like 50. I had little to no low-BG supplies since I figured I’d be safe just after eating. There were no other passengers to solicit help and my social skills go to zero when I’m low.

I knew the ride was only about 30 minutes and I decide to tough it out and get a quick candy bar when I hit the station. What I didn’t know is that the sub-terranium big-city station was a maze-like nightmare for even a BG-sober person with a bicycle. It was filled with those vertically circular roto-gates that would not let me through with a bicycle.

My brain was starving for glucose and everything seemed like some drug-trip out of the '60’s. There was not a vending machine in sight. I probably took 20 minutes to complete a 5-minute exit out of that station. When I finally emerged I asked a good Samaritan, a Vietnamese immigrant I thought, to help me find some food. I think he knew I was in trouble and he led me to a news stand selling commuter snacks. I finally was able to cure the low and I felt very grateful for the kindness of a stranger.

My pumping mistake was to not do a temp basal reduction considering a day long exercise session. The other lesson I drew was to always carry way more low supplies than I think I need. Having too many is not a problem, too few, an unintended drama that may end badly.

The worst mistake I’ve made was forgetting my pump at home and (because I was new to pumping) not handling it properly. I disconnected to shower at about 7:30 after eating breakfast and then left for work without it.

I realized when I did my after-breakfast test at 9:30 and went to correct my blood sugar (which was 13.6 mmol/L, if memory serves) that I didn’t have my pump. Instead, I corrected with an insulin pen. The mistake I made was just correcting my blood sugar but not replacing any of the basal insulin I had missed or would be missing in the future. By 12:00 I was feeling horribly sick and was 26.4 mmol/L when I tested. That’s when I realized I’d made a mistake and started piling on the insulin. I corrected every hour or two, but it took most of the afternoon for my blood sugar to come down and for the first part of the afternoon I was feeling so sick that I was seriously thinking about going to the hospital if my blood sugar didn’t come down. I had never felt so sick from diabetes in my life.

I had no way of testing for ketones at work, but when I got home (by which point my blood sugar had been normal for about two hours) I had moderate ketones, so I’m positive I had high ketones at work.

That incident made me realize how quickly things can get out of control when insulin delivery is cut off. Now that I have years of pumping experience, I know that my blood sugar tends to skyrocket and I get high ketones and feel sick after two to three hours of interrupted insulin delivery. I’ve since forgotten my pump at home on one or two other occasions but by making sure I replace the basal insulin I’ve kept things under control.

The other morning I was doing my first cartridge change on the Tslim. My 2 year old girls were interested in what I was doing and when I was trying to go into the menu and fill the canula my little girl got her fingers on the screen and hit fill tubing instead. I quickly realized after about .5 unit was pumped that you cannot simply cancel fill tubing on the Tslim because it has to pump at least 10 units first. DUMBEST thing I have ever heard of and could be extremely dangerous to a young or new pumper. Luckily I disconnected and had no adverse effect. Be careful doing cartridge changes around young children with the Tslim!

RE @Daisy_Mae’s conundrum, if you suspend the pump it will give you a decent idea how much was pumped, or at least on the Medtronic Bolus history screen.

I drove off to a fantasy baseball auction w/o my pump once, probably 15 miles away or so and went to check my CGM and realized it was still clipped to the towel. I turned around and went back and had floated up to 135, no biggie but a total bonehead move nonetheless.

I was on vacation to a small island in the Caribbean and had taken to getting up at dawn to walk the beach, or even to swim. Plus, there are no cars, so I walked everywhere, all day. By the end of the week, that was a lot more exercise than I typically get. I didn’t notice it though, because I was eating unusual food. I attributed my somewhat lower BG readings to me miscounting carbs. One morning, near the end of my stay, I hopped out of bed at dawn, pulled on my swim trunks and started walking.

Count the mistakes. 1) No finger stick before leaving. I started my walk, and it was a gorgeous morning, so I kept walking. 2) No glucose with me, just my pump, which 3) I hadn’t reduced my basal rate despite a week of increased activity. At some point in my walk, I began to realise that my lips were tingling - a sure sign for me that my BG is in the 50s. 4) I haven’t got my meter with me, so I have no idea if I’m somewhat low, imagining things, or whether I should start knocking on doors to find help. I was still thinking clearly enough that I immediately suspended my pump, and started walking back.

In the end, I got back OK - I didn’t need to read street signs, or work out foreign money, all I had to do was to keep the sea to my left. When I got back I was in the low 40s, used my glucose tablets and got back to normal. It was at this point that I realised 5) I should have reduced my basal for the whole time I’d been there.

Biggest lesson learnt: Always, always, always carry glucose. Runner-up: Don’t go anywhere without a finger stick.

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