Sky rocketing bG, no Control IQ

I’ve never had this happen before. My bG has been shooting straight up for over 2 hours. It went from 98 at 5 pm, past 400 at 7:15 pm with double arrow the whole time, just changed to a single arrow now, at 7:30pm.

I took 12.87 U for a meal at 5:30 pm, and got a 3.73 U control bolus at 6:37 pm. I currently has 8.07 U on board. The Control IQ is grey, i.e. no basal increase. There have been no control boluses since the one at 6:37. I switched to sleep mode about 10 min ago and the basal went up to 3.01 from 1.3 (2.3x). When try to bolus, the blood sugar does not show up and there is no compensation bolus. I tried to bolus before go to sleep mode, and it did not show a comp bolus. I don’t recall if the bolus screen showed the bG or not. I had over 11 U OB at the time, and thought it was not comp-ing due to IOB.

I just entered 450, and it did bolus 9.9 U. My bG is still raising. The basal is up yo 3.408, and I have a comp basal on board now.

What is going on?! My bG is running away faster that a out of control locomotive down the Swiss Alps on greased rails and Control IQ is basically doing nothing. I mean…except…the train is going down and my bG is going up…but you know what I mean!

First do a meter BG to confirm cgm.

Then check infusion site and tubing. Is there leaking or disconnect?

You may need to disconnect and do syringe injection to get bg down and bg checks until back to normal range.

1 Like

I JUST changed my clothes and discovered the infusion set was detached. I’m not sure when or how that happened. Might be on account of the dogs jumping on and off my lap. The cannula was still in, the set just disconnected. Never had that happen before either.

It still seems Control IQ was in absentia…

God, I feel like crap!

1 Like

Glad to hear you found the problem !!

One time, years ago, my cat chewed through my infusion set and had similar experience with unexpected high bg not responding to insulin.

I also use Tandem with C-IQ, and confused at what you think is not working. In sleep mode, it will only increase basal, as you noticed. Sleep off, it may bolus for correction, but assume the pump showed you had sufficient IOB so did not bolus.

1 Like

Good for you for noticing skyrocketing BGs as they happened. Can you imagine how things would go if you didn’t notice for another two or three hours?

I always make a correction with a syringe if over 300 (16.7). I also try to use a longer needle to inject into the deltoid muscle, upper arm, and then rub vigorously over the site for 30 seconds or so after.

You handled this well! Please update.

@TJG:

I have had this happen several times: either I completely scrape off an infusion set or it comes partially “unglued” and the cannula gets folded over across my abdomen so that whatever basal or bolus I’m getting is simply getting my shirt wet.

The good news is that now that this has happened to you once, you will be better at diagnosing this problem the next time. However, I’m always shocked how quickly readings rise when you are suddenly getting no basal and no bolus. Plus, it seems to always happen (Murphy’s law …) just after you give yourself a big bolus, so your pump THINKS that you have a huge IOB, when, in fact you have NO IOB and NO basal.

The best CDE I ever had … who is a T1D herself … ended up in the hospital for DKA because of a scraped-off infusion set and followed by not realizing what was going on instantly. If that can happen to a diabetes superstar, the rest of us should not beat ourselves up … but just do our best to identify the problem and react quickly.

I find that a “partially unglued” infusion set is easier to diagnose because the no longer inserted cannula often feels “scratchy” on my skin. To me, the completely torn off infusion set is actually harder to diagnose until you happen to look down and see 23” of Teflon tubing flapping in the breeze.

Good luck and stay safe!

John

When this happens, I take a manual injection shot using a brand new bottle of insulin as a first step. Then, start troubleshooting the hardware.

@John_S2

I’ve had that happen too. I have always been aware when the cannula gets pulled out. I have had some come partially peeled off, and the cannula comes almost all the way out. In that case, infused insulin tends to leak out.

I’ve also had slow response or trouble bring it down, but never to this degree and never had double up arrows after massive bolus. It usually levels off then stays high without going up or down. That tends to happen after a low, when counter-regulatory hormones are active.

I do wish someone would sell boxed of cannulas only. I’ve had irritation at the site that blocks infusion. It would be nice to change the site without having to refill the the cartridge or waste it.

@Terry4

Thanks Terry! As soon as I reattached and bolused, it turned around. It must have been very high because it took a couple of hours to get below 400. I should have done a finger stick. I’m not sure how it detects change when the bG is higher than the max. Probably only reports bGs up to 400, but still has a value. They must have decided that the error is too high to report, but okay for trends. It would be nice if there were alerts that reported an approximate bG and suggest a finger stick: “You’re bG is over [450, 500, 550…]. Please test your bG immediately for an accurate value.”

I had not thought of injecting IM . I will do that next I have a major high.

Thank you for your excellent counsel.

@MM1

Yeah, you’re right. I did have a lot of IOB. It just seemed to me that after one correction bolus, and the bG was still increasing very quickly, it should have done more. But to keep it simple and avoid overtreating, it makes sense to only consider current bG, IOB and maybe carbs. Including 1st or 2nd derivatives could be problematic. Leave it to the patient to do that. Also I didn’t switch to sleep mode until near the end. I did that to temp basal increases to control to 120 mg/dL, vs 180, knowing it would not bolus.

@mohe0001

Also great advice! I definitely do that with lows, since I’m not firing on all pistons and the risk is more acute. Usually my bG isn’t so high that quick treatment isn’t so imperative. It was in this case.

To all:

Thank you for your swift and very helpful input. One would think that after 47 years with diabetes, 33 on a pump, this would be “common sense.” We never stop learning! It’s great to feel like my self again. Cheers!

3 Likes

Thanks Terry! As soon as I reattached and bolused, it turned around. It must have been very high because it took a couple of hours to get below 400. I should have done a finger stick. I’m not sure how it detects change when the bG is higher than the max. Probably only reports bGs up to 400, but still has a value. They must have decided that the error is too high to report, but okay for trends. It would be nice if there were alerts that reported an approximate bG and suggest a finger stick: “You’re bG is over [450, 500, 550…]. Please test your bG immediately for an accurate value.”

I had not thought of injecting IM . I will do that next I have a major high.

Thank you for your excellent counsel.

How long a needle are you using for intramuscular @Terry4?

I use a 1/2 inch (12.7 mm) needle. I know there is some controversy about needle length with some saying it requires a 1 inch needle. I have observed in me a positive response as glucose levels drop more rapidly than when injected through a pump sub-q cannula.

I believe that the needle length I use is the one recommended by Dr. Bernstein.

1 Like

I frequently change reservoir on different day than infusion set+cannula. A few steps done differently, but it still works.

I’m talking about changing the site before I’m ready to change the reservoir, especially when it gets pulled out accidently, or if there is excess inflammation. I have a collection extra of reservoirs and infusion sets from when I had to replace just the cannula.

I change the cannula (site) every 3-4 days.
I change the cartridge + tubing when close to empty, about every 6 days.

Do you replace the cannula when you change sites, or just move it? How do you do it?

I also change the cannula (site) independent of the cartridge and tubing. I change sites every 3 days and use my fully filled 300-unit cartridge until it’s almost empty, about 10 days with my current insulin usage. This extended use of cartridges and tubing is not supported by the manufacturers or medical practitioners, your choice, your risk.

For my MiniMed Silhouette infusion sets, I cannot remove them and re-insert elsewhere. I’ve read that people who use steel cannula sets can easily withdraw the cannula and re-insert in a different location but the second-time use needs help with over-tape.

Yes, I use a new infusion set (XC) and insert it.
But I disconnect the new tubing from new XC set and don’t connect that to cartridge.

The pump, assuming still has 1/2 full cartridge with insulin and tubing (filled with insulin from previous connection) can now be attached to newly inserted cannula XC. Then need to remember to do fill cannula. But skip steps that fill tubing, since you reuse the existing tubing.

Next 3 day change, I replace full tubing, usually coincides with a cartridge change.

Its also good idea to carry spare infusion set, so if you accidentally pull out site away from home, you can do these same steps…

@TJG:

While I fill my cartridges for 3 days and a bit of insurance, more often than not, I actually get 4 days out of each cartridge and cannula. I change cartridge and cannula at the same time, unless I’ve dislodged a cannula. As a result of a mostly 4-day rotation, I build up a reserve over time. I use Autosoft XC infusion sets with a t:lock connector. If that is what you use, I could likely send you 3 or 4 infusion sets for backups. If you are interested, PM me your mailing address.

John

So when you change a cannula, you use a new one, and don’t use the cartridge or infusion set that goes with it.

I typically get 3-4 days out of a full cartridge, so most of the time, i.e. all the time, I refill my pump and change site at the same time. I’d say about 30-40% of the time, I’d like to the change site early because it’s inflamed, but I resist.

Maybe I should consider switching the a needle infusion set…

It’s been my experience when I do this, I build up scar tissue that can take that area out of service for a long time. If it were me, I’d change sites (cannula) at the first sign of redness or inflammation.

If you’re concerned with your supply of infusion sets covering early changes, I’d recommend that you ask your doctor to order infusion set changes every 48 hours. If you don’t take precautions with treating your preferred infusion sites well, you might face having to give them up altogether at some point in the future.

I’d hate to give up the convenience and better control that my pump with Loop offers me. I know many people do well with multiple daily injections but automated insulin dosing systems don’t work with MDI. Take care of your infusion sites!