Just looking for some ideas here - This morning's BG was a normal waking number for me, 87. About 30g carbs at breakfast, with a normal bolus on the way to work. Lo and behold, around 10:30, I started feeling generally terrible, and with the onset of some achy leg muscles (light jog last night), I knew the results on the glucometer were going to be bad: 394.
WTH?! I'm generally pretty well controlled, on the minimed pump and control numbers overall well with a mid-to-high 6 A1c. Highs are NEVER that high! A quick bolus did nothing to bring it down. One hour later it was 350, and one more hour (and another bolus) gave me 368. I tried a brisk 1.5 mile walk on break, but upon return, I was approaching 400.
TIME TO GO HOME! I got home, used a syringe to admin a 'fresh' bolus elsewhere (backside!) and proceeded to change the infusion site/tubing. I had just put a new one on this morning....and when I pulled the port out....blood. And lots of it. Well, there's the problem, I thought, no absorption. New site, fingers crossed.
And a new fingerstick just revealed.....360! I am starting to freak out now - I've really only eaten about 35g carbs today (dinner was eggs/cheese) and BG is just not coming down. What is really puzzling is the sudden onset. It literally spiked to nearly 400 in only a couple hours! Another site I read basically said it boiled down to "one of those days, we all have them" advice and to just keep track and be careful to not over-bolus.
Any similar experiences/advice from the Tu Diabetes crew?
Have you tested for ketones? I was taught that if you are throwing medium to large ketones, you should take a bolus equal to at least 20% of your total daily dose even if that is more than your bolus wizard calculates.
If you are throwing ketones and have been over 300 since 10:30 this morning, you might also strongly consider going to an emergency room. DKA is dangerous and unpleasant.
Thanks, Maurie! I just checked about 5 minutes ago, down below 180. FINALLY feeling better. I'm really concerned, though, what would cause the super-fast increase. I' m used to having high numbers when I get sick (worst is sinus infections, for some reason), but that is a gradual increase over a couple days and manageable.
I agree DKA is bad news - I was considering taking a trip to the local ER but it seems that this episode is nearing its end. Still curious about causes though. This has only ever happened to me ONE time before, in almost 6 yrs of diagnosed T1.
Sounds like a bad site. The sudden increase along with just changing that morning is the first clue. You can go high big-time in a short time if you are not absorbing from your new site. You are essentially not getting any basal as well as your.bolus insulin even though your telling your pump to deliver.it. if you start to get.unrelenting high within 2-4 hours of a site change that should be the first.thing you think of. Once you get no response to the first correction via the pump you should go directly to correction via pen or syringe. You can sort out the site afterward. Having a bloody mess when you pulled is a sure sign of a bad insertion site. Once you get high like that it can take a lot of extra insulin to get back on board since you can get a bit insulin resistance. You may need as much as 20-30% extra depending on how long you were high. Remember you had no basal or any bolus on board. Could you tell if the cannula kinked?
The other thing to consider when this happens is whether the insulin in your new set/reservoir was old or degraded in some way. Having a pen or new vial as an emergency back up is always a good thing. Even a syringe to pull insulin from your pump to manually inject can be priceless.
Some will even say do not wait for a pump correction when your that high following a site change go directly to a manual injection for.your correction. It will get you back on top quicker. What king of sets do you use? Can you see the insertion site or is it covered? The covered site is one reason I do not like straight sets. Can't see what they look like, and I get better control with a slant set.
Yeah I've had sets that bled like crazy before, but always at the end of the cycle, when removing it to change it out. This time the cannula wasn't kinked, just must have put that thing in a bad spot. UGH.
All stable now, should be good to go. Quite the reminder to have a full set of supplies with you all the time! (no syringe at work today. Already packed for tomorrow!)
THANKS to all for the advice - It's much appreciated.
You've been given some good suggestions (reasons for why sudden spike in BS) and while reading I've thought of a few more...Actually, the list of possibilities is so vast (endless), and individual, that sometimes it can't be figured out until it happens again + again...First, I must mention this did happen to me much more often when I was on an insulin pump (never trust "technology + mechanical" devices) - So like others said, usually best to first treat the high BS the old-fashioned way (syringe and bottle) if 1 or 2 boluses from pump don't bring the BS down. Factoring in "insulin resistance", which I think happens to everyone when their BS reaches a certain level, makes solving the mystery that much more difficult. (I usually become "insulin resistant when my BS reaches about 300, but this has changed over the years) - What I mean by insulin resistant is that when 1 unit of Humalog (regular) would bring my BS down about 75 mg/dl, when my BS is above 300 he might take as much as 3-5 units to accomplish the same drop. - -As for a few reasons you may not have considered yet (as contributing to the high BS)...Did you check (re-check) what you ate for breakfast? It's not uncommon for a food item to have much more carbs then we expect (calculated). E.G. If I calculated 30 gms for a small piece of apple pie, but ate a McDonald's or packaged apple pie that I did not cook myself, it would not be surprising if the packaged piece had double the carbs I expected (60gm instead of 30) which would be enough to raise my BS an extra 200 mg/dl above what I expected...A few more (of many) unexpected reasons for very high BS include meter malfunction (you probably ruled that out based on how you felt) but always to recheck your BS with another meter, another finger, after you washed your hands thoroughly (sugar on fingertips could effect test)...Emotions/hormones is another common reason for sudden surge in BS - Something as common of avoidance of an accident while driving (sudden surge in adrenalin) can cause very high BS...But overall, most often (even when pump and site seem to be ok) the insulin pump system/set-up malfunctioning is the primary cause. Good Luck!
