Ok this is what leads to rage bolusing. My previous infusion set started out fine, but on the second day my BG just kept edging up all day despite correction boluses that were if anything over-generous, until by evening I’m up over 200 where I’d normally be going a bit low (I seem to have some endogenous insulin left and that’s when it chooses to come on). Seeing some effect, but just really weak. No occlusions, no wetness around the infusion spot, or any other sign of a problem. Finally decided “gotta just swap this thing out” even though I’d normally be getting another day out of it. And when I yanked it, it looked fine. Ok, so I move on to the next spot in the rotation, a couple inches over (I’m currently on my abdomen). Yesterday everything was fine, but here it is day two and it’s doing the same damn thing. Creeping up and up. At 11:20 I was at 179 where I’m usually down in the 120 neighborhood. So I did a correction, and given the time I figured I might as well make it a pre-lunch bolus as well, so I did ten units. A solid hour and 20 minutes later I still haven’t eaten (I’ve had nothing but a.m. coffee so far), I should be in a pretty decently severe HYPO by now, but it’s only come down to 150. No leakage, no occlusion alarms, everything looks good.
Thoughts? Am I just hitting bad sites now all over the place? I’ve been pumping for only 5 years–am I already running out of real estate? I’m going to be seriously depressed if that’s the case. Have I mentioned T1 sucks?
I had a week or 2 where it seemed like I was swapping sets on a daily basis. I’ve been pumping since 2006 and overused my abdomen over the years. I took a break and so far I’m getting good absorbtion again. Maybe try a different area of your body if possible?
I have the same thing happening, a site seems great for the first day & then deteriorates. It’s like a hole in the flesh has been filled up! I often find when I change the bad set out, I get a drop or 2 of blood. So I assume that is the problem, also frequently there is a small lump at the insertion point. Like you, I tend to put off changing the set out until I really have to.
As you say, T1 stinks. I liove my pump but it can be very frustrating, I always think the infusuin sets are the weak link.
I should add I tried MDI for the last few months for the first real time in my life (went on the pump quickly after diagnosis) and still had days like you are experiencing. It was probably caused by stress, changes in weather affecting my basal needs and/or my basal insulin not absorbing well. It made me feel better about pumping - at least with a site issue I can change the site or set a temp basal increase to quickly deal with days like these!
If you’re confident that the pump/infusion set is faithfully delivering and not leaking insulin then you can rule out the pump delivery. By the way, your nose can help detect a small insulin leak; I think insulin smells like band-aids.
I once had a leak at the cartridge/luer lock connector that I could only detect by inserting a thin tissue near the connection and seeing the errant insulin wicking into the tissue.
In this situation I might try a previously unused site in an attempt to rule-out scar tissue that leads to failed absorption. In the past I’ve often stuck with sites too long. I’ve now adopted the philosophy of “when in doubt, swap it out.” At worst I waste an infusion set or two but I then benefit from the quicker resumption of insulin delivery.
But the first thing I thought of when reading your post is that your insulin sensitivity, insulin to carb ratios, and basal rates may need changing. I’m a big believer in Ponder’s portrayal of diabetes as a dynamic disease. I have changed these parameters in the past, regained BG control, and within a week needed to return them to the prior settings. Diabetes is a moving target. Don’t get too engaged with the settings that have worked well for you for a long time. They can and will change.
Finally, I’ve been disturbed to recently read reports that suggest we should not trust the labeled insulin concentration on our insulin vials/cartridges. A recent report from the Diabetes Technology Society found a random survey of NPH and R insulin to contain much less insulin concentration than the label claims. As if our life is not hard enough with all the other factors that can interrupt our best attempts to consistently deliver this life-enabling hormone!
Good luck with your troubleshooting. I hope you can identify the reason for your trouble. Don’t be discouraged if you can’t find the “smoking gun” that is the source of your trouble. Diabetes does not always reveal why your BG acts the way it does. The most important thing is that you notice and start taking some action.
Yes, that’s exactly what it seemed like both the previous time and this one. Except when I pulled the other one it was fine–no blood welling up or any on the sticky tape. And there’s no soreness at the infuser when I press it or move it, which is what I usually get when I’ve hit a blood vessel.
I know it doesn’t help that much to have peers with the same problem…
Today’s set change will be the TENTH site I’ve inserted in the last 12 days! I’ve had a series of bad sites going back well into last week. The “good news” is that THIS 9th one has in fact worked as expected the entire time that it’s been in place (even though it’s not in the most comfortable spot, I’ve left if because it WORKS!). Of course, at this point, I’m dreading the change I’m about to do, but I’m leaning on fact that I managed at least ONE good site this week to give me hope that I can have a repeat performance later…
So, I rotate regularly from my abdomen down to my upper thighs and back again in a loop that probably takes better then a month to arrive back to square one. The one big problem with pumping is just that it’s so darn hard to reach other areas that I used all the time when I was doing injections. I’ve tried to use my lower back but with clothing and sitting/standing motions and whatnot the accidental rip out rate is like 80%, not to mention attaching and detaching the clip for showering and whatnot is really awkward. Same with the backs of my arms–one minute of inattention taking my shirt off and whoops! it’s pulled. Whereas I could inject into all those places, no problem. OTOH, MDI is such a pain. Not the injections themselves, I don’t mind that, but the basal being so inflexible and no help with DP. I’ve still got a lot of years ahead doing this, and if I’m already hitting scarring issues with absorption it’s kind of depressing.
I, personally, would never attribute a 60 point difference to hardware failure. But, it that’s where your intuition leads you, then why don’t you try your upper arm - somewhere that you have never used (or rarely used) the pump before.
I start my exploration of things like this by assuming there has been a natural ‘drift’ in system behavior. I get system ‘drift’ that requires me to alter my basal rates frequently. I went a couple of months, recently, without any DP, but recently it has started popping up again, where I will shoot to 300 over the course of a morning. If I see that behavior pop up in a ‘predictable’ way, say, almost everyday for a week or two, then I might start adjusting my basals, instead of just hitting it with correction. After a week of bad data, I might start slowly inching up the basals.
When was the last time you required an adjustment in your basal rates?
Sorry you’re going through this. What I do is change site if it’s really bad but also do an injection instead to lower me. If I do an injection and it lowers me and things then go back to normal then I know it was not the site. For a bad high I usually just change everything right away even with no obvious site issues like pain etc.
I’m using 4 different areas, hips/back, 2 sides of tummy. Tummy lessoften because I can get severe pain but I have one in now. Maybe try your legs or arms to give the older sites a break? I know I need to use totally different areas too so I don’t wear out my normal ones.lately I also try I increasing basal a lot and walk around, sometimes that drops me also. If sites are falling off use opsite flexfix to cover the inset, mine never come off with that.
Check with your cde\ doc to see if they think it’s scarring, it could be somthing else. There are so many possibilities. Try steel insets if you’re using plastic it could be kinking.
