Weird bolus issue warning: inset was partially out

2 days ago for my dinner I did not receive the bolus. I realized because I started to feel ill and tested my blood sugar.

My Dexcom had been very sketchy- the sensor was having trouble disconnecting constantly and the sugar app also although it had been better than the dexcom app.

It connected once and all of a sudden it said 220 an hour after I ate so I tested. It was indeed higher than that and I knew something was wrong so I checked my inset. **I pushed on the inset right away to feel it and the needle went in further twice so somehow it had come out of me. I had just changed the inset before bolusing to eat because I was worried the one I had in was in too long.

I kept testing and it kept going up higher each time. Not long after the 220 after disconnecting again for a while it said 40 lol. My finger sticks confirmed what I figured had happened that I did not receive the full bolus as well as my symptoms that I get when I’m going up a lot etc. however I think I had to have gotten some of it because I think I would’ve gone up much faster and a lot higher had I not gotten any of it. But bg was 135 finger stick when I ate, and I decided not to do a pre-bolus wait because I was so hungry and tired after having gotten soaked in the rain when I walked the first time. I corrected for the bg and kept the basal up and I figured it would drop from the activity and not go too high.

When I put the new inset in I pushed it in and it felt like it was in fully but somehow it had come out a bit I am guessing. I am now using these little patches to put over it which are like IV 3000 but a different brand. I switched to them from opsite 3-4 months ago which was causing bad irritations, but they cause irritations also on and off.

I’m thinking what happened was that the patch must’ve been so sticky that maybe it pulled the inset out? It’s so strange because there is adhesive on the inset and I’m sure that I pushed on that as I usually do so I don’t know how this could’ve happened. I didn’t bang against anything or do anything that would’ve caused it to come out and it had the patch over it so the whole thing is very bizarre.

So my blood sugar ended up at 319 I think maybe higher after a walk and water to help lower it. I changed the inset right away. I was scared to inject so early on at one hour because I didn’t know how much insulin I could’ve gotten and I ended up going for another walk. I think it’s probable I did get some of the bolus because I think it would’ve gone even higher but there’s no way to know for sure. Fortunately I decided not to eat my yogurt and I think that helped it not to go even higher maybe.

I had just gone for a walk before this happened. I waited until the 3 1/2 hour mark at which point I did a 2 1/2 to 3 unit injection correction and kept my basal up for a few hours. finally by about 5 to 6 AM I was back down in a normal range and feeling better but exhausted. I fell asleep and then woke up quite low not having had my snack before sleep.

Has anyone ever had anything like that happen with a steel inset where you think the inset somehow came out not completely but enough so that you didn’t get a full bolus? I don’t recall this ever happening to me before. Fortunately as awful as it was it was not a situation where I was sleeping and I ended up going to DKA territory.

I also put in a new dex sensor and the current one had been restarted once and was on day 5 or so. I’ve been having a lot of trouble after restarting lately. So I’m wondering what is going on with that.

So what I have been doing now is I press on the inset to make sure it is really in me before a bolus. This is going to get pretty tiresome but I’m scared this could happen again.

Which infusion sets do you use?

I use Tandem Autosoft XC, and sometimes put a small adhesion tape strip on tubing, if I will be more active to avoid accidental pullout.
So if there is a tug on tubing, the tape strip will prevent tug on infusion set.

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I use tandem tru steel. I can only use the steel ones because I had terrible problems with the plastic cannulus. I didn’t used to put some thing over them because I have a lot of irritation but then I did have an issue at some point with insets, not with a bolus, and I ended up putting patches over them but it does cause me a lot of irritation on and off it’s never consistent. I usually get the irritation of the other part of where the tubing connects to it for some crazy reason but I often get irritation from the patch around the actual inset also.

The weird thing is I am sure I pushed on the inset when I inserted it and it felt like it was in and then I put the patch over it, this was a fresh inset, so it’s very bizarre that this could happen. The only thing I can think of is the patch is so sticky and it somehow lifted the inset out partially without me noticing.

But again I don’t see how I would not notice that so I don’t really have an explanation for any of this. I am now pressing on the inset before I bolus each time to make sure it is actually in me. Maybe the adhesive on the actual inset was faulty? When I put the patch over it I pressed down on everything and it seemed like it was in properly.

This happens.

Using the XC 90, which is a Teflon cannula, I believe 6 mm long, I’ve had a couple times where my sugar just went up and up despite repeat boluses.

Remove the cannula and sure enough, it shaped like a “U” so the insulin wasn’t even getting into me. No wonder my Dexcom is beeping like mad and my sugar is 22!!

Always good to have a pen with Humalog to give a quick 5 to 10 unit bolus. And then one unit every hour.

And change the infuser soon.

This was not a plastic cannula, I can’t use them. I had numerous issues like you’re describing with them and infections, so I switched to the steel cannula- there’s no way for a steel cannula to bend etc.

What happened was it somehow got partially pulled out even though I had just put it in and it was in properly and I had a sticky patch over it. This has never happened before.

That was the problem I had with steel cannulas. They slide out too easily. Even using over tape doesn’t help because your skin and fat layer move around even under tape.

I almost don’t want to suggest this but I’m im just telling you what I have done and do.

I use a plastic cannula and I buy the type that you can insert on a steep angle, almost parallel to your skin. This way it doesn’t hit muscle and it’s much more difficult to accidentally pull out.

I also gave the tru steel cannulas a try and they tended to cause pain because of the constant stabbing of the muscle as they move around a little.

I solved this by bending the metal cannula to about 45 degrees before inserting it. It takes some finesse to get this right.
Anyway it solved the muscle problem and also was less likely to pull out.
The steel sets are way shorter than plastic, so you don’t have much room to spare.
My allergy to my old sets was actually an allergy to the adhesive and not the plastic, so I was able to use an iv3000 under the set instead of over it and my site issues went away and I can use the sets that work best for me.

I will not use the plastic ones again, there were too many issues for me as I already mentioned above.

I have never had this happen before so it is not a regular event for them to fall out for me. Actually you are the first person who said that happens a lot with a steel cannula that I recall.

I think putting the adhesive pad, which was very sticky, over it pulled it out maybe. It was just a fluke event. It happened right after I inserted it and then I bolused 5- 10 minutes later. I will make sure to be more careful when I insert them and to make sure they are ok, it did feel like it was at the time.

Unfortunately I have irritations with all of these adhesive patches whether they are over or under the inset or the dexcom makes no difference. I found that DuoDERM under dexcom helped. I’ve just run out of them which is too expensive to use now. When I switch to G6 I stopped using anything over it and it was OK for a long time when I started doing the restarts maybe I had to start putting the patches over it again and then the irritation started again. I did have some without maybe but not as many. I have not really kept track of it. Anyway I don’t know if I’m going be doing the restarts anymore because as soon as I do a restart I get terrible readings and it’s disconnected all the time.

If I don’t start out with an irritation with x patch, eventually it develops so it is an ongoing thing and it’s not consistent it doesn’t happen every time. I have noticed if I don’t use any patch over the inset or the dexcom I am less likely to have an irritation but then I run the risk of them falling off or whatever

I think it depends on how much you move around and how much fat you have on your body.

When I was using steel cannulas I was more lean than I am now, the cannulas will hit muscle and push out a little bit. Especially since I was a long distance runner at he time.

Everyone has to figure out the things that work best.
I went from MDI to pump to mdi and back to a looping pump.

I’ve tried lots of different insulins along the way.

I’m not tied to any tech or insulin. I’m willing to try anything that gives me a little better control

I never though I could be vegan but here I am nearly vegan.
Only because I wanted to try high cab low fat.
It’s working well so I’m willing to keep at it. I still eat one cows yogurt a day and I eat eggs twice a week.

Eventually I’ll go all in, but right now I’m enjoying the ride.
Chick pea pasta. It’s pasta made from 100% chick pea protein and it’s pretty concentrated. It’s also almost as good as wheat pasta, but super protein rich.

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I all the years using a steel infusion set, this has happen a few times. But I don’t have adhesive issues so I do tape everything down. I use Opsite Flexifix tape and just tape the needle down and I cut a hole around the connector.
Another selling point to using a CGM. It is usually the first thing I see when something is wrong with the infusion set. Of course the CGM needs to be working correctly! Sorry it was once again a challenging day. Thankfully they don’t happen often!

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Thanks

It just got even worse because I’ve now had 180 to 260 blood sugar for the past 14 hours -I can’t get it down. I was on the phone with Tandem which was another terrible fiasco were they made me do a bunch of nonsense and none of it worked to diagnose anything and now she says I have to talk to the care consultation team or whatever to get a new pump when it’s obvious it’s the pump that’s causing this this time.

I had three occlusions where insulin shut off, did 3-4 injections, changed out my cartridge and insulin, changed out the inset three times now and my blood sugar is still this high in 250’s.

I was only able to sleep for two hours and then I woke up because my body can feel it’s not getting the basal obviously. One of the occlusions happened when I was doing an air bolus to do a correction injection. I did a four unit injection, I had to eat something so I ate a very low carb meal and my blood sugar only ever came down to 160 then started going right back up from the food and then went back up to the 250s. While I slept although it was 180 when I first woke up and then started going up again.

I have had three such incidents this week the first one happened last Sunday blood sugar spiked up to 250s for no reason I think it was actually 278 when I woke up and I had to correct it. I didn’t know if I was going to be able to work that night. Somehow I made it through although I felt awful. Then in the middle of the week I had another very high spike from this inset bolus issue and the inset not being in. And now this and I’m sure it’s something wrong with the pump because what else could be causing this except that I’m not getting my proper basal.

I did a one unit correction with the pump before I got on the phone with them at some point and instead of going down my blood sugar was going up.

At that point I change the inset for the third time while I was waiting on hold for over 79 minutes to talk to somebody! Then she was trying to get me to change it again and I said I’m not changing it again.

She also had me change out the cartridge again wasting tons of insulin to see if it was an air leak which it turned out supposedly there is no air leak but who knows. She made me bolusb for units to diagnose some thing else and now my pump says I have four units on board and after which all of this conversation where she said she’s not gonna do anything to help me.

I asked how am I supposed to know now how to correct my blood sugar because I don’t know how to do that anymore- I haven’t been on MDI for about eight or nine years probably now. And the pump says I have four units on board so it’s not going to give me a correction.

She said I should switch to MDI now until I wait to talk to the specialized people to see if I’m going to get a new pump, how ridiculous is that. Supposedly according to her they are going to be able to figure out the problem because they have medical degrees… Lol yeah right.

They’re not open now so course I have to wait 24 hours or more until Monday and then they’re going be calling me on a day I have to work and I’m not gonna have time to talk to them, assuming I’m not in the hospital by then. So she said if it were her she would switch to injections- I said I am extremely worried about switching. to injections because I have terrible lows from long acting which is why I’m on a pump. I’m supposed to switch to injections on the basis that Tandem can’t figure out what’s going on with my pump while I wait 24 hours to talk to some other specialized team who is supposedly going to figure this out. What a crock.

I can’t believe they’re leaving me in the lurch like this while I’m sitting here with excessively high blood sugar for hours and hours. I just noticed That my pump battery had gone down to 75% this is supposedly a brand new pump that they sent me about four months ago when the other one failed after sending the five pumps that failed or were the wrong type of pump or whatever. I know when I first received it it was not running down very much and it would never run down to 75% from the last time I charged it so something is definitely wrong. Which makes me suspicious that this was not really a new pump that they ended up sending me in the end.

I used to use opsite until that started causing terrible terrible reactions, even worse than usual, now I’m using some thing else and I’m starting to get reactions to that already. Yes CGM should warn you right sometimes it does warn me but sometimes it’s so off that I never really know what’s going on and I have to fingerstick this entire ordeal and most of the time to see what my blood sugar really is.

I just did another big correction injection so let’s hope this gets me back down and I can get some more sleep. My Endo said to inject 13 units of toujeo if I have to switch to mdi which I have non expired Toujeo now so if it doesn’t come down I guess I’m gonna have to do injections- hopefully I don’t end up with severe low blood sugar because of that and not being able to function at all. I cannot figure out all of this injection nonsense anymore and function normally.

I think the injection may be working now but if I’m not getting basal I’ll just go back up again. And if I don’t eat that can spike me for hours too.

What a crappy life this is. I am on the phone with Tandem again it has been 44 minutes and 14 seconds still no one is answering my phone call but they keep telling me how important my phone call is to them. Lol, yeah right. Not how you want to spend your weekend or any day. Most of the weekend was just working like crazy and trying to function with this high blood sugar now again with 0 help.

I was already on the phone for hours yesterday with Microsoft support and once again they failed to figure out what the problem is with the program. At least then my blood sure was in fairly normal range for me.

I really do not see the point, it is such freaking misery. When I was finally diagnosed with type one and ended up in the ICU life became nothing but a misery where I have to deal with all of these people while going through non stop stresses and problems etc.

Earlier this summer I had three times overnight where I unfortunately slept through some occlusion alarms or when I woke up, I just kept bolusing with no good results. I changed out my infusion set each time and it didn’t help. Finally after hours of readings above 300, I was smart enough to change out my cartridge and then my insulin worked well again. I’ve used Tandem for over 6 years and had tons of false occlusion alarms. This summer was the first time that I have ever needed to change out cartridges to get reliable insulin delivery after occlusion alarms.

I don’t know whether this is related, but these cartridges were from the same box(es) where I had difficulty injecting the insulin into the cartridge. Kind of wonder whether there are just some defective cartridges out there and you’d be wise to try a cartridge from a different lot, if you haven’t tried that. Unfortunately I had long since thrown away the box and packaging for my cartridge problems this summer. I wish I knew what lots to avoid since my cupboard is filled with various boxes of cartridges from different orders.

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Thank you, sorry that happened.

I think I used the same box for both the cartridges however I’ve been using that box for a while now and I didn’t have any problems with any of the other cartridges so I’m hoping they’re OK I’m going to try to sleep now but if I wake up really high again I’m either gonna have to go to MDI or I first will start a brand new box of cartridges.

I think I am down to about low 200s now maybe, after the latest correction. I’m afraid to eat anything but I’ll drop probably just eat some walnuts. The problem is not eating can make me stay high too.

I keep a supply
Of lantus in case I have issues like you are experiencing.
I also inject 10 units of lantus every day just to keep myself more stable, and to take pressure off the infusion site.

If I was running in the 300 s I would take a daily dose of lantus. In my case 23 units. And I would take a correction dose via syringe.

I’ve had absorption problems in the past and once your sugar goes that high, you also will have insulin resistance. Then overwhelming the site is almost impossible to avoid.

When I’m over 200, I will need nearly double the insulin to bring it back into range. My sites can not handle more than 50 units in a day before they stop absorbing.

So taking a small injection of lantus keeps my sites at around 40 units a day

It is mind numbing how many things can go wrong. Cartridge, insulin inset, your site absorption, and insulin resistance.

So difficult to figure it all out so will go directly for the syringe in this case. Sitting over 300 is a deal breaker for me.

I don’t think these were false occlusion alarms because it was shutting off the insulin, fortunately I was not asleep. I still have no clue what happened, however before I went to sleep I did a 3 1/2 unit injection and only ate a small amount of walnuts and some grain free very low carb crackers. I was so exhausted I fell asleep so I was still running in 180 to 200 at that point when I woke up my blood sugar was 31.

I corrected with some juice and it came up went back down to 30 and then I only took a sip of juice in it came up to 50. I got up and started doing things this was 9:30 PM at night by this point and it came back up to 90 on its own before I finally ate a meal. So I was starving as well.

Before I went to sleep I increased the basal rate in my profile from .42 to .47 for the large part of the time and I kept the basal rate of 250% which is what it was at the entire time I was high through this ordeal.

I think there may have been multiple issues here, I do not know what is going on but I am sure some thing is wrong with this pump now so I’m going to have to take a day off of work to be able to talk to them tomorrow and to recover from this. I had changed the cartridge twice and the inset three times.

I figured out at that time the pump has my correction at 1 to 75 but I did one to 50 instead in case I needed more basal and I would not be getting the basal still while I was sleeping.

Well it looks like something that I did changing the whole cartridge and insulin twice in the insert three times and several injections finally got me somewhere back to normal. But I still believe something is wrong with this pump because there’s no way its charge should go down to 75% in only five or six hours, that never happens and it’s a brand new pump supposedly.

It’s exactly what my previous pump started doing before I totally was having problems and they gave me a new one. It started taking longer and longer to charge and the charger go down more than it should. So I think they are putting faulty batteries in if this is indeed a new pump. That is my brother’s theory that with everything with the pandemic and all of the supply chain all of these companies are doing a crappy job now not only for technology but on their customer service.

There is no way I should have to wait 79 minutes to get someone to talk to me and then they don’t even do anything to help me they just put me off to some other group of people. I tried calling back again before I went to sleep about the charging issues and that was another sign that something is wrong and after waiting 44 minutes I gave up. Tg I woke up in a normal range- yes 31 is not normal but I will take 31 over 256 for several hours any day. For 31 all I have to do is drink a little bit of juice and I’m fine.

On my other pump it showed up first as shutting off the basal while I was alseep, supposedly due to not using it up for 12 hours which I don’t believe but that’s what they claim when they looked at the records, and then the history disappeared 2 weeks later. there were other problems with the battery obviously also. And another thing that was happening with both of these pumps is when I’m trying to type things into the menu it’s timing out before it’s time to time out. As for them claiming that it did not shut off by mistake I know they are wrong because before I go to sleep the first thing I do is check with my temp basal rate and I adjust it. I also eat a snack before I go to sleep most of the time and I bolus for it.

I think they were trying to tell me I had to actually go in there and do some thing like a bolus or something for it to register as being used which is crazy if that’s true. But I’m sure I also did a bolus or something else in a 12 hour time. I am sure it went fully into the menu to have to adjust the basal rate at the least.

Another thing I forgot to mention was I think the second inset I put on I made sure it was from a brand new box and it still had problems with the adhesive already and part of it was coming up so I think I am getting substandard supplies. Some of my supplies are older because for a while I was getting double what I needed because I had to change the insets every one to two days, but I made sure that one was from a new box and it was still having the same issue. So that may explain what happened in my original post- when I put the sticky patch on it the inset was not stuck down properly due to bad adhesive and it lifted up and the sticky patch lifted it out of me.

It’s still doesn’t really make sense though because I always check all of this when I put a new inset in and I felt like it was in me.

That is good you can take long acting and be on a pump. As I mentioned I can’t do that I couldn’t even manage mdi just long acting and fast acting because I have terrible lows. And even when I’ve had a situation like this where I was obviously not getting the basal for whatever reasons I can still crash instantaneously with activity or rapidly like what happened when I fell asleep. If I had a long acting in me as well that could be enough to kill me maybe. I truly never know what is going to happen. For instance the second time I woke up and blood sugar was in the 30’s all I took was like 2 g of juice and it brought me all the way back up to 90 eventually the only other thing I did was turn the basal down for a while.

I don’t know your metabolism or your struggles.

For me, once I started a cgm, it nearly completely eliminated my need to eat fast acting carbs to fight lows.

It sounds to me like you are on a roller coaster, a place we have all been before.

You go high, you take extra insulin to combat it and you crash so you take glucose to correct it and you go high again.

My suggestion to you is to have a basal study. Figure out what your basal needs are from hour to hour.

This means being able to fast for several hours at least.

When I’m not eating my sugar is flat and stable. At night or day as long as I’m not eating. Then it’s only meals that play into my adjustments.
If I underestimate I’ll take a little more insulin, but I purposely don’t over do it. Patience is key.

Same deal if I go low, I eat something but not juice or glucose tablets.
I eat fruit bars when I do strenuous exercise, but I’ve learned exactly how much I need because I do the same exercise repeatedly. Usually a bite per quarter mile is perfect for hiking.

I only need to use something like juice on very rare occasions.

But that’s only since cgm. Before that I often was on that same rollercoaster.

I didn’t mean to imply that your occlusions were false. I was saying that all of my previous occlusion alarms through Tandem were false and all I had to do was resume insulin and things were fine. But this summer I had three times where they were actual occlusions and my BG soared up to the 300’s. In each of those cases I had to replace the cartridge before the problem was fixed. Changing the infusion site was not enough. Definitely something wrong with the cartridges IMO.

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Thank for taking the time to give your advice. I have already done all of that and it is useless and did not help me. All of it, numerous times. I have been on a cgm for a long time and it is not accurate enough for me to bolus off of. I have already mentioned this in numerous posts.

The issues discussed here were caused by a pump malfunctions and I did a fantastic job of keeping myself out of a true emergency in both cases.

Thanks. When I talk to the other help group I will mention that. I still don’t know what caused this. It could have been a combo of cartridge and pump issues. I just went through a whole mess when my original pump had to be replaced due to failure and then the first one they sent failed, that is not the first time that happened. The occlusion when I was air bolusing makes me think it either has to be the pump or cartidge/ tubing or both.

I’ve had enough new sites not deliver insulin as predicted, that I test every new site.

First, I NEVER do a site change insertion less than 2 hours before or after a meal. I try to do site changes after breakfast or dinner so I have a chance to watch what happens. Immediately after I do the insertion I give myself a 0.5U bolus and roughly match it with one glucose tab. (My correction is ~1U: 30 mg/dl : 10g. ) Since I know how my BG was trending before I did the change, I can estimate where it would be without the bolus, and I know what the glucose tab will do. Three 3 hours later I can tell if the site is good, a dud, or a poor performer.

I had a lot of problems my first week in my pump, and I had to come up with a way to quickly isolate the problem to pump, tubing or site.

I can test the pump and tuning up to the cannula by disconnecting the tubing from the cannula and using the fill tubing routine, stopping it after 10 units. If that all works, the site is bad. If the site is bad, I change just the cannula. I use the fill cannula routine and a new site. I do this knowing that my cartridge load won’t last as long as predicted, and move the change reminder date and time up before completing the load sequence.

In 6 months I’ve not had a bad cartridge or blocked tubing. Not changing them when they are good saves all the remaining days’ supply of insulin (less the 10 unit test).

I initially used Tandem Autosoft cannulas and had inconsistent results with them.
Having previous experience with infusion catherers, I always used a supplemental tape hold down with a loop in the tubing to minimize the chance of fear of accidentally pulling one out. When I showered, I covered the cannula and the sensor with KT Tape.

Eight out of ten Autosoft cannulas worked ok initially, two didn’t, two became erratic. My theory was that it was because of my many years of doing MDI in those same sites and the harder fat around the flexible cannula moved to block the opening. I based this on my recent experience with CGMs sensors.

When I switched to using the same length (6mm) steel cannulas, I no longer had the degradation problem. I thought it was because I moved to using sites where I had rarely done injections. But recently I tried using the sites where I’d had the most problems and they either worked perfectly for 3 days (+95%) or they proved to be poor within my 2 hour test interval.

So my new theory is that the flexible cannulas that stopped working right weren’t going straight in but being bent or deflected by fat or scarring. If scarred tissue is firm enough, it could cause a flexible cannua to bend, to act like a spring, or it could create a barrier or pocket that delays the insulin from reaching the bloodstream before body heat denatures it.

I believe that the steel cannula does a better job of cutting through hard fat and scarring than a flexible cannula AND the supplementary anchor with the remote detach connection make it less likely to disturb the infusion site.

In 5 months I have had two Trusteel sites that were poor performers, where they started up slowly but then worked ok, four where I had to do small corrections for the entire 3 day period, and three sites that were bad from the start. That’s compared to two Autosoft sites that were bad from the start and 2 that became erratic out of ten sites.

For me, finding good CGM sites was a matter of finding good infusion sites because tissue fluid permeability is bilateral. Neither site needs to be moved much more than an inch from the last site. With infusion sites changing more often (and cheaper) , I use them as trailblazers, and keep the CGM sensors at least 3 site changes behind them.