if i have a high BG >250 and i try to do a correction bolus w/ my pump, most likely i will be doing corrections about 3 times before is see results of my BGs coming down. but when i use a syringe, my BGs start coming down w/in an hour after injection. over the years, i have noticed this situation, and have wondered why the reactions to the same insulin would have such different outcomes.
does anyone have an answer or speculation w/ regard to this observation? and, if there is a reason that you know of, why do we bother using the pump to do corrections at all? why not just reach for the needle?
I do all my corrections with the pump. they work fine. just a WAG: perhaps you have some inflammation going on at the site. I see no reason a correction via the pump wouldnât work well during the first day, but if inflammation is an issue, I can see how that may become a factor over the course of a few days.
ah, why correct via the pump, you ask? How about so you can see your IOB. And I donât want to mess with a pen. I have pens in the fridge just for emergencies, or when I travel far from home and need a backup method of getting insulin if needed.
The most obvious explanation is, as already suggested, that something is going wrong with your pumpâs insulin infusion site to hinder absorption. That is, you either have a âbadâ site or one that has degraded over time.
what you say makes sense, but i donât know if that is what happens w/ me. i do use new sites regularly and avoid scar tissue. also, when i give myself a shot, i am careful to pull up some skin tissue in order to inject. i donât think i am injecting IM. possibly.
but just for the hell of it: i had âone of those days.â couldnât get my BGs down below 200. tried correcting, changed sites, re-did my pump, used increased temp basal rates. nada. finally i tossed my insulin (which was not so old, but maybe slowed down) and voila, sugars came crashing down to 80 in less than an hour w/ my dex direction arrow trending down. ugh. tried to halt the low w/ a glucose tab. turned off the temp basal, and now am waiting to level off. must have been the insulin. its the only thing i can think of.
thanks john. youâve always been very supportive of me.
I would guess that the injection is in a new area that is not already saturated with insulin (and perhaps also an area that gets used much less often) and therefore absorption is faster/better.
When I inject via syringe I disconnect my pump and bolus the corresponding amount into the sink so that I can still track IOB accurately.
I had a day like this today⌠BGâs were high and stubborn. despite repeated corrections from mp, I saw little or no improvement overnight. Finally gave up and yanked out the infusion set (only around 15 hours old) â That was the problem - cannula was bent and probably not working.
Once the new infusion set was in place, I corrected with the pump⌠however, an hour or so later, I dd not see the expected improvement. At that point, I corrected with an IM shot - and improved rather quickly.
Odd part is â there seems to be nothing wrong with this infusion set! Itâs been working as expected ever since! Did I just need a much bigger correction than I thought, or was absorption just terrible in the first couple hours of a new set? I did not end up low, thankfully, so the extra IM injection WAS neededâŚ
Suspecting your insulin is bad is possibly an inevitable consequence of being human. I tend to doubt that insulin is bad as frequently as folks seem to think it is. And it can be hard to tell what happened after the fact. When you changed insulin did you continue to use the same infusion site? My guess would be no since I will usually change the set at the same time I swap a reservoir.
If you changed both the infusion set & the insulin, how could you attribute a change to just one or the other?
I suspect what happened was that for some reason your previous correction boluses took much longer than expected to be absorbed. You got frustrated and corrected again but eventually both some part of your previous corrections plus your most recent one all crept up on you and you crashed. In other words, possibly insulin âstackingâ?
But itâs just a guess and my assumptions could be wrong. In the past I have done something along those lines which is why it came to mind.
Did you check for ketones? If your site wasnât working for 15 hours you probably had them. I get ketones after 2-3 hours of a new site with a bent cannula. When you have ketones, you need more insulin than usual to bring a high down. I find highs caused by pump issues (lack of insulin) are much harder to bring down (and feel much more terrible) than highs caused by a miscalculated bolus.
no ketones. and i changed my site 3 times. now i boosted up my temp basal rate to 110%. maybe this will help. otherwise i think i might just need a basal adjustment. i see my endo next week. the temp basal seems to be effective for now.
My question was aimed at @Thas, but I guwas it could apply to you, too. Knowing what to do and when is som. ething I still havenât figured out. What I do know is that at times it seems like my body can change overnight with hormones and suddenly every one of my pump settings are wrong.
I too find that going high from âsilent occlusionsâ also makes me feel much worse afterwards way more so than just miscalculating bolus⌠Never thought it might be from keytones but that is a possibility.
Thanks, Jen.
thatâs exactly what i am going through. and to top it off, my dexcom went on the blink and i have not been able to get ANY correct readings. (reported this to dex tech support and they are replacing the bum sensor) but the thing that bothers me is that it seems that when i really am relying on my cgm, its not working. i know i am able to use my finger sticks, but when i am on a temp basal, it would be much more convenient to be able to look at the dex screen and know about any trends going on.
i am in a really frustrated and pissy mood. i am using up too many test strips and also the tegaderm tape (neither of which comes cheap)
Itâs probably because after a day or two your site may not absorb as well so an injection somewhere else works faster/better. I think there are other reasons but Iâve forgotten what they are now.
My totally unscientific guess for myself is that eventually the insulin bolused via pump all finally gets circulating and that is when I crash. Several hours after correcting with multiple small (but correct for BG) boluses. Sometimes it seems that whatever I ate just has more carbs than I thought or my digestion is different (tho I have no GI probs). All this is speculation but I have had to get up for juice next to the bed many times due to my BG finally deciding to drop whoosh after hanging at same level for too long.
I think I am just about ready to try those Afreeza samples I have!
I didnât check, but thatâs a good point â just because I never had a ketone problem in the past, doesnât mean I didnât have one then⌠I did feel terrible almost all day afterward, though. Who knows?
I think this is happening with me, although I donât think my site is degrading as much as the new site is more efficient. I get a good 3 days out of my site (steel needle insertion set) and my BGs are predictable right until the insulin runs out. The thing is, when I put in the new set, I have to run an 80% basal for four hours or so, or Iâll run lower than I expect to. After that four hour-ish period, the site settles down to ânormalâ.
