# BG rising & trace ketones... drat!



## Twitchy (Sep 7, 2010)

Hello all...

Think I might have a problem with my infusion set?... BG on waking up was 7.7 (did several tests last night so no reason to think went hypo & bounced btw), had no breakfast (no chance lol!), then by lunchtime it was 14 (previous mornings I've been 4.5 - 6), corrected with 2u then v carefully carb counted & dosed for lunch, 2hrs later 17.8!!  Tested & sure enough, trace ketones (not surprised as feeling siiiiick!!).

I've checked for air bubbles (none I could see), disconnected the tubing & run a few units 'priming' to confirm insulin is coming out, all ok... so guess it's the cannula?...  in hindsight I've been feeling a bit 'aware' of it today (tiny bit stingy), but I thought that was just because I dropped the pump twice yesterday, so had a bit of a tug on it!   So in short, I've changed the cannula a day early... just have to watch & see if that helps now I guess... 

Checked again a few minutes ago (it's a hour since the last bolus which was prior to the set change - guess thinking about it if the cannula WAS dodgy it won't have had much effect, doh!) and it has come down a little, 14.8mmol... so I've had another little bolus (2u) now, accepting I might go hypo - but frankly would prefer a hypo to these ketones! Nursery would probably shoot me for this...!!

Does any of this make sense?!


----------



## bigpurpleduck (Sep 7, 2010)

Of course it makes sense Twitchy!

I had a similar problem in my first couple of months. It was hard to tell at the time that there was a problem with the canula. My first major warning sign was blood in the canula... Things were going in the wrong direction!

You did right to change the set. I doubt you would have come back down to 14.8 had the change not worked. Since it's only quick-acting insulin in a pump, if it's not working your BG rises very quickly.

Have you checked for ketones again since you came down to 14.8?

I should imagine you will continue to come down now, so don't panic. But do keep checking!

Also be comforted by the fact that you handled it brilliantly!


----------



## novorapidboi26 (Sep 7, 2010)

getting the hang of a pump must be murder, but it also must be worth it in the end............what I dont understand is why........its the same as a pen pretty much apart from some of the obvious differences..........

Also you have been correcting 14.8 with 2u, and you expect a hypo?

Depending on sensitivity, 2u should bring you down to just above target (8-10mmol/l), so you shouldnt, in theory go hypo, i would need an extra 1u as its over 12mmol/l.


----------



## Twitchy (Sep 7, 2010)

From what I can see, the main relative disadvantage (& main benefit too, ironically!) with a pump is the lack of background insulin 'ticking along' as it were... so you get ketones quite quickly if there's a problem... from what I can see so far too, it's quite hard to tell when a rise in BG is an indicator of oncoming illness, bounce back from a hypo, poor carb counting or a pump problem (at least initially!)... all I'm aware you can do is check for obvious pump problems (air bubbles / leaks) try a correction bolus, leave a while, retest, correct again, retest & then have a go with a pen & see if that works! 

Typically for me, 1u approx equates to 3 mmol, I'm assuming that to get the drop from 17 to 14 at least some of the previous 3u bolus must have managed to get in but have no way of knowing how much, so 6mmol off 14 would normally be fine, but not sure what extra to expect, if you get my drift?...  bit fuzzy headed today too, lack of sleep due to testing lol! (& rascally todderl falling out of bed, doh! Bless him....)   Still wouldn't give up this pump though!!


----------



## Twitchy (Sep 7, 2010)

Thanks Bigpurpleduck, just saw your post!  Feeling more confident now!!


----------



## novorapidboi26 (Sep 7, 2010)

stick at it..............


----------



## bev (Sep 7, 2010)

You did all the right things - so well done. What we have learnt is that if there is a need for a second correction then we get the set-change ready as it invariably means we need a set change. The rule is 2 corrections fail - go to injections. Was the canula bent? Perhaps you have a site infection? Perhaps your brewing an illness? Insulin in date? Bubbles? Battery ok on pump? Dont forget to put a temporary basal on for an hour or so if you are high as it does help with resistance. Perhaps you could start with 140% and go up by 10% per hour or until your levels are within range. You probably went through all of these things and ruled them all out - so just put it down to one of those diabetes blips if none of the above. We also found that a set change was needed every 2 days not 3 days - so whilst its a nuisance - its much better to know why there were high's. Hope your feeling better now.Bev


----------



## bigpurpleduck (Sep 7, 2010)

Seems like a day for cannula problems! Been pumping for over a year and tonight is the second time I've had a problem and needed to change earlier than planned. It's so frustrating! I was getting there today and now the bent cannula's just messed it all up. Grr!


----------



## bev (Sep 7, 2010)

bigpurpleduck said:


> Seems like a day for cannula problems! Been pumping for over a year and tonight is the second time I've had a problem and needed to change earlier than planned. It's so frustrating! I was getting there today and now the bent cannula's just messed it all up. Grr!



What sets do you use? Alex has just changed from quick sets to sils as he had quite a few that bent.Bev


----------



## purpleshadez (Sep 8, 2010)

Hi Twitchy, hope your levels are back as they should be now. I had issues with bent canulas with the quicksets so now using the sils. 

Which until this last set has been problem free! After my high few days my canula site started to get sore last night so I changed it and very quickly came back down to normal levels so I guess I should have swapped it sooner really.

Heh this morning was definately a case of "hello 6.4, I haven't seen you in a few days"


----------



## bigpurpleduck (Sep 8, 2010)

I'm using the quicksets. I very rarely have problems with them. Been pumping for over a year so have done around 130 set changes , and only had problems with 2... I don't think this is too bad. Will keep an eye on it though, it's possible there have been other occasions where high BG was because of the cannula but I've just put it down to my crazy body.

Bev and purpleshadez... How do you find the sils?


----------



## purpleshadez (Sep 8, 2010)

I find them okay to be honest. Sometimes (rarely) get a little twinge when inserting but nothing too dramatic.

I have to confess I found them quite scary at first. Because it goes in at an angle the needle is much longer so I was really nervous the first few times I used them. I don't use an inserter though, I do it by hand.


----------



## Twitchy (Sep 8, 2010)

Hiya...BG's back to normal, phew!  Still tweaking the basal rate overnight, but already soooooo much better than mdi!! 

Are sils etc trademark names?...don't think I've heard of them yet?  I must be a real coward because the first time I cocked the 'linkassist' device, the site of what seemed to be a BIG needle (compared to my pen needles) poised to jab into me gave me quite a wobble!  I'm actually amazed at how fine it is to put them in though!  What a wooss I am hehe!!

Luuuuuurve this pump!!!


----------



## bev (Sep 8, 2010)

bigpurpleduck said:


> I'm using the quicksets. I very rarely have problems with them. Been pumping for over a year so have done around 130 set changes , and only had problems with 2... I don't think this is too bad. Will keep an eye on it though, it's possible there have been other occasions where high BG was because of the cannula but I've just put it down to my crazy body.
> 
> Bev and purpleshadez... How do you find the sils?



Alex has used them for 11 months with few problems (quick sets) - but ran into problems of kinking recently. I was talking to Adrienne today and she told me that a lot of people on the childrens list have also been having problems with them recently - especially the 6mm ones - so some have changed to 9mm and others have changed to the mio's, which, by all accounts, are great. They have the inserter and the set all in one and are easy to put it. We will stick with the sils for now as they seem to suit Alex, but might give a mio a go too. You can always ask for 1 box to trial before you decide if you want to make a permanent change. I got a box of sils and a box of mios.Bev


----------



## bev (Sep 8, 2010)

Twitchy said:


> Hiya...BG's back to normal, phew!  Still tweaking the basal rate overnight, but already soooooo much better than mdi!!
> 
> Are sils etc trademark names?...don't think I've heard of them yet?  I must be a real coward because the first time I cocked the 'linkassist' device, the site of what seemed to be a BIG needle (compared to my pen needles) poised to jab into me gave me quite a wobble!  I'm actually amazed at how fine it is to put them in though!  What a wooss I am hehe!!
> 
> Luuuuuurve this pump!!!



Hi Twitchy,
Sils is short for 'silhouettes' - but not sure if they fit every pump or if they are just medtronic. Sorry - I cant remember what pump you have.Bev


----------



## Patricia (Sep 8, 2010)

Sorry coming very late to this. The one off rise seems to be the set kind of going 'off'? But if recurrent it's absolutely worth looking into another type. We switched to Sils about 4 months ago, because of a lack of fat layer. They come in at a 45 degree angle so can function well in a very thin layer. The quicksets (and mios I think?) are 90 degree insertions and kept throwing us highs we think because of going into muscle. Sometimes they were dreadful highs and malffunctions, but sometimes they seemed just random. I can honestly say that for us sils have made dramatic difference: more stable numbers generally, and no set problems AT ALL.


----------



## tracey w (Sep 9, 2010)

Twitchy said:


> Hiya...BG's back to normal, phew!  Still tweaking the basal rate overnight, but already soooooo much better than mdi!!
> 
> Are sils etc trademark names?...don't think I've heard of them yet?  I must be a real coward because the first time I cocked the 'linkassist' device, the site of what seemed to be a BIG needle (compared to my pen needles) poised to jab into me gave me quite a wobble!  I'm actually amazed at how fine it is to put them in though!  What a wooss I am hehe!!
> 
> Luuuuuurve this pump!!!



Hi, sorry not sure of your pump. I think its the combo same as me? If so, sils are tenderlinks at roche. These are what i use. Dont worry about the needle length, does look scary but you only insert the same amount as you would with the other type, the rest is a guider (not sure thats the right word).  Ive never had a problem with bent canulas. do sometimes get blood in canula and have to change, but this is only recently and am doing more vigourous exercise so dont think it can be helped.


----------



## Twitchy (Sep 9, 2010)

*Grrr it's happening AGAIN!!*

Tracey - it's an accu-chek combo...

Deja vu....actually slept through last night (not the plan, oops!).... 7.8 on rising (for me, at least half what it used to be, so brill!)... rushing around with kids, didn't get breakfast until 8.40 at the sains' cafe, so I carb estimated (it was a breakfast bap, sooo naughty I know, don't tell the others in the weight loss group!  ).  Quite a big roll, so I estimated 3.5 cps or units to bolus...3 hours later BG was 13.1, thought oops, got that wrong, so had 2u correction bolus... well I had been aware that the area around the set is tender, but it's that time of the month & even my C section scar is throbbing at the mo, so didn't think anything of it... an hour later & its 13.7 now!! Just had another 2u correction (I know, I should really wait 2hrs)... 

But I'm a bit confused - nursey said to do 2 pump corrections THEN use a pen & change the infusion cannula... but in the pump manual (& from what I've read, everyone else is doing this) it says to do just ONE correction, if no response to that correction after a couple of hours & showing ketones & over 11mmol give a PEN bolus, change set etc & check again later... ???

Does anyone else find they can only go 2 days on the teflon cannula?  I'm on the plump (well, plump & saggy post baby mummy-tummy) side at the mo, so I don't think I'm hitting muscle... (muscle?... I remember those lol!)

Any thoughts?... I know the pump kit is expensive, so am worried this will give them an excuse to take it away if I have to change cannulas every 2 days...


----------



## novorapidboi26 (Sep 9, 2010)

No advice on the pump, but maybe the fat from the contents of your roll/bap delayed the release giving you a large peak later.......

Also I do believe that insulin is just as effective if delivered into muscle....have you tried moving the site of your cannula to somewhere you would be more confident.....

Hope you can find the answers.....que pumpers........


----------



## Twitchy (Sep 9, 2010)

novorapidboi26 said:


> No advice on the pump, but maybe the fat from the contents of your roll/bap delayed the release giving you a large peak later.......
> ..



LOL, more of a spare inner tube or two!!

The thing is, all the sets have been in the general area & I've not had any problems with injections there, so I don't think (!) that's it...

Ho hum....!!


----------



## Twitchy (Sep 9, 2010)

10.1 now, after 2nd correction on the pump... does that mean I don't need to change the set then?!!! 

Haven't eaten, don't want to add carbs to everything else now!  Still waiting for a call back from nursery at some point today... not holding my breath...


----------



## Twitchy (Sep 9, 2010)

*Think I've been a plonker this time...!*

Thinking about it... inaccurate carb est for roll / bap thingy... plus naughty cappuccino; and what was sprinkled on the cappo?  Choc sprinkles...

Durrrr 

Just never ever had to bolus for a cappo before!!  Maybe it's my body's way of telling me I'm s'posed to be dieting lol!!  BG finally coming down, in single figures now... that'll learn me, wheat puffs or weetabix from now on...!!


----------



## tracey w (Sep 9, 2010)

Twitchy said:


> Thinking about it... inaccurate carb est for roll / bap thingy... plus naughty cappuccino; and what was sprinkled on the cappo?  Choc sprinkles...
> 
> Durrrr
> 
> Just never ever had to bolus for a cappo before!!  Maybe it's my body's way of telling me I'm s'posed to be dieting lol!!  BG finally coming down, in single figures now... that'll learn me, wheat puffs or weetabix from now on...!!



OK, thing is now your pumping you need to bolus for EVERYTHING, like you i didnt used to bolus for 10cho etc according to dafne, however the pump is so sensitive, i even bolus small amounts of veg/salad or i go sky high. Cappuccino definaltely, milk is slow release cho and you are having quite a bit of milk there. You will get used to it i promise.


----------



## bev (Sep 9, 2010)

Twitchy said:


> Thinking about it... inaccurate carb est for roll / bap thingy... plus naughty cappuccino; and what was sprinkled on the cappo?  Choc sprinkles...
> 
> Durrrr
> 
> Just never ever had to bolus for a cappo before!!  Maybe it's my body's way of telling me I'm s'posed to be dieting lol!!  BG finally coming down, in single figures now... that'll learn me, wheat puffs or weetabix from now on...!!



I am intreagued that you still think in terms of units per food item rather than just putting the carbs in the bolus wizard. I never look to see how many units for each food item anymore as it seems irrelavant.I really couldnt tell you how many units Alex has for a pizza - but I could tell you the carb count, the ratio and the dual wave etc..

Dont forget that on the pump you dont have the background insulin to help mop up things like cappucino's - so you have to be fairly accurate with the carb couting. Alex doesnt drink coffee's etc so not sure what the carbs would be in them. I think the fat in the bacon roll will have contributed to the high level later on - did you do a dual wave or similar? I would do a 70/30 split for a bacon roll over 3 or 4 hours to help with timing.

Alex cant tolerate any canula for more than 2 days so we change it as often as he needs it. Dont worry about the cost - when you think of how many needles, pens etc your not using it evens out.Bev


----------



## Twitchy (Sep 9, 2010)

Bolus wizard.... sigh... I still haven't got the handset part of the combo yet, just the pump... due tp staff training at the hospital (only 2 pump nurses & both training at the same time!) and their not being willing for me to come in with baby for the training session on the handset (& she's a good baby too!!!)  So next date I can make with childcare & them not training is in a couple of weeks time alas....


----------

