# Consistent high readings even after corrections?!?



## Unicornz (Nov 7, 2011)

Hi guys

Not too long ago I posted about problems with daily hypos (that's hopefully currently being sorted out so thanks for all your replies!), but now I've found ANOTHER problem! 

I've been seeing it for a while now, but I used to only get it right after a cannula change. Sometimes, my BG would 'shoot' up to 12-14 and whatever I do, it wouldn't budge. No correction or temp basal would make it come down. I used to think I must have been too adventurous with cannula sites and found a place with bad absorption, or hit a muscle or something. I would change the cannula and my levels would come down back to normal almost straight away. 

The last few weeks though, the same thing has been happening to me but to cannulas that were on day two! They were fine on day one, but then all of a sudden again my levels shoot up to 12-14 and won't come down. The other night I had tried 3 correction boluses and two cannula changes and by 12am it hadn't even come down by 1 mmol! Then, 6 hours after the first correction they all 'hit' and I spent the entire night fighting off hypo after hypo. 

Last night it happened again, but I was wise enough to give up after the second correction. This morning I woke up on 6.5 and it's been fine again until the scheduled cannula change on day 3. 

I use the Silhouette cannulas. I've already tried to explain this to my DSN but she had never heard of it before - has anyone on here ever experienced the same? 

The strange thing is that my BG doesn't go UP either, it just sticks really firmly between 12 and 14, and every time it happens it rises up to the same levels!


----------



## Phil65 (Nov 7, 2011)

Unicornz said:


> Hi guys
> 
> Not too long ago I posted about problems with daily hypos (that's hopefully currently being sorted out so thanks for all your replies!), but now I've found ANOTHER problem!
> 
> ...



I often have similar problems, I had dramas with the teflon cannulas and have used the steel d link ones ever since.  I still have problems with siting/absorbtion though and change every 36 hours on average sometimes 2 days depending if my levels go high.  Sometimes you just have to go back to basics don't stack too many corrections or you will inevitably come crashing down.  If I have a high reading 2 hours after a correction, I change cannula/site immediately.  My biggest complaint about pumping is cannulas/absorbtion.....although on MDI just as easy to hit a lypohypertrophy site with same outcomes.


----------



## Pumper_Sue (Nov 7, 2011)

This is what I was taught.
Change cannula before a meal thus your bolus clears any debry in a newly inserted cannula.
Leave your old cannula in place for at least 2 hours thus it drains all the insulin left in it and it's also a back up incase there is a problem with your new set.
Any unexpected results ie unexpected highs after a perfect previous 24 hours, think about what you ate.
Was it high fat or high protien? If so the highs could be due to this so a temp basal needs to be considered. (Protein and fat can take a lot longer to work through your system than you think)
The next site change check the end of your cannula and see if it's pinched.
If it is then you have the wrong size cannula. (hitting muscle)

A high reading can be brought down easier by upping your basal and using a correction bolus at the same time. (Obviously lower the correction dose)

Different infusion sites require different basal rates. Legs for me is a 15% increase.
Also remember the higher your blood sugar the more insulin resistance you become.
I was given the ratio of over 14 a 15% increase in the correction
                                       16 a 25% increase
                                       25 a 50% increase
                                       25.5 a 100% increase
No corrections to be made within 2 hours though.


Everyone has to remember that these cannulas are medical devices so are made to a very high standard, so most of the problems are user error as in not understanding how your body reacts to food. Wrong size cannula or just plain have the pump set up wrongly 

Hope some of the above helps someone.


----------



## Unicornz (Nov 7, 2011)

Thanks Sue, I've considered most of the above but I am pretty certain it doesn't have anything to do with what I have eaten - it's not just any high seeing as it always goes up to exactly the same level... this somehow feels different. I have also not changed my eating habits in the past months, so for my levels to react so differently in the past week or two just doesn't seem right. It has never done this to me before and I've always had a very varied diet so I've tried a lot of different things. 

The fact that it used to happen after a cannula change but now can also happen in the middle of a cannula use worries me. For some reason it almost feels like the insulin I use to correct gets 'stored' somewhere until hours and hours later, when it is all released at once. But then, if this is the case, wouldn't my BG go up until the insulin is released? Because it doesn't, it stays exactly at the same level. And how can it be that whenever this happens it always rises to the same level? 

It's just so confusing I just can't get my head around it!


----------



## Pumper_Sue (Nov 7, 2011)

Unicornz said:


> The fact that it used to happen after a cannula change but now can also happen in the middle of a cannula use worries me. For some reason it almost feels like the insulin I use to correct gets 'stored' somewhere until hours and hours later, when it is all released at once. But then, if this is the case, wouldn't my BG go up until the insulin is released? Because it doesn't, it stays exactly at the same level. And how can it be that whenever this happens it always rises to the same level?
> 
> It's just so confusing I just can't get my head around it!



This is just my personal view, but I would say you are using the wrong size/ type of cannula. If as I suspect you are hitting muscle so your cannula is obstructed and only a small amount of insulin is seeping out then your blood sugar would stay at the higher rate. It would be exactly as if you had put on a temp lower basal.
Have you had a run through with your dsn to double check your cannula insertion is correct? If this is all ok then it points to the wrong cannula for you.
I went through all this and all it was was a need to go down a cannula size due to weight loss and body shape change.


----------



## elaine1969 (Nov 7, 2011)

My daughter started having problems like this.  Every morning her BG would shoot up to 18 - 20 mmols and would not come down.  We increased her breakfast ratio several times and corrected mid morning but it stayed up there until she corrected again at lunch time.  She would have a couple of weeks of these post breakfast highs followed by a week of hypos which occurred at exactly the same time,  around 10.30am.  During this hypo week she would drastically reduce her bolus with breakfast and even turned her basal rate down to the pumps minimal setting but the hypos still came.  It went on for several months.  Her consultant thought the most likely cause was her body producing antibodies which were binding to the insulin and releasing it periodically.  Her problems have eased over the last few months and it was never proven either way,  apparently it is extremely rare but it might be worth keeping it in mind.


----------



## Unicornz (Nov 8, 2011)

Pumper_Sue said:


> This is just my personal view, but I would say you are using the wrong size/ type of cannula. If as I suspect you are hitting muscle so your cannula is obstructed and only a small amount of insulin is seeping out then your blood sugar would stay at the higher rate. It would be exactly as if you had put on a temp lower basal.
> Have you had a run through with your dsn to double check your cannula insertion is correct? If this is all ok then it points to the wrong cannula for you.
> I went through all this and all it was was a need to go down a cannula size due to weight loss and body shape change.



That makes sense! I have tried to quickly explain to my DSN but she hadn't heard of the problem before. I'm seeing her again on Thursday so I will try again. 

I have been going to the gym for a few months now and I have to say that I did get more muscular and lost some body fat in that time (I've always been quite athletic in build anyway), so that would also support what you are saying. I think I am already using the shortest cannula length for the Silhouettes though, so I don't think there is the option to go shorter. I have already tried the Quicksets but they kept kinking under my skin, and my hospital don't fund Mio sets. The only other option would be the steel cannulas, but if I don't have that much body fat I'm not sure if they would be more useful than the Silhouette ones?


----------



## Phil65 (Nov 8, 2011)

Unicornz said:


> That makes sense! I have tried to quickly explain to my DSN but she hadn't heard of the problem before. I'm seeing her again on Thursday so I will try again.
> 
> I have been going to the gym for a few months now and I have to say that I did get more muscular and lost some body fat in that time (I've always been quite athletic in build anyway), so that would also support what you are saying. I think I am already using the shortest cannula length for the Silhouettes though, so I don't think there is the option to go shorter. I have already tried the Quicksets but they kept kinking under my skin, and my hospital don't fund Mio sets. The only other option would be the steel cannulas, but if I don't have that much body fat I'm not sure if they would be more useful than the Silhouette ones?



Worth trying the steel ones.....they are what I use....couldn't get on with the teflon ones


----------



## Pumper_Sue (Nov 8, 2011)

Hi Ilse,
         That's daft your hospital not funding certain sets. If a set works then it's cheaper than having to throw all the others away before time.
With the quicksets are you using the twanger to insert them or doing the job manually?
If using the twanger try a manual insertion and see if that's better. From reading the net it seems as if many find this a better option.

Sue


----------



## Unicornz (Nov 8, 2011)

Pumper_Sue said:


> Hi Ilse,
> That's daft your hospital not funding certain sets. If a set works then it's cheaper than having to throw all the others away before time.
> With the quicksets are you using the twanger to insert them or doing the job manually?
> If using the twanger try a manual insertion and see if that's better. From reading the net it seems as if many find this a better option.
> ...



Yeah, the Mio sets are more expensive because they come in their own little pods with built in inserters so they are not funded sadly. Other than that our hospital has a lot of people on pumps so maybe that is one of the ways they can afford to fund more people without driving costs up too much? 

Either way... I don't use the Quicksets at the moment I only had them very briefly because they kept kinking and they also hurt very badly for the entire cannula duration even if they weren't kinked, so after two weeks I went on to use the Silhouettes instead which have been much better up until now.


----------



## Ellie Jones (Nov 8, 2011)

Somtimes when your BG is up around 16mmol/l then injecting the insulin (with pen or syringe) works better than using the pump to do a correction bolus...

Have you tried manually inserting?

I've never used any inserter to do my sets..  Don't like the idea of having somthing fire my cannular in..

So I use an angled cannular, which I find very handy if you like me skinny, as you can feel when you are insert whether you'll hitting any underlaying muscle


----------



## Unicornz (Nov 11, 2011)

Ellie Jones said:


> Somtimes when your BG is up around 16mmol/l then injecting the insulin (with pen or syringe) works better than using the pump to do a correction bolus...
> 
> Have you tried manually inserting?
> 
> ...



I tried manually inserting it once but I just couldn't get myself to push through I'm such a chicken! Every time it was about to push through the skin it hurt too much and I had to pull back. I am nowhere without my inserter I can only do it when I know it's going to be over quickly lol 

Saw my DSN about it yesterday and she is also mystified. I had a week's worth of CGM data to look through and most of the time corrections started working soon enough and quickly brought me down, but those few times where it happened you could see clearly that the bolus corrections had no effect whatsoever and it took up to 7 hours for my levels to finally return back to normal. 

The strangest thing is that there is no pattern to it, it can happen at any point after a cannula change and at any point of the day and with the cannula in any of the sites I use. 

Next time it happens I will definitely try a correction with my pen though!


----------



## Pumper_Sue (Nov 11, 2011)

Is there any chance at all you have a faulty pump?
My pump decided not to deliver bolus correctly at one point. If it's an intermitent problem then hard to find so perhaps ask to borrow another pump and see what happens.


----------



## Unicornz (Nov 11, 2011)

Ah hadn't thought of that thanks Sue! Will bring it up with my DSN  had it happening again this afternoon so it's getting a bit too frequent for my liking now!


----------



## Pumper_Sue (Nov 11, 2011)

Unicornz said:


> Ah hadn't thought of that thanks Sue! Will bring it up with my DSN  had it happening again this afternoon so it's getting a bit too frequent for my liking now!



Well get hold of dsn asp then  It better to be safe than sorry.
If your basal is fine the easiest way to find out if it's the pump not delivering the bolus then use the pump wizzard and disconect whilst you bolus. Then use a pen for your bolus. If all ok then it's your pump  You still have the bonus though of the IOB so you can track everything doing this.


----------



## Phil65 (Nov 11, 2011)

Unicornz said:


> Ah hadn't thought of that thanks Sue! Will bring it up with my DSN  had it happening again this afternoon so it's getting a bit too frequent for my liking now!



Definitely sounds like the pump is faulty.......it's funny isn't it, sometimes you have to look at basics rather than overcomplicating a reason!


----------



## Unicornz (Nov 15, 2011)

Phil65 said:


> Definitely sounds like the pump is faulty.......it's funny isn't it, sometimes you have to look at basics rather than overcomplicating a reason!



Yes you're right! I guess you sort of take it for granted that the equipment works, it hadn't even come up in my head that it might be faulty! 

Not sure if this is me being paranoid now but I have noticed my pump has started making a more rattling noise than usual when it vibrates. That might have nothing to do with the problem though.


----------



## Pumper_Sue (Nov 15, 2011)

Unicornz said:


> Yes you're right! I guess you sort of take it for granted that the equipment works, it hadn't even come up in my head that it might be faulty!
> 
> Not sure if this is me being paranoid now but I have noticed my pump has started making a more rattling noise than usual when it vibrates. That might have nothing to do with the problem though.



You really need to ring your pump company then and tell them you have a problem with your pump. Better to get another one before you end up on MDI whilst waiting for a replacement. The week end is fast aproaching.
Make sure you have all your pump settings saved as well.


----------



## Unicornz (Nov 15, 2011)

How do you save pump settings? I've left a message with my DSN hopefully she will pick it up quickly to sort me out. I can't deal directly with Medtronic sadly they have to have approval from my DSN before they will send me anything other than my normal supplies. Thanks for all the help!


----------



## trophywench (Nov 15, 2011)

Don't think that can be right UnicornZ.  

If you went on holiday to say - Benidorm or Brighton - and your pump packed up - they would send you a new one immediately by courier.  They most certainly would NOT go via your DSN or anyone else.

So would Roche and probably all the other pump people too.

The Helpline is a different number than the supplies line, the Medtronic Helpline goes through to America when no-one available in the UK.


----------



## Hanmillmum (Nov 15, 2011)

Hi unicornz, just to say we use Medtronic and don't have to go through DSN, just phone and ask, always been helpful as far as we are concerned


----------



## Unicornz (Nov 16, 2011)

Hi guys thanks for the info - I've rung them this afternoon to explain the problem and they are going to do a test with me later to make sure the 'no delivery' alarm is working as intended (couldn't do that at work as apparently I need something for it from my pump box). I don't know what they're going to say if the alarm is working - because if it is then that means I am getting the insulin and the problem couldn't be with the pump then. 

I know that should be a relief, but it isn't because that will leave me right back at the start with no clue why I'm having these weird levels


----------



## Pumper_Sue (Nov 16, 2011)

the simple way to tell if you have a problem with delivery is to keep basal on your pump and do all corrections and bolus by pen/syringe.
You can also use a small measuring spoon and bolus into it and measure the amount into a syringe.

Do make sure you tell them the problem is intermitent.
It's also all very well them saying this test of theirs will tell if no delivery but it wont tell if you are being short changed on delivery will it?

If they are unhelpful just ask your dsn for a loan pump and transfer all your data over and see if you have better results.


----------



## Unicornz (Nov 16, 2011)

Thanks Sue, I did make sure to mention the problem was intermittent. What do you mean by short changed on delivery?

I'm carrying a pen on me at the moment so when it happens again I will correct with my pen instead and see if that does bring it down


----------



## Pumper_Sue (Nov 16, 2011)

Unicornz said:


> Thanks Sue, I did make sure to mention the problem was intermittent. What do you mean by short changed on delivery?
> 
> I'm carrying a pen on me at the moment so when it happens again I will correct with my pen instead and see if that does bring it down



Short changed as in the pump is delivering but not the full dose.
So instead of say 5 units it might just be delivering 4 units.


----------



## Unicornz (Nov 17, 2011)

Well, rang the helpline last night and as I feared I am now back to square one. It took ages to get through, asked me loads of questions which I guess is his job and he has to make sure I am not doing anything obvious wrong... 

Either way, they tested if the 'no delivery' alarm was working, which it was (eventually, after 4.8 units it kicked in although I never take near that much when I'm correcting) so there was nothing else they could do for me. They won't send me a new pump because as far as they are concerned it's working as intended. 

I'm completely at a loss now, although it hasn't happened again for quite a few days.


----------



## Pumper_Sue (Nov 17, 2011)

It's quite simple then ask your dsn for a spare pump to try out. 

As I also said measure out amount in a spoon and then use a syringe to see if full amount in the spoon. Do this in front of your dsn.

Other options to think about. The corrections that do not seem to work are they at the same time of day? If so then perhaps you need your correction factor changed.


----------



## Unicornz (Nov 17, 2011)

The problem is that this is happening very sporadically, so if I measured the amount of insulin given now it would almost certainly be the right amount. The only way is to wait until it happens again and try it then. 

The problem corrections also happen very randomly, they can happen at any time of the day (had a few in the afternoon and one at night before I went to bed and also one in the morning) and they can also happen with any site. Sometimes it happens just after a set change and sometimes it happens halfway through day two of the change


----------



## Pumper_Sue (Nov 17, 2011)

As already stated ask for a loan pump for a couple of weeks then see what happens.

I do have to say though I think it's very poor service from medtronic. If you are not confident the pump is working correctly then they should replace it.


----------

