# High BG lewvel after canula site change



## Amanda102 (May 27, 2012)

Hi,  I wonder if anyone who is using a pump has experienced this.  Recently when my daughter changes her omnipod after 3 days and puts it in a new location, we end up with high readings throughout the night (she currently changes it at 8pm in the evening although I am going to change to a morning as advised in the 'Pumping Insulin' book I bought after a helpful tip on here!).  She has been getting high readings of 16-18 at about 11pm and again at 1am and 3am even after corrections.  After that it has settled down in the morning and we are back to normal.  I wondered if the change of site meant it was taking a while to get the insulin into the system, but really I have no idea!!  Anyone else experienced this?


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## Pumper_Sue (May 27, 2012)

No idea with the pods workings but if using an ordinary pump and cannula the simple solution is to leave the old cannula in for a couple of hours after the change.
It's always best to change before a meal then the bolus for that meal flushes through the cannula and makes sure all is working ok. 

No 1 rule of pumping is never change a cannula before bed or late evening.  The risk of DKA is very high if you have a failed pod or cannula.
Hope the change to mornings results in better numbers.


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## RuthieG (May 27, 2012)

The times his has happened to me (a few times) is when the cannula has bent on its way in or not gone in right. I have had to go through the whole rigmurole again. This is my least favourite thing about my pumps.

I am assured this is rare but it doesn't see that rare (I am quite heavily pregnant though so harder to get it in!)


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## suziepoo (May 27, 2012)

Have u remembered to run one unit through, after insertion, to make sure there is insulin in the cannula?

I usually change my cannulas in the early evening as I don't have time in a morning to change everything! 

Hope things improve!


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## Pumper_Sue (May 28, 2012)

suziepoo said:


> Have u remembered to run one unit through, after insertion, to make sure there is insulin in the cannula?
> You are joking yes? 1 unit would be a recipe for disaster (hypo land) esp for a child. You only need to fill the cannula before The idea of changing the cannula before a meal is so that insulin in the form of a meal bolus is pushed through the cannula rather than empty insulin causing a massive hypo and also if the set fails (very rare) it is spotted very quickly insertion with the amount specified by the cannula manufacturer.
> I usually change my cannulas in the early evening as I don't have time in a morning to change everything!
> Very  If things go wrong it could be an all night testing and bolusing/correcting. It takes all of 3 minutes to change a cannula over. You do not need to change the cannula and cartridge at the same time either
> Hope things improve!



Obviously using the pod you do need to check re the cannula as very few if any on this forum have one, due to them costing almost twice as much as a tubeless pump.


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## everydayupsanddowns (May 28, 2012)

No experience of omnipods, but Medtronic suggest rather less than 1u to fill the quickset cannula. I guess Roche/Omnipods etc would have details in the Patient Information Leaflets in the packs of cannulas/pods.

For clarity (since I got a bit confused reading this thread) - this was how my DSN explained it:

Change reservoir and tubing - obviously the tubing takes a lot of insulin to fill, so I keep pushing the units through as instructed during the 'reservoir setup' dialogs until droplets are seen at the end of the tubing

Insert cannula - The little bit of tubing inside the body is now 'empty' any delivery of insulin from the tubing would need to push this air through before insulin was delivered into the body, so if you don't fill the last 6mm/9mm of the delivery route you could effectively end up with a basal shortfall. Depending on the length of the cannula (6mm/9mm) different tiny amounts of insulin would be needed. Medtronic suggest 0.3u for 6mm ones and 0.5u for 9mm.


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## suziepoo (May 28, 2012)

Originally Posted by suziepoo

*Have u remembered to run one unit through, after insertion, to make sure there is insulin in the cannula?*
_You are joking yes? 1 unit would be a recipe for disaster (hypo land) esp for a child. You only need to fill the cannula before The idea of changing the cannula before a meal is so that insulin in the form of a meal bolus is pushed through the cannula rather than empty insulin causing a massive hypo and also if the set fails (very rare) it is spotted very quickly insertion with the amount specified by the cannula manufacturer_.

I was told by my DSN to fill the tip on the new cannula with insulin otherwise your dosages would be reduced on your next dosage. Obviously, we all have different rates so just assumed Amanda would reduce to the amount for her child's needs.

* I usually change my cannulas in the early evening as I don't have time in a morning to change everything! *
_Very If things go wrong it could be an all night testing and bolusing/correcting. It takes all of 3 minutes to change a cannula over. You do not need to change the cannula and cartridge at the same time either 
Hope things improve! 
_
Sadly, for me it takes a lot longer than 3 minutes to change my cannulas. I hope one day to be able to do it so quickly but in the meantime, I'll stick to what works for me (with my DSN's support).

However, in future I won't make any suggestions or give my experience on things.


_Obviously using the pod you do need to check re the cannula as very few if any on this forum have one, due to them costing almost twice as much as a tubeless pump._


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## Pumper_Sue (May 28, 2012)

Suzie,
some cannulas you prime before insertion, so you know the cannula is full on insertion.
Others you prime after insertion and you must follow the instructions per cannula for the prime. My previous cannulas used to take 0.02u to prime it. 

So if I filled it with one unit of insulin I would have been on the floor.This is what I was trying to explain to you, I was not having a go at you.


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## Belle (Jun 23, 2012)

We experience exactly the same we are about the test having a unique basal setting for new pod days whereby we increase the ratios.  Obviously we will do it at a weekend when our daughter is with us and not at school.  But it is a shame to have such great control interrupted every third day.  Good luck


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## trophywench (Jun 23, 2012)

Well my cannulas are 1u, Sue.  However, I know the Roche angled ones for my pump, even though the actual cannula bit is longer - actually take LESS than 1u to prime!  So every single make and model is different.

I don't actually know too much about the Omnipod except I have the impression that the whole thing is attached to you, ie the pod includes the insulin and the cannula, no tubing visible and you control it with a remote.

What do Ypsomed/Omnipod say about cannula change timings and prime amounts?  Is it perchance accessible online?  I mean - I had a blind panic when I first had my pump and couldn't remember what the prime amount was, I was in a right tizzy till Pumper Sue calmly found the instructions for my exact cannula on the Roche website and gave me the link LOL - it just never ocurred to me to even look there!

DOH ! as Homer Simpson would say !


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## Ellie Jones (Jun 23, 2012)

All cannula's inserts will give information on priming etc...

But some people who find that their BG raises after a cannula change, find leaving the old set in for a couple of hours, sort it out!

So always worth giving this a try


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## HOBIE (Jun 23, 2012)

I havnt had that problem.  It has to be somthing wrong with delivery ? Hope you get sorted


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## Twitchy (Jun 23, 2012)

Not sure if this is relevant to the Omnipod, (am on AccuChek spirit combo with flex-link canulas)...if I keep a canula in for the full 3 days they tell you to try as a default, more often than not I find my levels sky rocket on the third day as the old canula seems to 'go off' somehow. Is it always immediately after changing that levels goes up? Not sure how it would work trying to maybe change half a day earlier or something as the omnipod IS all in one, isn't it & I don't know if you have any control over the amount of insulin in the reservoir etc?? Just pondering...


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