If it does not come down real soon you might want to give a manual insulin injection then possibly change the infusion set.
Sent from Tony's iPhone
Sent from Tony's iPhone
new pump, bg is 378. Yikes!!!
We are so stressed with the adjustment process for this new Medtronic pump. Keep sending the Endo the numbers daily as directed and now Ronnie is red faced and sleepy and grumpyyyyyyy!
He did so good in speech and physical therapy today that we gave ourselves lunch at Red Lobster. I fully intended to get him a big salads with double order of grilled shrimp. He became hostile and insisted on lobster pizza. He had one biscuit and the whole pizza and I gave him keyed in 90 gm of carbs. On review, I discovered that that was 15 carbs to much. All in all, that should have caused him to get to much insulin. We have a call in for the Endo. Against orders, my son keyed in a correction bolus of 5.6 units. We just checked his bg again 1hr post bolus and his bg is 382. 1 hr ago it was 372.
Anyone got any comments/advice.
Son is stubborn and says it couldn't be the set because there aren't any kinks in the tubing. Ronnie's shoulder brace pillow, is where it can put pressure on the insertion site for the cannula. How soon should we notice if something is wrong after changing the infusion set? Could external pressure dislodge the cannula without any outward sign that it has been moved?
He did so good in speech and physical therapy today that we gave ourselves lunch at Red Lobster. I fully intended to get him a big salads with double order of grilled shrimp. He became hostile and insisted on lobster pizza. He had one biscuit and the whole pizza and I gave him keyed in 90 gm of carbs. On review, I discovered that that was 15 carbs to much. All in all, that should have caused him to get to much insulin. We have a call in for the Endo. Against orders, my son keyed in a correction bolus of 5.6 units. We just checked his bg again 1hr post bolus and his bg is 382. 1 hr ago it was 372.
Anyone got any comments/advice.
Son is stubborn and says it couldn't be the set because there aren't any kinks in the tubing. Ronnie's shoulder brace pillow, is where it can put pressure on the insertion site for the cannula. How soon should we notice if something is wrong after changing the infusion set? Could external pressure dislodge the cannula without any outward sign that it has been moved?
1 - 17 of 17 Posts
I agree with a couple of caveats.
That's a lot of carbs at one sitting whether its the correct count or not.
Might be a good idea to check the suggested bolus against your usual calculation for awhile anyway until the insulin to carb ratio and basal settings are dialed in. As Marsha pointed out someplace earlier, the initial pump settings are likely on the low side.
I don't generally see my fast-acting boluses kick in until about two hours after a meal. Usually if the bolus was too small, glucose will continue to rise especially if there was a large component of protein and fat like you would have with pizza.
If you give an extra bolus, do it with the pump so the endo can see it recorded along with the other data. Makes it easier and more accurate plus you can give smaller boluses as necessary. Better to bring that high number down a little more slowly rather than risk a hypo and start bouncing.
Your pump may allow an extended release feature to cover meals like you describe.
I'm assuming your checking for ketones?
Pumping is great, but it takes some time to adjust.
That's a lot of carbs at one sitting whether its the correct count or not.
Might be a good idea to check the suggested bolus against your usual calculation for awhile anyway until the insulin to carb ratio and basal settings are dialed in. As Marsha pointed out someplace earlier, the initial pump settings are likely on the low side.
I don't generally see my fast-acting boluses kick in until about two hours after a meal. Usually if the bolus was too small, glucose will continue to rise especially if there was a large component of protein and fat like you would have with pizza.
If you give an extra bolus, do it with the pump so the endo can see it recorded along with the other data. Makes it easier and more accurate plus you can give smaller boluses as necessary. Better to bring that high number down a little more slowly rather than risk a hypo and start bouncing.
Your pump may allow an extended release feature to cover meals like you describe.
I'm assuming your checking for ketones?
Pumping is great, but it takes some time to adjust.
Blood Keystone was .3. BG was 201 this AM. Its going to be a long weekend! I am sure the Endo is being extra cautious due to my husbands history of seizures due to his stroke.
Thanks for the information.
Thanks for the information.
The infusion set was changed today. The cannula was bent sideways but not obviously kinked. I suspect Ronnie was getting some but not all of the insulin. Son still put the new set in a precarious spot, Subject to being pushed against by the pants waistband or the pad on his shoulder brace/sling. I'm surprised Ronnie's BG didn't go even higher.
Problems like this can happen rather often when starting to use a pump. It takes a lot of practice and changing the settings gradually before good control is achieved. I started pumping in 2007 and also had test of over 300 at the end of the first day. It took some major changes to get the numbers more normal, and then a lot of minor changes over the next three weeks before I was happy with my control. Pumping is terrific after a lot of practice.
I recommend the book "Pumping Insulin" by John Walsh.
I recommend the book "Pumping Insulin" by John Walsh.
Found a kink just barely away from the tip.
The endocrinologist doesn't want us arbitrarily changing settings. He wants us to only make the changes he dictates and for son, it is difficult because he is pretty sharp and fairly well read.
The endocrinologist doesn't want us arbitrarily changing settings. He wants us to only make the changes he dictates and for son, it is difficult because he is pretty sharp and fairly well read.
Probably best to go with the endo's settings at first - I was scared to death to change anything for months, but now do it often as I have better understanding of the rationale.
Just curious, what are you using to check ketones? I have a meter that does that, but the strips are very expensive and expire quickly despite foil wrap.
Just curious, what are you using to check ketones? I have a meter that does that, but the strips are very expensive and expire quickly despite foil wrap.
Precision Extra blood keytone test strips. $55 for 10 strips. I had a hard time even finding a supplier. Had to use a pharmacy inconvenient to use and the insurance didn't cover the strips.
I buy ketone test strips for my Precision meter from a Canadian pharmacy :
https://www.universaldrugstore.com/medications/precision
they are $20 USD for a box of 10 and shipping by USPS for $7.00 or free for orders over $ 100.00.
I have purchased twice with no problems.
https://www.universaldrugstore.com/medications/precision
they are $20 USD for a box of 10 and shipping by USPS for $7.00 or free for orders over $ 100.00.
I have purchased twice with no problems.
Thanks for the information. Didn't know Precision had a meter for ketones. I'll have a look today.
How's Ronnie doing?
How's Ronnie doing?
Thanks Wally. How long does it take to get to you after ordering?
?? Would not want to keep to many on hand considering short shelf life. on the other hand, don't want to come up short.
We have spent thousands on meds since Ronnie came home from rehab in May. I hope his medical condition stabilizes soon. I know it could be worse so I am thankful it is as good as it is.
Tamagno, Ronnie's lowest BG today was 180. It was 214 just now before lunch. He felt pretty chipper till about 30 min before lunch. I was so tired last night I didn't do his 3 AM bg till 5 AM. He was finally sleeping well and didn't want to disturb him. We are trying to keep him well hydrated due to the high bg and that is keeping us running to the bathroom day and night.
?? Would not want to keep to many on hand considering short shelf life. on the other hand, don't want to come up short.
We have spent thousands on meds since Ronnie came home from rehab in May. I hope his medical condition stabilizes soon. I know it could be worse so I am thankful it is as good as it is.
Tamagno, Ronnie's lowest BG today was 180. It was 214 just now before lunch. He felt pretty chipper till about 30 min before lunch. I was so tired last night I didn't do his 3 AM bg till 5 AM. He was finally sleeping well and didn't want to disturb him. We are trying to keep him well hydrated due to the high bg and that is keeping us running to the bathroom day and night.
I got mine in about 10 days, both times I ordered, but I have heard it can take a little longer. The expiration date on mine is 10/31/2014 and I ordered them last month so they are apparently good for one year.Thanks Wally. How long does it take to get to you after ordering?
?? Would not want to keep to many on hand considering short shelf life. on the other hand, don't want to come up short.
We have spent thousands on meds since Ronnie came home from rehab in May. I hope his medical condition stabilizes soon. I know it could be worse so I am thankful it is as good as it is.
Tamagno, Ronnie's lowest BG today was 180. It was 214 just now before lunch. He felt pretty chipper till about 30 min before lunch. I was so tired last night I didn't do his 3 AM bg till 5 AM. He was finally sleeping well and didn't want to disturb him. We are trying to keep him well hydrated due to the high bg and that is keeping us running to the bathroom day and night.
We were told to check for keytones if the bg is over 240 and stays up for 4 hours. How does everyone else do it. Ronnie's bg is still up (228) and I don't like it a bit.
I'm glad Ronnie was able to sleep. The constant urination with high glucose is awful. I wonder if you all could manage a CGM. I usually am in bed before my wife - the CGM lets her check my glucose without waking me. If it's too high or low she can do a finger stick and make a correction. I usually don't even wake up. Happens often.
Wally, the year-long life of those strips is great. My previous ketone meter strips only had a shelf life of about a month!
Wally, the year-long life of those strips is great. My previous ketone meter strips only had a shelf life of about a month!
Tamagno, we were told we could get a CGM at no charge to us, supplies and all. The only catch is that Medicare wants all sorts of information to confirm the medical necessity. I just today got a letter requesting the records.
Hope I can produce all that they want.
Hope I can produce all that they want.
Hope so too!
In some circles CGMs are becoming standard therapy for t1s. Medicare is messy though and varies by state. I went through a similar process with my insurance company however and it turned out all right. I still have to pay 20% of the cost but it has been literally a life saver.
About checking ketones - 4 hours above around 240 sounds right. Personally, I have to be in the 300s for awhile before I run into trouble, but I always start checking if I'm high.
Good luck with Medicare!
In some circles CGMs are becoming standard therapy for t1s. Medicare is messy though and varies by state. I went through a similar process with my insurance company however and it turned out all right. I still have to pay 20% of the cost but it has been literally a life saver.
About checking ketones - 4 hours above around 240 sounds right. Personally, I have to be in the 300s for awhile before I run into trouble, but I always start checking if I'm high.
Good luck with Medicare!
1 - 17 of 17 Posts
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