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From time to time I will get a series of highs that will drive me crazy. I review what I ate, how much insulin I took, if my basal rate stopped working or even if my pump battery somehow died without warning me. To no avail, everything will seem to be right. A few extra crackers won’t send a blood sugar from 125 to 290 within a few hours. So what gives, Mr. Diabetes? When I get a series of unexplained highs or my blood sugar doesn’t come down after one or even two correction boluses, I start to go through my mental checklist. If you pump insulin, I’m sure you can relate and probably have defined your own system for troubleshooting the highs.

Unexplained Series of High, what I do:

First, I review my carb intake vs.insulin taken to ensure there wasn’t a snack consumed while I was “sleep walking” or something. If everything checks out, then…
Take a correction bolus and don’t eat or drink. If that doesn’t work, then…
Take a correction injection and remove the infusion set, then…
See if there is a gusher or a fair amount of blood from the site, then…
Check the infusion set tubing to see if it looks like it was kinked or damaged, then…
Insert a new infusion set at a different site.
In the rare instance (happened maybe twice in 10 years) that the next infusion set doesn’t resolve the unexplained highs. I throw away the insulin and get a brand new one from the fridge. I have had two instances where the only thing I can logically explain is that the insulin was bad. When this happens be sure to save the vial and report it to your pharmacy. They have a way of tracking the lot number on the vial to see if others were reported.

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When these unexplained highs happen, it’s so demoralizing. You try to do everything right like, count carbs, basal rate is “dialed in”, eat right and exercise only to find out the site was bad or the insulin was bad. Scott, who has type 1 diabetes and writes for Diabetes Daily, said it best:

“We are in this imperfect war, fighting unbalanced battles, sometimes barely winning the fights, and almost always taking a blow to give a blow. It is not easy…” Scott K. Johnson via Six Until Me blog

The title of this post is right; all the trouble with infusion sets isn’t an issue if you are on injections. You can’t really mess up an injection, unless the insulin is bad. That said, I wouldn’t trade my pump for injections.

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12 Comments

Rachel Said,

March 25th, 2009 @10:27 am

Nice post Tony. I’ve never had the problem of insulin being bad. But I’ve had to change sites because of high blood sugar with no explanation. It sucks but like you, I wouldn’t trade our pump for anything.

Jeff Said,

March 25th, 2009 @3:10 pm

Never had the bad insulin problem, but I (my 10yr old daughter actually) have had to go through the above procedure. On the other hand, its better than shots all day and night

Scott K. Johnson Said,

March 26th, 2009 @12:38 am

Hey Tony! Thanks for the mention!

I too run down a list that matches yours almost exactly item for item. I also really appreciate the way you describe it as demoralizing, which is a PERFECT word for it.

Tony Said,

March 26th, 2009 @9:29 am

@Rachel & Jeff – Yes, I wouldn’t trade the pump to go back to injections. Just remember, there’s a small chance it could be the insulin.

@Scott – really it was the first word that came to mind, but completely fits the description. Whenever I think about how hard it can be sometimes, I always am reminded of your quote from the SUM blog comment. It is so very true.

Yesterday, I mentioned to a few people that it would be nice to be free of the pump/infusion sets for a very shot time. Typically when I change my infusion set, I shower after removing the old set and before inserting the new one. It’s kind of a nice feeling of freedom to not be connected to anything. Maybe some time I will go a little while with no set and use my shots. Even still, the pump is here to stay and I can’t imagine not having it. I fear the day that my pump dies on me.

rainbow Said,

March 26th, 2009 @10:05 am

How nice that you have a choice in the matter. How nice that if you wish, you can choose either a pump or injections. Guess what. Some of us don’t have that choice. It’s shots or nothing. I can’t choose between pumps and shots because I don’t have the money to buy a pump. I get laid off from my job next week, and even if I weren’t being laid off, my job doesn’t provide extended medical benefits that would extend to the thousands of dollars a pump costs. So forgive me if I don’t have any sympathy for your “demoralizing” pump problems.

March 26th, 2009 @12:45 pm

@Rainbow – I know a lot of people who successfully control their type 1 diabetes with injections. I wish better health care was available to everyone and the cost of pumps and CGMs were more reasonable. But they aren’t.

Yes, I do understand that some people may be limited because of the cost of the pump, which was not free for me either.

I didn’t ask for nor do I want sympathy from anyone about the demoralizing aspect of unexplained high blood glucose numbers. This issue that I discussed is not just limited to those on the pump. People who take shots can also experience erratic numbers due to stress and other factors.

If you reread the post, you might understand that being on injections can have its benefits. This post isn’t anywhere near a bragging about how much I love my pump.

Finally, look at the positive side. At least you have the medical care and coverage to control diabetes unlike many unfortunate people across the world who truly don’t have a choice. Be grateful for what you do have.

March 26th, 2009 @12:57 pm

While I believe that overall a pump is much better for my daughter, There are times when it would be easier without one — Sports/Swimming come to mind. Last year at summer camp my daughter was in a program where they turned off her pump basil and put her on Lantus so that she didn’t need the pump during some activities. It worked quite well. They called it the ‘untethered’ program.

March 26th, 2009 @4:26 pm

@Jeff – I agree that there are times and activities, like water sports where the pump can be difficult to work with. I like the ‘untethered’ approach and will keep this in mind. The pump becomes difficult to work with when on vacation and in the ocean/pool for extended periods. Thanks for sharing your experience.

Sheri Said,

March 29th, 2009 @10:44 am

I’ve had my daughter’s insulin ‘go bad’ before; she is a pumper and loves the freedom that comes with it.

Gail Said,

March 30th, 2009 @3:40 am

Hi Tony, I have just found your Blog, and am quite interested because I am a 33 year Type 1 Diabetic who is considering a pump and trying to learn as much as possible before hand. Your site and the comments that have been left have already taught me so much, but I am still am unsure if a pump is the right thing for me. Right now I am on Lantus and Novolin daily injections and doing well, but my diabetes Dr. has suggested a pump, just to tighten up my control.