New infusion site and high glucose spike

Hello! My daughter uses the Tandem x2 slim pump and when we change her site we see a huge spike! Example
Tonight when I changed it she was 112 and about 30min later she bloused for snack and 2 hours later she is over 400 :expressionless: any tips??

@Dee314 , you have not indicated what site set you are using. If you are using an AutoSoft XC or 90, I hope you were well trained on using that wonderful site set. I have used them for 20+ years of pumping.

The key is assuring the cannula is on the inserter completely before firing it and being 100% certain you pulled the inserter out straight without tilt or wobble.

It has been 3 hours since your post. If she is still elevated, the site set is suspect. The supportive answer would be to change the site set and reuse the cartridge.

There is a Facebook group where you may find faster support, though a little more rambunctious.

The group is “Tandem Diabetes Control-IQ Users’ Group”.

Hope this helps.

Hi @Dee314 . I hope by now her numbers have come down due to corrections, or you’ve switched sites. The pump prompts to check numbers after two hours, in case you might hit scar tissue or perhaps the connector was loose - that’s rare but I try to remember to twist it each time I fill, to be sure it’s tight.
A gentle reminder - this site is a wonderful source for suggestions, but if you have something urgent going particularly overnight it’s best to place a phone call:

  • Tandem’s tech support is available 24/7 and can walk you through things to check, but I would consider just starting over with a new site as the safest course, before bolusing to bring down the numbers. (Make sure she drinks some water to wash out any ketones - I find my numbers don’t even start to drop off I don’t do that.)
  • If you feel the need, call your doctor’s office (on call line after hours) for guidance and reassurance on bringing the numbers down. You may be able to manage the high at home even if the numbers are scary.
  • You could call your insurance’s nurse hotline, although they might suggest going to the ER, which might not be necessary.

My doctor’s office gave me guidelines on when to switch out an infusion set and at what point to switch to injections. If you don’t have one ask your doctor.
FWIW, the other day I started a new set and also was around 400 a couple of hours later. I thought I had completely blown my meal bolus (CIQ can only do so much if you’re off). In fact, I inserted it at an awkward angle on my stomach and it turns out the set was on top of my skin, not under it😬! Even we veterans have issues sometimes.

1 Like

Call Tandem or your Doctor for things like this. No one here is a doctor. We only share our personal experience and every patient is different.

@Dee314 , definitely talk to a doctor but this is something I see at every set change. The question I have is, does your daughters blood sugar come down after a correction or do you have to change sets? I see a higher than normal blood sugar at set change time. I add insulin to cover the set change and that’s about it. I have attributed the higher blood sugar to inflammation at the set site interfering with insulin absorption. For me it goes away unless the set is occluded, which takes about 4 hours for me to figure out. This inflammation goes away by itself, it goes away faster with a hot shower or with mild exercise. Cheers and good luck :four_leaf_clover:

Here’s a crazy thought (surprise surprise) - it might not apply to you personally but you never know: some people can switch out sites very quickly while it’s more time consuming for others. If you’re off for a longer time, and if you don’t stop delivery while you’re filling (so the pump will know there’s less insulin on board once you reconnect*),maybe that contributes to the rise, although probably it wouldn’t be sky high?
Food for thought (that you don’t have to bolus for😊).

*Does anyone know if the pump recalculates insulin on board based on what’s missed during fill time🤔? I never thought about that until now as I can fill quickly, but I’ve heard of people who take a very long time in the interest of clearing out “champagne bubbles.”

Pumps do not count cannula fill as iob. When I need a typical extra 4-5 units at site change time (enough for a 5 hour set change and I can assure you it takes me 5-6 minutes) that correction counts as iob but I subtract it if I’m eating within 3 hours of a set change.

Others correct and they’re fine. Still others can change a set and they don’t see any spike at all. I just know for me, I need that boost at set change time and so I don’t see a spike. Today’s set change included a correction and it was during CGM warmup but I ended up right where I wanted to be at the end. I manually added 6 units. For the op asking the question- please do not adjust insulin doses without your doctor approval unless you are comfortable doing so!

I would guess it was a bad infusion setup. For me, a sudden spike like that (or even a day of higher than normal readings after an infusion set change), is nearly always a result of a bad infusion setup. Once I realize this, and take that infusion set out, I see that the cannula was bent. I am usually kicking myself for not realizing this sooner. As I am responding days after your message, I assume you have now figured out what the particular problem, but thought I’d chime in just the same, as I have found the need for a new infusion set to be the problem in 95% of instances like this over many years of pumping.

Always have your daughter take her insuling to match up with what she eats, at least 20-30 minutes before eating the food. Make sure her insulin to carb ratio, approx 1 unit of insulin for every 8 grams of carbs applies.

hi @gzelnik hey just wanted to point out that not everyone here can (or wants to) adjust their own insulin doses. We try very hard here in the forum, to not advise people when or how much insulin to take!

@Dee314 , insulin to carb ratios are set by an endocrinologist, or by your own testing, and if you use them, the calculation indicates how much fast acting insulin for each gram of carbohydrates. 1:8 IS NOT RECOMMENDED unless a doctor agrees, or unless your specific testing agrees. my I;C ratios are 1:10 mornings and 1:12 lunch & dinner, for example! These can be significantly different for different people.

cheers and good luck.

My sugars on the three different pumps I have used over the last 15 years have always gone very low after changing infusion sets. But there is one possible obvious cause for a high, and that would be air bubbles. I have had that happen even a day after changing sets. I will be high for a few hours and then come back to normal. Some people so not get rid of the air at the top of the tubing before inserting the infusion set, and this will cause sugars to go high.