Sudden, severe meal spikes?

General
1

Hello all! I’m dealing with a rather baffling problem the past few days, and wanted to see if anyone could shed some light on what could possibly be going on here.

So, I changed my pump site Thursday morning, took my breakfast insulin on it, ate, went on about my business, no problems. Ate lunch later, took insulin via pump, lived my life - again, no issues. Few hours later, I’ve just arrived at my parents’ place to spend 4th of July together, and my BG’s running a little low with IOB, so I’m like, “Oh well, it’s snack time anyway, I’ll just eat a few multigrain tortilla chips and not take anything for it.”

An hour or so later, all hell has broken loose. I’m going to bolus for dinner, and find that my CGM is showing that my BG has rapidly shot up from the low 70s to 180. Well, I’m annoyed, but that venison spaghetti sauce was calling my name, so I just bolused for dinner, expecting that I’d probably go a little higher, but then come back down later. Never happened.

Throughout the evening I watched as my BG climbed higher and higher - 250, 290, 336, 350 - I was growing increasingly alarmed because this was entirely unlike me. Against all common advice, I began taking additional boluses; I just was NOT slowing down. I considered the possibility of a bad site, but disregarded this possibility because I’d been doing perfectly fine on this site all day until near dinner.

Around 11PM as I was going to bed, I was at 376. In desperation, I took a correction bolus by syringe to my arm (which has always absorbed faster for me, as I have very thin arms). I set alarms on my pump to wake me a few times throughout the night so I could make sure I was coming back down. I did, finally, about 2 hours after the syringe bolus, start to trend back down, I dropped briefly (not severely) low around 4 AM and was finally stabilized at 96 with no IOB by breakfast. I ate breakfast, and the severe spike started all over again.

So I finally changed my site at that point, using a new vial of insulin. But I’ve been getting mixed results. Breakfast this morning was fine - I pre-bolused like I usually do, and had no meal spike. But lunch and dinner today both showed the same pattern of severe post meal spikes, despite the fact that I’m eating the same foods that I always eat. Worse yet, I’m forced into doing exactly what I know I’m NOT supposed to do, and have to stack additional boluses to force my runaway BG to stop rising. I couldn’t even exercise tonight because I couldn’t get my BG to rise to a safe range for me to run - I guess I was still eating all the extra insulin I had to take after lunch, even though it had been over 5 hours earlier.

If I didn’t know better, I’d say I’ve got a bad site, but I’ve already changed it out once and I’m still having these problems. Is it possible that I somehow managed to get a bad site twice in a row? Are there any other explanations for what could be happening here? Any suggestions are greatly appreciated! Sorry my story is so long! :stuck_out_tongue:

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Are you in a hot place? Lately, I have also been seeing spikes in my blood sugar when it is hot or the temperature has risen then what I am used to. Another thing that I have noticed is if the tub that is connected from the pump to my skin is bent then my sugars are usually higher. During your next site change see if it is bent.

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Hi Maddy @MaddyFresh, a horrible time for this to happen to you - just when you wanted to kick back and enjoy time with your family, and if you are like me and my family there would be some great tasting foods probably loaded with carbs. This has been party week for me - the 4th, my birthday, our daughter’s birthday and the 62nd anniversary of my diabetes - on my 16th birthday.

You did the right thing when you switched to a needle and syringe after the second pump bolus did,t work, and like me you may have waited too long to give up on that infusion set that had been in place for only a day. Last week I changed a set at 3:30 in the morning - and fortunately I was awake enough that it worked.

So what possibly happened? You traveled [I don’t know if you changed altitude or climate] and probably hefted a bag and somehow that movement may have ‘twisted’ the cannula - did you inspect it when you removed it? You ate that awesome spaghetti and sauce - for me, if I eat a 'larger amount of that wonderful stuff, I need to use “extended” bolus and sometimes add a second bolus a few hours later. The most tasty spaghetti sauces have tomato paste - different from tomato sauce - which is concentrated carb needing a bit more insulin. Looking retrospectively [20/20 vision?], you/we shrugged off the 110 mg/dl jump in BGL from such and insignificant snack of chips; that may have been the first indicator that you infusion set was dislodged - had your seat belt caught on it? From your experience, you might know how one horrid incident, like what you had on the 3rd into the 4th, begets a day or two before all is well again.

Sorry if I rambled on too much and I hope that now you are feeling well and comfortable. And to answer your question as to why? - because YOU HAVE diabetes of the autoimmune variety. But as I can see, you will not let diabetes control you, but rather you will manage diabetes to fit your lifestyle and live a grand life.
.

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Do you keep your insulin refrigerated? Its supposed to stay good something like a month at room temperature, but if it gets exposed to the summer heat it could quickly lose effectiveness.

It kind of sounds like your body is just up to some weirdness. It happens to all of us type 1’s. Everything will be running smooth and suddenly nothing is working right. You know the drill, anything and everything from stress to the weather can impact your body’s metabolism and utilization of insulin.

I had an infusion set go bad a few weeks ago, the cannula popped out of my skin under the adhesive patch. My SG was over 400 for six hours. I was about to go to the hospital when I tried changing sites and found the problem.

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Did you have high fat meals at lunch or breakfast? Also during times where you have those non stop runs. Up your temp basil. I was running at 200% on 4th of July after the pulled pork beans beer and everything else. Up to 290, I think I took about 110 units in Bolus from 4p-10pm that day on-top of my 200% temp basil

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I’ve experienced similar challenges when BG spikes. Since going on pump it seems like I chase a high forever. I try to avoid manual injection, because I tend to go low later on. If not, I continually chase it. I do fresh infusion, but that’s not the problem…just so slow.

One thing that I have found is that I can’t eat any carb without adequate bolus. Even if it’s very low carb, it will affect me.

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@MaddyFresh. You had 2 wonky sites, in a row. My record is 5. You may be prone to occlusion or you might be in a vortex of &$$& luck. Stay the course. You did everything right I woulda gone to the syringe a little earlier. Live n learn.

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@MaddyFresh, I am relatively new to using a pump (about 8 months or so), but if this was me I would have written the two off as bad infusion sites. The main thing is you didn’t panic and did the right things by changing infusion sites and taking the insulin with the syringe. I have been taking insulin mostly by syringe for more than 40 years, and since I’ve started the pump I suspect there is some sort of non obvious scar tissue below the surface in parts of my abdomen. Certain areas of my abdomen just will not work with the infusion sets or I have to use longer 9 mm cannulas rather than the 6’s. Unless you see any patterns I suspect you may never know 100%. Good luck!

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Wow! All these stories are exactly what I just recently experienced . I was sailing along in auto mode 98% with my 670G, that I recently got in May, I was feeling so relieved because I had a pretty frustrating 1st month. Then I got an alert that my maximum basal had been running for over 4 hours overnight. I was due for a set change anyways so I changed it. 4 hrs into it I had soaring Bgs
Ended up doing a 2nd and then finally a third set till I got a good site. I have tried expanding my site area but that has never been successful
I’m running out of “good” site areas due to scarring and 48 yrs of diabetes.
I just keep trying until it works
It is what it is

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Hi MaddyFresh, I have to say that your experience mimicked mine exactly. Mine went on for three days and like you I put off exercise because I didn’t want my numbers to go higher. Numbers in the 300s can and have put me in the hospital. Anyway, I finally decided I had to try something different so I went for a 4 mile walk. Numbers came down and stayed down. I talked with my endoc the following week at my appt and all she could say was that it was just one of those unexplainable times. That sometimes you just cant come up with a reason. So frustrating. Glad you are back to normal

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That sounds really frustrating. Any chance you’ve taken any acetaminophen? That can falsely elevate readings for a CGM. It’s also possible you got a bad batch of CGMs (my dad has had that happen a few times, they had to send him an entirely new batch). The other thing I’ve seen (although seems pretty rare) is if the type of insulin you use changed (ie from Novolog to Humalog or vice versa), insurance companies say they’re the same but some people respond differently.

I hope you’re doing better!

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Is it possible that something is going on with your pump and not your site? I would contact your pump provider if possible. That does seem strange, but there are also times when my sugar is high or low for no particular reason and that is what makes T1’s “brittle”. Just something to consider.
Good Luck. Things WILL get better, but I totally understand the frustration of T1D and I am always here for you or anyone if you need to talk or email.

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That’s a bummer. I had a vacation like that last year. Here are a few ideas.

  1. When you reconnect the pump after taking a shower, it doesn’t always reconnect properly. I have heard mine click into place, and then have had my blood sugars get up as high as 300 before I figured out the problem.

  2. Having a bent cannula under the skin is another possibility. I’m using a Medtronic pump and after about a year with it, just inserting the cannula by hand stopped working every time, and I had to get an injector/inserter–I think they call it a “serter.” By using the inserter, the cannula goes all the way in without bending. If the cannula gets bent your blood sugars will shoot up. It doesn’t have to get bent very much.

  3. If I eat a lot of fat, it has its effect about 12-14 hours later, sometimes the next day, and then I’ll remember the fat load I ate the day before.

4.For some people tomatoes and tomato products react like pure sugar in their systems.

Hope this helps.

Your Sister in managing T1

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Hi, Madalyn. Funny that I just had 2 days of flying high till I changed out this morning. Here’s what I did during that time.
9pm July 8, changed site and gear.
8pm july 10, BG rocketed to near 300 post-meal
7am, July 12, BG at 376, changed site and gear.
11am, July 12, BG below 100, ate meal. Since then, great glucose control.

I’ve been diabetic 62 years, on pump about 17 years. I sometimes get these out-of-control events. I attribute super high BGs to one of three things (which are endemic to pumps but not injections:

  1. insulin exceeded 85 degrees for 10 minutes or more.
  2. Bad site.
  3. bent cannula when you inserted OR slightly pulled out cannula but you don’t notice it.

I was told by Lily that their insulin is good to 85 degrees. I found that I can go to 90 for at least a few hours as long as the pump is ventilated AND shielded from sunlight. I always wear my pump holster on my belt with shirt hanging over it.

Bad site: I did put the infusion device into an abnormal spot a couple inches above and just to the right of my navel. This is the lease often reason for the high BGs.

Messed up cannula. This is the reason about one-third the time I pull it out to examine it. Either it was bent or the tape was not holding the infusion piece tightly to the skin.

I live in central AZ, in the middle mountains. The sun is a beater in the Summer. I worked outside this week, Monday through Wednesday, about 4 hours each. Two of the days were not hot because I went out in the evening. BUT Tuesday I was out in the heat for a few hours. I pulled out the cannula and it looked fine. The infusion cloth was tight against the skin, and no reddening of the insertion site, indicative of bad site. So this time, I attribute it to hot insulin.

On a similar topic. I always wondered by when I’m over 300, why it takes hours to get down to below 120. It’s frustration and sometimes painful due to keto acidosis, a toxic chemical in your body formed when the cells are trying to get glucose into them for energy. Since they normally use insulin to “open the door” to the cell for glucose to go through, the body has to find another method to get glucose to the cells. Well, it does a poor job of it, but I do know that process is how the ketone acids are formed. As they are quite toxic, it is not good to do much manual labor till the BG drops beloe 250.

This is a good topic to discuss. I recommend to those who must work very active jobs out in the sun, to stick to syringes and needles. Your very active lifestyle will ensure staying within good BG range with occasional downward excursions. In your case a pump may be a hindrance.

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I wish I could express sufficiently how very relieved I am to know that others have had this happen to them. Our 33 year old (with a mild intellectual disability) has had T1D since she was 22 and I am responsible for all treatment/bolusing decisions. I often feel like a terrible mother when K’s numbers spike up to 300 (and sometimes higher). K is easily stressed and has other medical issues so I know that those things affect her BG too. Still, I end up blaming myself if I can’t keep her BGs under control. Every day, I thank my lucky stars that my pancreas works so well (knock wood. so far) !

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Hi Madelyn
One thing I have found in my short time(5 yrs), is this, slow down think out the problem. I know we dependent on the technology and really want to trust it. But it does malfunction, on a reliablely worst time situation.
I’ve learned to go to the basics when stuff starts goin hay wire. Test and treat the old way, get yourself under control and then think about the situation. What are the possible causes, check each one go from there. Sometime when your feeling well make a flow chart of what to look for. I know sounds like a lot of work, but it might not be for your use!
But when your compromised, your high or low, your not thinking clearly. Just reading it can cause a duh moment! But someone ( a non diabetic suggested) can help you with the chart. Even by just asking questions about things can help. But with a flow chart, the questions can be more relevant to you.
Being high is dangerous to your health as well as being low. So using other people as a sounding board is a good thing, especially if they have a list to help you with. Asking for help when your diabetic is something I think we all DONT want to do! It’s the I can do it myself attitude we all get, especially the older we are. We are used to being in control of our lives, treatment etc. Our pride gets in the way and we forget that this disease can and will mess with your mind. Why, Because it can! No other reason to it. But other people, with your written instructions can help if you include one small statement. Don’t trust my answers, make me check!!
Hope you figured it out! I’d add the way you have resolved problems in the past to your list too!
Charlie

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I’d like to offer another reason for sudden unexplained high Bgs
I find that in very warm weather bubbles sometimes accumulate in my reservoir. Especially if my pump is directly against my body. The bubbles reduce the actual amount of insulin you’re receiving either by basal or bolus. It’s time to change out my set right now and there were several bubbles left behind.
When I’m having unexplained highs I disconnect my tubing from my body and remove the reservoir and check for bubbles. If I see any then I flick them to the top and reprime.

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that’s a lot of bubbles, @Jodijay Jodi, are you filling your reservoirs with cold insulin (from the fridge)? anyway yes, big bubbles you can just knock them out and re-prime unless you use a POD.