This morning I woke up really sick to my stomach and had no idea why — until I checked my blood sugar and it was a whopping 498. I did a set change last night and it was still stuck in prime mode, so I didn’t receive any insulin for hours! I also checked for ketones and had those too ugh! To avoid a hospital trip I took all of the necessary steps to get my blood sugar down and was starting to feel better after a couple of hours. 7 to be exact.
Do you know what to do in these cases? have any tips you want to share?
For me, I always need to give about 1.75 - 2.5 times my normal correction factor to get my blood sugar down during those episodes (late caught highs). I have found that I can usually get it back into range in under 4 hours (usually less than 3). Also, I know I have mentioned that I take the Benfotiamine and Alpha Lipoic Acid combo before - one side effect seems to be feeling less icky from highs - I have the research posted on my home page here - and it is still very preliminary but the one thing that seems pretty certain is it can't hurt ya'.
I'm sorry to hear you had a rough moment and always grateful for you keeping the lights on around here :)
Gina, I'm so sorry this has happened! It happened to me in 2007 when I started pumping and my endo had given me programming that was totally incorrect for me. I was at least 350, with ketones, that evening. I can not depend on my ISF (insulin sensitivity factor) when I am that high. Normally one unit will lower my BG 12 points, but I am lucky to see it fall 8 points when I have a mega high. I take almost twice the normal dose to bring my BG down to target range under those circumstances. I use a syringe too, in case the pump or infusion set is malfunctioning.
This happened to me on wednesday! I had an occlusion in the middle of the night and didnt realize it til the next morning at work. It took all day to get it back down and i had to leave work 3 hours early:( The throwing up was awful! I almost headed to the ER cause i couldnt get ahold of my CDE or Endos nurse. But then the bs finally went down and ketones disappeared.
One thing that really helps me get rid of Ketones is to drink a ton of water. I've had large ketones and I change my site/get a shot with extra insulin/and drink water and the ketones will be gone in at least a couple hours. It depends on how much I drink. :) Hope you feel better
My Minimed pump alarms whenever there is no insulin being delivered. Even when I place my set in scar tissue, and the delivery is terribly slow, it alarms. I think it would alarm if it was in prime mode too.
I just recently started pumping, and my CDE said to always test my BG about 2 hours after a site/insulin change to make sure nothing's wrong. For this reason, she advised against pre-bedtime site/insulin changes, since "best practice" would require waking up to test.
Seems like a decent policy to me.
As for handling a super high number and DKA, I'm too new at this to be able to be much help!
My Animas ping also lets me know if it's not delivering insulin, come to think of it. I mostly find that annoying during site changes, but the thought of sleeping overnight with no insulin makes me think it's actually a very handy feature!
my endo never said anything about testing for ketones when i get high...heck, nobody in the hospital where they diagnosed me or the endo's office even mentioned ketones to me, i learned about them on here. should i get one of those home tests to make sure im ok when i spike high? and if so, what level of ketones is considered dangerous enough to go to the hospital?
Gina I am sorry that happened,how long did it take for your numbers to come down ??? This has been one of those days for my daughter too-she left town and left her purse with her insulin pens in there-which meant missed shots-then she gets back to her things and test and her sugars are close to 500. She is trying to bring it down-but I am now concerned about the pens getting too hot today and not being any good..she is not home where we have more pens. (her pens and back up pens she had were left in the hot car. We can get new ones to her in the morning.Waiting and watching tonight...
There are actually two ways to test ketones. One is with a strip with urine which is what is most commonly done but we also have a meter that takes a blood sample which is more reliable. We use the urine strips (for lack of a better name) for general checks but if my son gets a cold or flu or just runs high for no reason we use the blood sample. The one fo blood sample is the Precision Xtr or something like that. It will provide a number that will tell you where you stand. The urine strips will have stages from none to high.
When to test I have found varies with just about every person and it seems no one does it the same. Some say when you get to 300 to check. We have found my son will eat a and on occassion get to 300 and if we tested for ketones everytime that hapened we would be using strips by the ton.
Instead we watch for unusual things like flu symptons or things out the ordinary or especially high BG levels like 400 or higher. After one of those we check and try to see what caused it (blocked infusion, something he ate and did not bolus for) and then see the frequency.
If we get a 300 BG reading and he feels fine, all previous numbers were within range or close we just treat the 300. Its not the same for everyone but our Endo is fantastic and is actually the one who gave us this advice. If we ever have a doubt anyway we just call the office.
I just recently started pumping, and my CDE said to always test my BG about 2 hours after a site/insulin change to make sure nothing's wrong. For this reason, she advised against pre-bedtime site/insulin changes, since "best practice" would require waking up to test.
Seems like a decent policy to me.
As for handling a super high number and DKA, I'm too new at this to be able to be much help!
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Hi Elizabeth,
I had no choice I had to change the set before bed. We are human and sometimes it just happens that you have to do it before bed especially when you only have 10 units left in your pump. It wouldn't have been enough insulin to last me throughout the night.
Moderate to high are when keytones are bad. There's not much to do when you have keytones except lower your blood sugar and drink LOTS of water. Don't use your pump to take the correction bolus, but take a shot since the insulin will absorb better in fresh tissue. Within a few hours keytones should disappear.
If you have high keytones for too long and/or if you can't keep water down, then you need to get medical help. This is especially important if you get loopy or if you start having short, shallow breathing (this is your body's stress response to handle the poison of the keytones). Doctors can give you intravenous fluid and insulin.
Also, you can have totally normal blood sugars and have keytones if you eat a low carb Atkins diet. Keytones are just created when your body burns fat because there aren't carbs available.
[quote user="Gina"]I had no choice I had to change the set before bed. We are human and sometimes it just happens that you have to do it before bed especially when you only have 10 units left in your pump. It wouldn't have been enough insulin to last me throughout the night. [/quote]
Gina, I certainly wasn't suggesting you "did something wrong!" Merely passing on the education I was given very recently. Really, it's that two-hour test rule that I think is the decent part of the policy, anyway. The most useful piece of advice I got from her.
Lord knows I don't do this stuff perfectly, either. My mom (a nurse) was recently horrified to see that I sometimes don't wash or swab my finger before a BG test, but will lick and wipe it instead. I know this isn't the best option, but if I'm feeling low and there's not a sink nearby and I've forgotten to put a couple alcohol swabs in my kit, then I also feel I "have no choice." (And heck, sometimes I just really don't feel like getting out an alcohol swab...)
Ketones are the worst feeling ever! Even a BG > 250 feels pretty crappy. As your BG gets higher and when ketones start to appear in the urine or blood, it takes more insulin than just the standard correction bolus recommended on the pump to get back into control. Plus, when I am high, there is no such thing as too much insulin. :) Getting back down and treating a low is a breeze compared to being high with ketones. :)
So, here is what I do: I take the recommended correction on the pump for high BG + 20% of my basal dose as a bolus for large ketones, +15% of basal for moderate, or +10% for small. Then I drink as much water (not diet drinks) as I can hold and chew on ice chips. If I don't know the cause (sickness, pump issues), I will yank out that infusion set and move the site. We are full of scar tissue that can hinder the absorption of our insulin. I rarely use a syringe to inject - just because I don't like it, but that is a great idea.
And I would check for anything >300. It is never too early to prevent DKA.