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High BG, pump / site problems, was: Re: [IP] Problems!


Sorry to hear this is a struggle ;-(

Was the alarm before or after the set change you mention here? If the alarm
happened after the set change, there could have been a kink or obstruction
in the cannula. It appears from your story that you first had the high BG,
then the next day got the No Delivery alarm. I assume you were still using
the same set.

These are the things I typically check if my BGs are high after a set
change (I use Disetronic Tenders - same as the MiniMed Silhouettes):

1)  Angle of insertion - not "too steep". If the angle is too steep, I can
usually feel the bolus. It's like a stinging or burning sensation. (Much
more noticeable with Humalog). Unfortunately, there is no tried and true
method for estimating the optimal angle. Success breeds success, though.
Once you find an angle that works well, you will tend to remember it. Sorry
I can't be more specific than that.

I have inserted at too shallow an angle right over a muscle. This results
in the cannula having a "bend" toward the skin surface, which is very
visible when I remove the set. Unfortunately, it's not obvious until I
remove the set. One symptom of this problem for me is high BGs after meals
(as if the bolus did not absorb well), yet the other BGs seem fine (basal
rates work o.k.). This is sometimes accompanied by the stinging or burning
sensation when bolusing, which in this case hints that I'm close to the

2)  Depth of insertion - not "too deep". How much of the cannula is left
"showing" before you tape down the other half of the cannula base? To
troubleshoot this, picture inserting the cannula *all* the way, so there is
absolutely no cannula showing between the skin and the base of the set.
This is clearly inserted *too far*. If you were to tape the rest of the
base down at this time, there would be a sharp angle formed at this spot in
the cannula. It would probably be sharp enough of an angle to kink
slightly, yet might not be noticeable when you remove the set. You need to
back off from this somewhat. See what happens if you leave slightly less
than 1/4 inch of the cannula "outside" the skin when you tape the back of
the base down.

3)  When you checked and moved the arms on the pump motor, did you bolus
another 5 units *before* connecting back up to your set? If not, the arms
may not have been fully seated against the reservoir end. This free play in
the pump motor arms could result in improper or no delivery. Based on your
particular insulin / BG ratios, this non delivery of 5 units could easily
raise your BG to 400. Sometimes you have to work the math "backwards" to
get a hint at what could be causing the problem.

4)  I *always* check the bolus history on the pump to make sure I didn't
forget a meal bolus, or program it improperly. Since I *never* forget to
bolus, imagine my surprise when I forgot my lunch bolus recently. When I
checked the bolus history on the pump, it was obvious I missed the bolus.
The BG of 300 + made a lot more sense. Fortunately, that doesn't happen often.

5)  Don't hesitate to try bent needle infusion sets, as someone else
mentioned. I find them quite comfortable and very reliable. They are a
viable alternative.

BTW, I learned a lot of tricks for dealing with the Tenders by
"sacrificing" a cannula or two. I never inserted the cannula. I just
removed the insertion needle, then placed the cannula next to a bent needle
set (my old stand by - they usually work very well). I tried to mimic the
angle and depth of the bent needle, and memorized this for my "model" when
I insert the Tenders.


mailto:email @ redacted

Laurel wrote:

>I need some help.  Tonight I got a no delivery alarm with my MM507.  It
>wasn't the bolus and basal simultaneous delivery.  The site is new, is
>absorbing well, and appears to be fine.  I opened up the back of the pump
>and moved the arms forward and then back into position.  Didn't see
>anything odd.  Do I dare go to bed without doing anything else?  And, if
>not, what do I do?
>Also, yesterday I inserted a Sil.  I must have done it wrong because
>shortly afterwards my BG went up to 400!  I'm getting pretty stable, and
>almost never go over 250 unless I've done something really stupid, like
>forgetting to bolus.  I didn't forget, and there were no other external
>circumstances that could account for this.


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