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[IP] Marion - high after site change

I agree with what you typed - next time correct for the high and the missed
basal. When you change your basal rates - you make the change somewhere from
~90 mins to 2 hours before the time that the sugar was out of range. So if
Gabe was high at 5pm  (and normal before that) you would increase his basal
rate at say 3pm. Of course, this should be done while you are testing your
basal rates - ie no food recently. So I would guess that if everything else
seemed normal - his sugar level was fine at 4pm ~ 2 hours after his lunch.
So the insulin he missed between 4-5pm would be noticed by his body starting
around say 5:30pm -6:30pm. I believe this is why his blood sugar continued
to rise. I know the basal testing is hard to do - I am sure harder for
children to go without food. So if Gabe is consistently going high starting
around 5pm for a few days then I would increase his basal rates. It is also
difficult to test your basal rates if they are not in the ball park -
because if you go too high or low you must stop the test. 
You probably already do this but just in case...If Gabe goes high again
before a meal - maybe try feeding him something no carb or low carb - maybe
a large salad or even a handful of peanuts or a piece of chicken - no bread?
I try to drink lots and lots of water but some times are more difficult than
others. I try this when I am starving and my b.s. is high. 

I think this was mentioned before but at 246 I would take more insulin to
bring my b.s. down to a normal level because you are more insulin resistant
when your b.s. is so high. 

As far as site changes - I usually bolus for more than the insulin I missed
because of the time I was off the pump. So if the shower and site change
took me an hour, I would give myself bolus for ~1.5 hours. I don't leave in
my old site. So when I pull the old site out, there is a small hole where
the catheter was and a small amount of insulin leaks out. Sometimes it is
small and I don't notice it, other times there is a large dropful. Of
course, I have to adjust accordingly after my new site is in.

Congratulations on doing such a wonderful job. I sure it does not seem like
it to you, but I have been (and probably many many others on the list)
impressed with your amount of knowledge and dedication. I wish I knew that
much when I started the pump. :)
My thoughts are with you and Gabe,
Date: Mon, 4 Mar 2002 00:05:34 EST
From: email @ redacted
Subject: [IP] What was the conclusion?  High after site change?

Gabe pumped for the last 48 hours and did fantastic!  Highest b.g. in that 
time was 109..he had one or two hypos that we corrected; his basals, clearly

need adjusting.

Now, I need help with this; I spoke to the doctor on call and he said to
the CDE tomorrow.

4p.m.     b.g.     98    1 hour off the pump for shower and site change
5p.m.     b.g.    176    bolused .5 to replace missing basal as I calculated

6:30 pm b.g.     246   bolus 2.5 (this is what I would use with syringe)
7:15 pm b.g.     246

The bolus of .5 did not work and the bolus of 2.5  did not bring b.g. down
all for 45 minutes.  Lunch was at 2 p.m. and was not high fat or high 
protein.  At that point (7:15)  I gave him dinner as he was very hungry.  He

bolused and rose to 269 and then 297 at one hour after dinner and the
at 8:30 p.m. dropped to 239.

What did I do wrong?  Did I maybe not replace enough basal? Maybe you need
replace the basal and correct the high sugar?  That would have been about
units instead of .5.   I know that the hip site is much slower than the arm 
with injections; in the past, injections in the butt area always worked more

slowly.   This kind of scenario, before we decided that we were pumping or 
else, would be very discouraging and I would have assumed that the site was 
bad.  Maybe I need to leave the old site in and continue to pump until ready

to change to the new site.  But, I thought you could disconnect and just 
replace the basal.  I thought it would be nice to shower without the site
then put a new one.

So please advise.  Obviously, I will call the CDE too...but you all are 
really the best source of information.

We do love the pump!!!!  I definitely need to learn to solve these problems 
because we are NOT going back to syringes in the near future.

(Gabe and his pump)
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