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[IPp] Tough one to figure out....

Here's a tough one for those of you who like to troubleshoot problems.  It
may be even tougher to explain than to figure it out!


I changed Patrick's night time basal rates between 5PM - Midnight about 3
weeks ago because he was trending up and we were doing a lot of correction
boluses.  At first it seemed fine, but a few days later he went low after
dinner, and then still was low all the way until 1 AM.  He needed between 60
- 75 carbs to get back to normal.  I didn't change the rate for the next
night because I figured it was an anomaly.  Sure enough the next two nights
were fine.  The night after this, the same thing repeated again!  And again
followed by 2 nights of pretty good readings!?


I started to see that the trend was always that the low readings occurred
immediately after a site change.  We usually do it right before dinner.  So
a logical conclusion might be that he is having an absorption problem on
days 2 - 3 after the site change, right?  Well there are two reasons why I
don't think this makes sense.

1.	His levels are consistent at all other times for all the days.  If
his site was "going bad" or wasn't absorbing as much, you would expect a
trend up during the time he has the infusion set in.  I have tracked this
and graphed it for the last 6 site changes and there is no such trend.
2.	There wasn't a significant difference in nightly readings before I
changed the basal rate regardless of the when the site was changed


So my conclusion is that it may be the pump, but that doesn't really make
sense either.  I don't know how the pump registers the new cartridge or the
volume in it, but maybe there is a problem during the first 12 - 16 hours?
Does anyone have any other wild ideas?
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