Re: [IPk] High blood sugar/ airport x-ray machines/ skin infections
Melissa and Bill,
Thank you very much for your replies. It was an adventure I could have done
without but thankfully my boss was very understanding.
Pleased to say am heading back to normal. Basals and boluses set to 133%
currently and have been in single figures for about 16 hours. I had been
finishing off my old Humalog to avoid throwing away. Not much to pick
between it and Novo, except the Novo is faster for corrections and gave me
less bubbles. The Apidra was no use for me. So will stick with Novo. The
insulin that had been on all 3 trips was thrown, but still have two 3ml
tubes of the Novo that went to Holland with me.
1) Wish I had not thrown away the Humalog as that link confirms my
suspicions. Each successive trip saw a bigger problem with hyperglycaemia,
and increased dose requirement. Same with both Novo and Humalog (as had a
box of each with me). I'll ask for hand inspection next time. The x-ray
machines were busy and my bag sat in the x-ray machine for a good while
while the two people in front of me were searched.
3) Both - strips and dip sitcks - and never above 0.3 on the blood strips.
Drank loads of water. The time that really surprised me was when was 21 in
the night, took 10 extra units and was still 18.5 on waking. At that point
I was worried.
Will carry on using my sides and the steri strips...
Bye for now.
Marc
Wow Marc, what a wild adventure. Glad you are back home and getting to
normal again!
>
> 1) Can airport x-ray machines damage insulin? The
> official answer is "no", but if your supplies had been through 6 x-ray
> machines could their effectiveness be reduced? (3 trips in last 7 weeks,
> taken same box of vials with me).
A) Actually the official answer is YES, airport x-ray machines can
damage insulin. If you put insulin through the hand baggage machine
just 2-3 times, it's not necessarily going to affect the potency but
Lilly does advise against prolonged or repeated X-ray exposure:
http://www.lillydiabetes.com/product/insulin_faqs.jsp?reqNavId=5.6#q2
Putting vials of insulin through the hand baggage machine 6 times
might well have had an effect on it - no way to be sure as you have
thrown out the goods. If in the future you should ever suspect your
insulin is dodgy, you can contact the UK offices of the manufacturer
and ask them if they'd like to test it or can give you some advice
about what might be the issue. You can still try contacting the UK
offices of Lilly (if you are back on Humalog - I have lost track) if
you want, but they may not be able to say much without the goods.
If you ever don't want to put your insulin through the x-ray machine,
as far as I know you have the right to put the vials (in their boxes
or whatever) in a clear plastic bag and ask for hand inspection/no
x-ray exposure.
> 2) If you are in insulin deficit and have been running
> high for 4 days, and even if the cause was damaged insulin, can the
> desensitising effects of prolonged high BM take a while to wear off?
A. What do you mean by "desensitising effects"? Do you mean
hyperglycemia induced insulin resistance? If you mean hyperglycemia
induced insulin resistance, I can't find a relevant article instantly
but I'd say 'probably' . Prolonged hyperglycemia can affect the
balance of a number of hormones and it could take a bit of time to
clear everything up.
> 3) How can you run mostly at 12-22 for 4 days and have no
> ketones?
A. A question and a thought - 1) were you using blood (Xceed meter)
or urine (Ketostix) to test? If you were using Ketostix it's possible
that you have a higher threshold for spilling ketones into the urine
than you thought; if you tested your blood, indeed it seem be a bit
weird not to see ketones. 2) But you still had some insulin in your
system most of the time; even though your glucose was high your body
may not have switched to muscle-n-fat-burning mode. There may have
been just enough insulin available for your body to use glucose for
fuel. If your body is using glucose for fuel you won't have ketones.
> 4) I was told the alcohol based wipes (steristrips) I had
> for skin prep are no good at preventing infection as they dry the skin
out.
> Is this true?
A. Um, that sounds like a marriage of two things that are true into a
dubious cause-effect relationship. Alcohol is not strong enough to
kill the most dangerous bugs out there but it can wipe out a number of
the common lesser evils that you are more likely to meet every day.
That's why alcohol is used to clean the skin before immunizations,
blood draws, at public health screenings, etc. It would be a massive
waste of money for the NHS to buy alcohol wipes if they were truly
useless!
The drying of the skin thing is, as far as I have heard, a bigger
problem in terms of not exacerbating dry skin related to poor diabetes
control. Dry skin is a very common problem in people who run high
glucose levels (I was putting Neutrogena hand cream - yes, the stuff
from a tube - on my sides before I got diagnosed!). When dry skin
becomes cracked, germs can get into the body and cause infection. In
someone who runs high glucose levels the immune system is often
compromised and healing is slow. Thus, a skin infection in someone
with poorly controlled diabetes can be both more likely to occur and
more difficult to treat.
Personally I swear by IV Prep wipes as they contain alcohol and they
leave a bit of sticky stuff behind. My sets stay on longer, with less
infusion site irritation, when I use IV Prep. If you want to try it
send me your address off list and I'll post you a few wipes.
> 5) I was also advised not to insert on my sides. Does it
> really make a difference to infection risk and control.
A. Um, I have no idea where that advice came from. The point of
preferred infusion site diagrams, as I understand them, is to show
where there is likely to be enough fat for the insulin to be absorbed
well from the set. If you have love handles and you can see what you
are doing when you go to insert a set in them, have at them. As far as
I have heard there is no direct correlation between where you insert a
set and the risk of infection.
Marc, I would love to hear the logic behind some of the possible
cause-effect relationships you've mentioned tonight. If you heard
these bits of advice verbatim from a source you can contact, please
ask him/her for the details and mechanisms - 'how can an alcohol swab
once every 3 days make the skin more susceptible to infection?' 'where
is there some data on insulin pump infusion site location and
infection rates?' for example.
Cheers
hope they let you stay home next time!
Melissa
Type 1 14+ years; MiniMed pumper 7.5 years; Animas pumper 4+ years
.
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