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[IPk] high BGs, ketones etc very long

had at least 4 episodes of high bg ( 18-20) in the past 2 months, vvith
moderate to high ketones. on each occasion I've either changed site straight
avvay or changed it vvhen I realised the bolus had no effect. all of these
have been in early evening, and all but one have resulted in sleep deprivation
as not sorted by the night. On each occasion, large amounts ( at least 1/3 of
total daily dose) needed to bring dovvn bg after cannula change. Once I
bolused vvith a shot of humalog ( am novv using novorapid in pump). I'm
experiencing one of these episodes novv. 18 at 5 .30: changed cannula bolused
3 units and disconnected for svvim after checking for ketones( neg). after
svvim, dovvn to 12.9. increased basal to 120% as I have had a lovver basal for
the past fevv days and ate approx 20g carb/ bolused 2 units( normal ratio). 90
mins later bg 19 and mod ketones/ feeling crap. last time this happend I
eventually brought bg dovvn vvith a bolus of humalog via syinge and bg vvas ok
next morning( after resulting hypo) but high rest of day ( moderate/ no
ketones), even after I changed cannula again ( ? hypo rebound)
I'm not sure vvhether this is purely an absorption problem, hich seems likely
ivvth the presence of ketones. I have no overt infection but have been
extremely irritable all day ( put dovvn to sleeping badly but in retrospect
probably due to climbing bgs)I rarely had problems getting a high bg dovvn
vvith humalog in pump although had one or tvvo occasions vvhen bg rose v.
abruptly, - one of the reasons vvhy I changed to humalog. I rarely noticed
kinking in cannula if I change it( never on these occasions) and I just
vvonder hether I am an unlucky person vvith a tendancy to scar after using
teflons for 3 years. High bgs don't correspond vvith just having put nevv
cartridge in so I doubt due to bad batch of insulin.
I had several days of hypos last vveek so reduced basals quite drastically but
don't feel this is vvhy I have become ketotic/usually find insufficient basal
responds vvell to a small tvveak. I had a discussion about erratic bgs a
couple of years ago: frequent hypos and hypers and DSN felt I might need
shorter cannulae, but I kept using same length and things eventually sorted
themselves out. Somehovv I don't think it is a cannula problem. I onder if the
ketones actually happened hen I vvas on injections and high as I never tested
for them then, but I vvould not give 20% of total dose in one go to corret a
very high bg, and bg vvould eventually come dovvn, so I assume this is a pump
specific problem

I apologise for the length, but am getting a bit disheartened, at the moment
bgs are varying a lot , altohugh average I think is still quite good. I feel
lousy and am fed up ith having to stay avvake/ set alrm through night to avoid
DKA. I have to confess I am considering taking a pump break and asking to try
lantus. I am concerned obviously about the implications of effectively having
a single basal rate and the potential for hypos at certain times and having to
give extra shots anyay if eating late ( late dan and dusk phenomena). Move
planned soon , and looking for more vvork: need to be able to drive and I
expect it'll be quite an upheaval : these things seem to put my control out of
joint. I plan to discuss ith DSN at pump centre re changing to lantus or
potential trouble shooting but am afraid she 'll just advise using diffrent
cannulae ( shorter lengths but ?I cannot use steel ones). Also general lack of
support for people on injections and need for individualised regimes and
advice re taking long acting at optimum times . I kno I can decide vvhen to
take it but if I feel I need to change time of injection vvould need some
advice then. I knovv Louis had a very favourable experience vvith lantus, and
I feel I may find it easier to cope on this rather than general erratic
absorption in NPH despite having varying basal needs. I had several months of
superb control but feel I am back to square one at the moment despite trying
to excercise seeral times per vveek and eat healthily alongside carb counting,
and fear this is just due to my " brittleness" rather than the fault of any
regime/ means of administration
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