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Re: [IPk] high BGs, ketones etc very long

Hi Abi,
I know this is highly unscientific but your email is timely in that both 
myself or rather my son, and another mum with a young son are also having 
similar problems. For the first time ever on Saturday Sam had large ketones 
on a bg of 15 and spent the morning vomiting. It took a long time to get rid 
of the ketones and he obviously felt dreadful. We've had the most awful 3 
weeks with extremely erratic readings and have felt quite 'out of control'. 
There isn't a pattern. Yes he is coming up to 6 and apparently that's a time 
for a growth spurt (how true is that I wonder) and yes, he is suffering with 
hayfever (living next to a hay field loses it's attraction at this time of 
year) and we've changed to a Paradigm but still the unpredictability of 
diabetes has never been more apparent. I suppose we have so enjoyed the many 
benefits of pumping and the diabetes really had been pushed from centre 
stage that to have it once more back in our faces is very disturbing.  What 
to do? I've spoken to Hannah at Medtronic and she has discussed the 
possibility of the site of the infusion set possibly healing up too quickly 
because such a small basal rate dripping through and not forcing it's way, 
but why suddenly now?
I think it's probably easier for me and Sam to 'live with it' for a little 
longer as our livelihood doesn't depend on him, although of course it is 
vile feeling out of control and he is undoubtedly suffering.
We too have done the works, new vial of insulin, set changes, different 
sites, checking technique for reservoir and set changes.
Sorry Abi, this is no help to you whatsoever. I still do feel that the 
benefits of pumping outweigh the disadvantages of injections for Sam and I'm 
hoping to contain this feeling of helplessness and give it more time.
I'm sorry you're having such a bad time but selfishly find some reassurance 
in that it's not just me. I dream of the day when we manage bgs of between 5 
and 7mmols as Pat was saying recently.
Best wishes,

>From: "Abigail King" <email @ redacted>
>Reply-To: email @ redacted
>To: <email @ redacted>
>Subject: [IPk] high BGs, ketones etc very long
>Date: Wed, 18 Jun 2003 22:19:02 +0100
>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 
>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 
>as not sorted by the night. On each occasion, large amounts ( at least 1/3 
>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 
>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 
>the past fevv days and ate approx 20g carb/ bolused 2 units( normal ratio). 
>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 
>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 
>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 
>don't feel this is vvhy I have become ketotic/usually find insufficient 
>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 
>ketones actually happened hen I vvas on injections and high as I never 
>for them then, but I vvould not give 20% of total dose in one go to corret 
>very high bg, and bg vvould eventually come dovvn, so I assume this is a 
>specific problem
>I apologise for the length, but am getting a bit disheartened, at the 
>bgs are varying a lot , altohugh average I think is still quite good. I 
>lousy and am fed up ith having to stay avvake/ set alrm through night to 
>DKA. I have to confess I am considering taking a pump break and asking to 
>lantus. I am concerned obviously about the implications of effectively 
>a single basal rate and the potential for hypos at certain times and having 
>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 
>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 
>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, 
>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 
>superb control but feel I am back to square one at the moment despite 
>to excercise seeral times per vveek and eat healthily alongside carb 
>and fear this is just due to my " brittleness" rather than the fault of any
>regime/ means of administration
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