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Re: [IPk] Re: Ketones/ bleeding


I had four sets on the trot from the same box all causing bleeding, after
months of plain sailing; so replacement sets are en route from Medtronic to
be on the safe side.  Given the level of ketones the pen was the safest
option in case the next insert developed similar problems.  I checked BM
every 45 to 60 minutes all evening, and the blood ketones had gone within an
hour, which is very reassuring.  Like you, I've only reverted to a pen on a
very small number of occasions.

I did feel very strange when I went home but put that down to just having
been told about two sudden and unexpected deaths.  My hyper awareness is not
as sharp as my hypo awareness which kicks in around the 4 mark.  The
difficulty for me is sharp post meal rises, so even though my BM is not high
for long, it does go to 15 on a regular basis.  Don't get me started on my
symlin rant again :D   Once again, post meal rises will be my complaint at
the clinic.  I over basal/ under bolus for breakfast which seems to keep me
flatter.  I think I'm going to have to do the same in the evening which is
when most days I hit 15 plus.  But then I have to be careful.  I can get
away with that in the morning because breakfast is reasonably constant, and
already if I am late for dinner, I will hypo.  It's a tricky one.  My last
Hb was 6.7, so I know I'm close at least.  I'll ask for a CGMS review.

Anyhow, lesson learned.  When feeling odd, always check BM, even if there
appears to be another obvious cause.

Best wishes,

On 27/05/2008, Nanette Chana Freedman <email @ redacted> wrote:
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> Marc,
> this is very much a YMMV thing as far as solutions go.
> I personally haven't given myself insulin by injection since starting
> pumping 10 and a half years ago. I have always found it possible to use the
> pump to give more insulin. I can probably count on my fingers (I only have
> the usual number!!) the number of truly failed sets in that time. I find
> that almost always the reason for high BG is peculiar metabolic things or
> reactions to food or stress due to travel or excitement or minor subclinical
> infections or anything but the set, and it passes without changing the set,
> though on occasion very persistent chasing of the high BG with frequent
> measurement is required.
> Don't forget that once you get above the threshold for excretion of glucose
> in urine, your BG measurement is really an underestimate of the effective
> true level, and so you may need to take more insulin than the pump will
> calculate in order to bring BG down to normal levels.
> One thing puzzles me about your story - even had you stayed at work,
> wouldn't you have been aware that BG was sky high and tested, and if
> necessary changed the set there. While hypo awareness is of course a major
> safety issue for driving etc, cultivating an awareness of hyperglycaemia is
> also important.
> Nanette
>> Subject: Re: [IPk] Ketones/ bleeding
>> Marc,
>> Here is a bit of very simple advice whenever you get high bgs. Give
>> yourself
>> an injection rather than struggle with a possible dodgy set. The set  can
>> be
>> sorted out later. If your bg is rising it is important to give yourself
>> some
>> insulin, and you can be reasonably sure of getting it with an injection.
>> This
>> should be a safe guard to prevent you from going ketotic. Get the insulin
>> in
>> first and then you can change your set afterwards if need be. If my  bg is
>> heading towards 15 when I know it shouldn't be, I will grab the  syringe
>> and
>> then sort out the set.
>> Cheers,
>> Ken
>> In a message dated 26/05/2008 20:10:12 E. Africa Standard Time,
>> email @ redacted writes:
>> Panic  over I think.
>> Inserts in to abdomen as usual, and the first 5 from the  box were fine.
>> I'll call Medtronic tomorrow and see.  BM down to 22  and falling, so a
>> narrow escape!  Meanwhile I'll revert to Sils as I  get mixed supplies
>> depending on site.  I've been incredibly  lucky.  Had to come home from
>> work
>> early for another reason so was  having my dinner BM check 2 hours early.
>> Another 2 hours without insulin  does not bear thinking  about!
>> Thanks,
>> Marc
>>  ------Original  Message------
>>> From: Marc Taylor
>>> Sender:  email @ redacted
>>> To: Insulin Pumper
>>> ReplyTo:  email @ redacted
>>> Subject: [IPk] Ketones/ bleeding
>>>  Sent: May 26, 2008 17:35
>>> Hi,
>>> Help.  BM  24.7.  Ketones 1.1 (out of the blue).  Lots of blood from
>>> insert
>>> site suddenly (4th time in as many days - the blood not the  ketones).
>>> Any
>>> ideas?
>>> Thanks,
>>>  Marc
>> .
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