More Set Change Stuff – Again.

QuicksetI’m beginning to think that the issue is quantity of insulin infused rather than the amount of time the new site is being used.

For this set change I tried yet another suggestion, which was to take my breakfast bolus on the old set. The idea was to give the new set a longer time to start absorbing.

My blood sugars were pretty good for the morning, with the exception of waking up high. I responded well to the correction and I was also pretty accurate for my breakfast bolus. Once I got myself into the target range, I spent most of the morning/early afternoon there.

Where it gets interesting is at 2:00 in the afternoon, which is when I had lunch. This would be the first meal on the new infusion set. I had a box of Amy’s Organic Macaroni & Cheese, which clocks in at 47g of carbohydrates and 3 servings of cottage cheese, which clocks in at 15g of carbohydrates. These were both packaged items, leaving little room for error in terms of measuring serving sizes. The mac & cheese has a lot of complex carbs in it and and good dose of protein (16g). The cottage cheese is also a heave protein item. So with the complex carbs and heavy protein, these items don’t seem like they should raise my blood sugar very quickly.

Within 2 hours I had skyrocketed up to 321! Based on no manner of scientific testing whatsoever, I don’t think that what I ate warranted a rise up that far.

Though it could be something with my insulin/carb ratio – I just don’t think that is the case. I’ll have to do more testing. Maybe I need to experiment with some other lower carb options as well.

I worked my way down, not taking any additional corrections. I played basketball later in the evening, and there was some strangeness with another real high spike afterwards. I haven’t figured that one out yet.

I get frustrated with these spikes that always seem to happen on the first meal of the new infusion set. I fight with it for the next few hours. Then I will often times crash – either from the serial rage bolusing, or it may be from pooling insulin that is finally catching up to me. I haven’t quite nailed it down yet.

I’m still playing around with different ideas, and am confident that I will eventually stumble onto something that works for me. This is yet another example of the old adage “YMMV” or Your Mileage May Vary.

Diabetes is such a personal thing, and there is no “One Thing” that will do the trick. That in itself can be so frustrating.

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8 thoughts on “More Set Change Stuff – Again.

  1. Scott,
    I was having this problem. Two things have eliminated it for me:

    1. I upped my “fixed prime” from 0.5 to 1.1. (On my pump the fixed prime is the one I do just after removing the needle). Oddly, nobody told me about the “fixed prime” when I got my first pump.

    2. I went on Symlin. Symlin has done two things that help keep my pump sites and post prandials in check. First, it slows down the food emptying from the stomach so that the food & insulin can be better timed. Also, because of the slow release of food, I square wave out my boluses so that my sites never get flooded. Well, they don’t get flooded until I meet a big ass bowl of ice cream and skip the Symlin. Then I enjoy both a post-prandial spike and a lovely stinging sensation in my pump site.


  2. It was Lala over at Lala’s HiLo Log that had the Oatmeal test I mentioned.

    Kathleen — Do you experience any problems on *new* sets? Like right after you change and start a new one, do you do anything differently?

    Julia — I really feel like it’s the first meal on the new set that does it. I used to do my set changes at night, and things would be fine through the night (well, go to be Ok and wake up Ok). But that first meal on the new set just goes crazy. Plus in this case I had the site in for over 7 hours before I had lunch, and was in target that whole time.

    Laura g — this was one of those frozen entrees packaged as a single serving. So I’m pretty confident in the carb count. It’s not like the dry box mac & cheese which usually has like 3 servings in it. I’ll try your idea one of these times around.

    Kevin — yeah, nailing down the variables is the damnedest thing. And it never fails that something doesn’t jive up right and you’ve got to factor that in. I’ll look into working with Gary. I’ve read his book and got a lot out of it. How does that work with your insurance? Is it covered for you?

    Thanks everyone for the concern & ideas – I do appreciate it!!

  3. What a pain.

    My only thought is to try to do the EXACT same thing tomorrow food and bolus-wise. Eat the same lunch at the same time, starting at the same BG (most difficult task), and give the same bolus.

    That way you might be able to troubleshoot how much of the rise is from a problem in your basal rate/carb ratio and how much is due to set change.

    After that, I’m at a loss.

    I don’t know if you’ve seen Allison or Skytor post about working remotely with Gary Sheiner or not, but I’ve signed up to work with him and I think he’d be a nice resource to help you figure this out.

    Just a thought…

    Keep punchin’!

  4. Hi Scott,

    Yeah, site change highs seem so undeserved and unfair…

    just wondering, but is 47 g carb one Box, or just one Serving of amy’s mac and cheese? I think a whole box might be a lot more than 47 g carbs, and that would sure explain a 321…

    These days my site change routine finally works pretty well after lots of trouble and trial and error:

    a. leave the old set in for 3 hours or so
    b. bolus on the new one about a half hour before breakfast, i.e. give it extra time to start working before food hits
    c. prime the cannula an extra .5 u just to give a little extra to cover the new site.
    d. keep fingers crossed

    anyway, good luck with the next one…

  5. Pasta kicks Olivia’s butt. I hate it.

    Have you tried doing an extended bolus for pasta? Give yourself 2/3 up front and the other 1/3 over 2 hours? Maybe that would help.

    The oatmeal thing sounds like a good idea, although something with no carbs would probably be better to test your site change problems. I know you don’t really eat veggies, though, so I don’t know what you could have. Eggs? Omlettes? Something with little to no carbs that will fill you up. That way, you could see if it’s the site or the food that’s making you spike. It’s either that or do a site change before bed and check yourself every hour all night.

  6. I’ve definately found it true, that infusion sites are affected more by the quantity of insulin infused than by the actual time on the body.

    I’ve always had problems with sites until I figured it out — I can put about 150 – 200 units through a set before it starts degrading.

    When I told my CDE this (a pump expert), she said “Duh!”.

  7. That’s a great thought – and one I hadn’t completely considered.

    Damn variables.

    Who was it that recently posted about testing insulin/carb ratios using packets of oatmeal? Something about the packets of oatmeal being packaged by weight, making them a very consistent and very accurate carb value.

    What are some other pretty straightforward things to try?

  8. Scott,

    My first thought here is the fat content in the macaroni and cheese– I know that when Joseph has mac and cheese (even Amy’s), he tends to go high. I’m thinkin’ because the fat tends to lower his insulin sensitivity.

    Thus, even though the food might not normally hit hard and fast, his bolus just might not be as effective from the get go.

    If that makes any sense.

    Hope you figure this one out…