Why, why & Why

We all know that time flies and life without the insulin pump seems a long time ago already.  It is only just three months that I am "hooked" up.   I remember that I was very anxious when I had the training and I wondered how it would change my life.   It has definitely changed my life.  Luckily in general for the better.   I spoke with my specialist and with the diabetic nurse and both consider me some kind of "miracle" as they have not seen any one who reacted so well to the use of the pump.  As you can imagine I am really happy about this.  But it is not all roses.  

The reason it goes so well in general is the fact that I do the carb counting really well.  It goes not so well when I go for a walk or after I have done a walk.  This is a learning process and I will write about this in my next blog: " my new goal,  a day walk".  

Another learning moment was a couple of weeks ago, when all of a sudden, within one hour,  the BGL went up above the 18 and I had not clue why.  Unfortunately it was not because I had a nice piece of cake.  It was even more alarming as the BGL's according to the BGL meter were 27. I got quite stressed and I was wondering: why, why & why.  

During the training, the diabetic nurse urged me to check for ketones when the BGL's are above 15.  Ketones is a new thing in this blog.   Ketones are bad for patients with diabetes 1 (and I was told, you dont have this when you have diabetes 2).  In short,  ketones poison the body.  You can measure this with the BGL meter and special test strips.  I was told that when the result is above 1.5, you need to look for medical attention.  Well,  the meter advised  me 1.7, so I had to take some action. 

                              

                                                                     Action required

I followed all the the roles in the training book.  First thing I gave myself insulin the old fashioned way, with the insulin pump as there was obviously something wrong with obtaining insulin via the pump.  Second thing  I did was drinking 0.5 liter water, to take care that the ketones would leave my body as soon as possible.  The third thing  I did was changing the infusion site as I had the feeling that this could be the problem. The fourth and final thing I did was calling  the medical assistance help line and after some questions of a nurse, I was advised to see a doctor.  Of course this all happened in the evening, so my husband and I went to the after hour service in the hospital.  In this current "Covid" world,  a place you like to avoid, even in New Zealand.  

Luckily there were no other patients and I was seen by a very friendly doctor within 10 minutes.  This very friendly doctor advised me straight away that I probably knew more about the insulin pump than he did.  But he also told me that I did the right thing by coming to the hospital and have a check up.  The good thing was that I did not feel unwell.   I was just shaken and very insecure about this all and I needed re-assuring.  The doctor did some checks and with a BGL/Ketone meter of the hospital, the values were re-checked as well.  This showed that the ketones were back to 0.4. This is within the normal range and BGL's were 19, so still high,  but not as crazy as 27 and not rising.  

So,  yes, I was re-assured that there was nothing serious, but I still had a lot of questions.  For instance, was my meter correct because the ketones had come down so quickly  and was I overreacting?  Well,  on both these questions I got the answers from my diabetic nurse.  Yes, ketones can come down so quickly, because as soon as your body gets insulin again, ketones are "chased" away.  And he also advised, no, I was not overreacting, it was the first time that my body did not receive any insulin and I did exactly what I was suppose to do.  It was a very good learning moment and now that this happened, I know that next time, I don't need to see a doctor,  but just do the things I did and it will all settle down again. 

 Spot the insulin on the infusion set

So why did the BGL's go up so quick and why did I not obtain any insulin.  It all happened after I changed the infusion site of the pump.  I need to do this every 3 days.  I was entering the little needle somewhere in the abdomen.  This is also the location where I injected myself with the insulin pen.  These  injections have caused that on certain spots there is scar tissue underneath the skin.  You can not see or feel this scar tissue, so it is kind of "hit and miss".   This time, it was a hit and because of this the insulin could not enter my body and was "send" back along the needle, out of my body. (This is called tunneling in the medical world)  See the photo of the infusion set with the needle and the wet spot of the insulin.   Unfortunately you don't see this when the infusion set is in. You really need to take the infusion set off, to spot this.                 

 For me, the solution to avoid this from happening again is to place the infusion set on the area around my hips and/or in my lower back.  So far, so good.  I now know what to do, when the BGL's suddenly rise above the 15 and I have no clue why.