That's Just Plane Crazy

Luggage? Check.
Boarding pass? Check.
Passport and credit cards? Check.
All your fluids sequestered into 3oz. containers and in a Ziploc baggy? Check and check.

While most people go through the more common airport checklists, diabetics have a few atypical tic-boxes to consider. Such as a note from your current doctor explaining that you are a diabetic and that you need to carry your liquid medication. And that the medicine needs to be kept cool in a container that will most likely have some kind of jelly or liquid inside. Insulin pump wearers especially need to be weary when going through security because you must NEVER put the pump through the X-ray machine. Every insulin pump wearer knows

Bloody mess

Today, I'm talking about a new issue I've encountered with my infusion set for the insulin pump. I should have learned my lesson the first time, but I repeated my mistake. I thought I would share my experience to possible help others in the future.

I use the Paradigm Insulin Pump from Medtronic and the Silhouette infusion set. A couple days ago, when I put on my new infusion set, I noticed a little blood in the catheter. No problem, I needed a morning Bolus and the blood went away instantly. However, because of a past experience, I believe I should have changed the set right away. The site began to look progressively worse over a couple days time and I took it out this morning.

I was very surprised by what happened next (warning for those that are squeamish about the description of blood). From the site, blood began coming out at a pretty good flowrate. Bright red and quickly streaming down my side. I scrambled for a napkin to sop up the mess and as quickly as I could I covered the site and applied pressure for several minutes.

This is the second time this has happened within a year's time. In very basic terms, it really freaked me out. A stream of blood coming from a puncture on your stomach would do that I guess. Now I'm left with a very sore and bruised area about 1/2 inch in diameter. I cleaned the area thoroughly and bandaged it as I would bandage any other basic wound.

Blood in the catheter should have been a strong warming that the site was not good for me. I had crazy high blood sugar readings for nearly 3 days and I was also very high this morning. Aside from using excessive amounts of insulin, the experience was frustrating and then frightening. I don't like having to change an infusion set right away because its painful and wastes supplies, but in the long run, I felt much worse when I kept it on and I wasted insulin, time, and health. It just isn't worth it to save an infusion set

Changing my set changes the effect

Every so often, I change the infusion set for my insulin pump and my blood sugar rises unexpectedly. Sometimes I see this effect for an entire day. I follow the common advice of frequent monitoring and correction as needed.

Because this happens regularly with my Silhouette infusion sets, I began to ask why it would be happening. My endocrinologist suggested my basal rate needed to be adjusted, however, when I increase my basal I tend to be too low after the first day. At my next appointment with a nurse practitioner, I heard anecdotal accounts of problems with sites immediately after changing. I also read similar stories on other blogs
http://www.insulin-pumpers.org.uk/badsite/
http://www.diabetes-insulin-pump-therapy.com/high-blood-sugar.html

I really enjoy the UK Insulin Pumpers site because there is so much useful info that I can't seem to find anywhere except from people's personal experience. But I digress. Back to my original question - Why would you get high blood sugar from changing your site? From other diabetics and physicians, I found several possible explanations.

• The site could be too close to muscle or the infusion set slope is angled to steep and is too close to muscle causing higher blood sugar because insulin absorption is hindered.
• The site becomes swollen or irritated or at worst, infected, which causes inflammation and compromises your insulin activity and/or absorption.
• The site has hardened fat tissue, which prevents absorption.
• Site isn't taken very well and your body reacts to it negatively for a number of immune response reasons, which leads to inflammation and results in the same problems as above.

This problem doesn't happen all the time. Maybe 2-3 times per month out of 10-12 at the most. Usually if I give myself the infusion set and it really sings for a few minutes afterward, I know its going to act goofy for a day. Another case would be if its sensitive in that area when I press on the infusion set. I am now considering changing the type of infusion set I use to see if there is another set that may work better.


If you do call a helpline, I can give you an example of what you might hear, but please do call and do not rely on my personal account to make judgements on your own situation.

First, the insulin pump company asked me to perform a Pump Self-test and to make sure the tubing wasn't tangled or leaking. Ensure that the basal rates and bolus ratios are correct. Make sure the site isn't painful or problematic (is it red? swollen? is there blood? was it primed correctly? were there air bubbles?). You may need to change the set.

I found this MiniMed site helpful.
http://www.minimed.com/help/sitemanagement/index.html#a6
And there are also the National Institutes of Health and Center for Disease Control with useful sites too. http://www.cdc.gov/diabetes/ndep/index.htm
http://www.ndep.nih.gov/partners-community-organization/index.aspx
And I really like this book called "Insulin Pumping"... here's the website founded by the authors.
http://www.diabetesnet.com/pibook.php

Bipbimbap overload

Some days it feels more difficult ot control my blood sugar than others. Today was an example of my diet and stress making my management difficult.

I had homemade tom yum soup with rice noodles for lunch. I particular love rice noodles in my Thai food but there's something about those high carb noodles that tends to throw my levels for a loop. They have a lot of carbs to begin with, but then if we boil and wash them too long, I tend to go low because we are washing off a lot of the starches on the outside of the noodles. If I'm eating a lot, that makes a larger difference in how much insulin I take versus how much I need.

Today, it resulted in a mild drop in my blood sugar. Its important to follow the trends because I will revisit this dish and then I'll be able to take the correct amount. It requires mindfulness of what most people consider mundane details of daily life.

Later we had bipbimbap and doen jang (two of my favorite Korean dishes)soup for dinner. These dishes I eat frequently and I can control very well. However, the first few times I wasn't very successful and my blood sugar went very high. It turned out that I wasn't accounting for the gochu jang (pepper paste) that has some carbs, as well as the carrots.

But after some trial and error, I almost never have any problems.