Trouble in paradise - help needed

[Platty1953]

Hi folks,
Need your help and advice pretty quickly.

I am holiday in Thailand, been here nearly two weeks and can’t get any control on glucose levels.

Todays example
Had lunch with about 70 gms of carb. Using my usual 2 units to 10 gm I took 14 units of Lyumjev. Two hours later (about the active time for Lyumjev) I was still 12.8 so took a correction dose of 2. Now getting alarms from Libre2 app saying high glucose and it’s gone up to 13.3.

When I first arrived I couldn’t keep readings up (getting lots of night time hypos) now it’s gone totally the other way and can’t get a balance to keep in range.

Any thoughts or suggestion? Any advice welcome.

TIA
Stewart

 

[Platty1953]

As an added bit of info my latest HbA1c two weeks before leaving the UK was 49

 

[Pumper_Sue]

Have you cooked your insulin by any chance?

 

[rebrascora]

Hi. Sorry to hear you are struggling with your levels.
Which basal insulin do you use and could you have forgotten to take it?
Could your insulin have got too hot and degraded? I am guessing it is hot in Thailand so Frio pouches would be necessary.
Do you always do an air shot before injecting? If not, could the needle be clogged and not delivering the insulin?

My guess is that you were going low when you first got there due to the change in temperature which for me would mean I needed less basal insulin and then possibly degraded insulin due to the heat now..... but I am just guessing. Try a new cartridge/pen of Lyumjev

 

[Platty1953]

Have you cooked your insulin by any chance?

Could be but I’ve changed the cartridge twice so would have had to be pretty unlucky

 

[Platty1953]

Hi. Sorry to hear you are struggling with your levels.
Which basal insulin do you use and could you have forgotten to take it?
Could your insulin have got too hot and degraded? I am guessing it is hot in Thailand so Frio pouches would be necessary.
Do you always do an air shot before injecting? If not, could the needle be clogged and not delivering the insulin?

My guess is that you were going low when you first got there due to the change in temperature which for me would mean I needed less basal insulin and then possibly degraded insulin due to the heat now..... but I am just guessing. Try a new cartridge/pen of Lyumjev

I use Lantus basal, and have an alarm on my phone to remind me so pretty sure I’ve not missed it.

Have changed cartridge twice but will try another and use a different Lantus pen. Air shots and fresh needle most times but again will be ultra diligent.

Insulin might have degraded during 48 hours transit from home to Thailand but it was in insulated case with frozen chiller blocks and in flight refrigeration, and then straight into daughters fridge when we got here.

Thanks for your input. Will do some more experimenting to see what works.

 

[Piglet]

To me it sounds like the temperature is having an affect on your insulin. Can you keep spare insulin cooler than the ambient temp, try keeping it in a glass of cold water and replace as necessary. If you travel loads to hotter climates I would consider investing in a Frio wallet. they are fab at keeping insulin cool.

Good luck and try to enjoy the rest of the holiday.
Piglet

 

[Bloden]

it was in insulated case with frozen chiller blocks

Was your insulin damaged by the frozen blocks?

I hope you get to the bottom of the problem asap.

 

[Platty1953]

To me it sounds like the temperature is having an affect on your insulin. Can you keep spare insulin cooler than the ambient temp, try keeping it in a glass of cold water and replace as necessary. If you travel loads to hotter climates I would consider investing in a Frio wallet. they are fab at keeping insulin cool.

Good luck and try to enjoy the rest of the holiday.
Piglet

Thanks for your advice. After the messages I received yesterday I went back to basics and changed everythin, pens, cartridges, needles, and tried again. Within a hour or so things were back to normal and have been straight down the middle of my target range overnight.

So it would appear that the insulin had degraded, so thanks to Pumper_Sue and Rebrascora for getting me to take that route again.

I did order a Frio wallet before I came away but old Amazon didn’t deliver in time. (My fault I guess for not ordering in time.)

Have tried to get one here but not found a supplier yet, but will keep looking.

Thanks again

Stewart

 

[Platty1953]

Was your insulin damaged by the frozen blocks?

I hope you get to the bottom of the problem asap.

Thanks for your response. As per my other replies seems the insulin had been cooked due to high ambient temperatures. I was careful on our outward journey to keep the pens and cartridges in their original boxes so that the cardboard and plastic would shield them from the ice blocks, providing a bit of insulation (and so I wouldn’t have any problems with Thai immigration!)

Hopefully problem solved but will report back if anything changes.

Thanks all again, you guys are always helpful.

Stewart

 

[SB2015]

I am glad that you got things sorted

in the absence of a Frito bag I bought a small soup flask. I kept it in the fridge, and then put my insulin in that when moving between hotels. It kept it cool, no need to have it out in the air as you do with frio bags, so I was able to bury it in my bag away from any direct heat. I have now stuck to that on holidays as there is no danger of damage to the insulin due to freezing.

I hope that you enjoy the rest of your time and levels behave themselves (as much as they ever can when away)

 

[everydayupsanddowns]

Thanks for your advice. After the messages I received yesterday I went back to basics and changed everythin, pens, cartridges, needles, and tried again. Within a hour or so things were back to normal and have been straight down the middle of my target range overnight.

So it would appear that the insulin had degraded, so thanks to Pumper_Sue and Rebrascora for getting me to take that route again.

Phew! Thank goodness @Platty1953

Hope you can enjoy the rest of your trip.

Can be tricky travelling with insulin, as either too hot or too cold can damage the insulin and stop it working properly