New pumper question - help, it's Sunday!

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Lilmssquirrel

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So DD started on a T-slim on Thursday. Did our first set change this morning before lunch and now she's gone through the roof to 30. No ketones. A finger prick is showing she has 3u of active insulin so I'm now not sure if a set change is the right thing to do?

Out of hours aren't any help as there's not a T1 specialist on duty...

Really don't know what to do for the best :(
 
In that situation, I would do a set change and use fresh insulin from the fridge.
Some people do a correction with s syringe or pen just in case.
 
Lilmssquirrel said:
Thanks @helli When people say a set change is that both the thing that goes in the pump and the cannula too?
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I would change everything just to be safe.
The cartridge with the insulin (and get a fresh be vial of insulin out of the fridge) and the cannula.
Whilst changing it keep an eye out for anything that looks awry so you can learn for next time.

If you have problems after that, I would be tempted to revert back to pens until you have had a chance to talk to your diabetes team

Remember, we tend to be insulin resistant at high levels so DD may need more
 
Thanks. We did a full change and nothing. She's had two corrections with the pump. I could cry as I was hoping this might make things better for her but it feels worse as her numbers are uncontrollable again.

I had an email exchange with our PDSN mid evening and she said to change everything too but now it seems worse as the numbers haven't come down and she has 0.3 ketones.

I'm going to test again in an hour and maybe pen correct
 
Lilmssquirrel said:
Thanks. We did a full change and nothing. She's had two corrections with the pump. I could cry as I was hoping this might make things better for her but it feels worse as her numbers are uncontrollable again.

I had an email exchange with our PDSN mid evening and she said to change everything too but now it seems worse as the numbers haven't come down and she has 0.3 ketones.

I'm going to test again in an hour and maybe pen correct
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Pumps are hard work to start with but keep going with it and you'll see the benefits soon I hope.

How is everything now?
 
MrDaibetes said:
Pumps are hard work to start with but keep going with it and you'll see the benefits soon I hope.

How is everything now?
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She's on the way down thankfully. At around 12.30 she was 24 with no IOB. At 2.30 she was 19.6 and now she's 18.6. All with no correction so I am hoping this means the set change worked as the basal is bringing her down slowly?

The bit I didn't get was the new basal calcs. They said not to worry but it feels like knowing a language but not the local dialect. I think the slow down is reflective of the time bands but of course I cant look in the middle of the night as she has it in a belt.

But all ends up she's going in the right direction. Was just so worried I'd done the set change wrong again.

It all may be to do with her Tresiba from pre pump wearing off as we got the pump on Thursday and she's been on a big dose.

Sorry for rambling... Completely sleep deprived with worry/frustration (situation normal there!)

Thanks everyone. Only a few more hours til the PDSN is contactable
 
Lilmssquirrel said:
She's on the way down thankfully. At around 12.30 she was 24 with no IOB. At 2.30 she was 19.6 and now she's 18.6. All with no correction so I am hoping this means the set change worked as the basal is bringing her down slowly?

The bit I didn't get was the new basal calcs. They said not to worry but it feels like knowing a language but not the local dialect. I think the slow down is reflective of the time bands but of course I cant look in the middle of the night as she has it in a belt.

But all ends up she's going in the right direction. Was just so worried I'd done the set change wrong again.

It all may be to do with her Tresiba from pre pump wearing off as we got the pump on Thursday and she's been on a big dose.

Sorry for rambling... Completely sleep deprived with worry/frustration (situation normal there!)

Thanks everyone. Only a few more hours til the PDSN is contactable
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Don't apologize for rambling. Basal calculations will change, and you might have to do some fasting tests but that will be explained in due course.

Glad it started to come down, you're doing incredible. Glad the team is contactable shortly.
 
Golly you’re not even a week in, please don’t despair! When you go from a fixed amount of long acting insulin every 12-24 hours to variable doses of fast acting every hour for your basal, I have absolutely no idea how they work it out... so it will probably take a lot of fiddling before things settle. Basal shouldn’t really be bringing her down slowly, it should be keeping her level, however at least she is coming down now! You’ll need to be in very close contact with your medical team for the next week or two until they get the basal sorted, it sounds like it’s not close enough to her requirements yet. And like you say her long-acting was probably still wearing off.

Please hang in there, ultimately the pump should be better, for example if you find she’s going low at the same time every day you can tweak the basal just for that time of day and leave the rest alone. It just takes a while to get it set up right in the first place.
 
Sorry to hear you has such a rough time @Lilmssquirrel - and obviously it had to happen over a weekend!

Sounds like you handled it really well, and will know what to do if it ever happens again.

Sometimes (if I am confident that the insulin is OK, but have doubts over the site) I would only pop in a new cannula, prime it and then try a correction.

It can also be worth checking back through daily history, to make sure meal boluses from earlier definitely were delivered (sometimes the final confirm confirm confirm step can get missed).

Not sure which sets she is using, but one other quick check I make now that I haven’t on any other pump, is to rub a finger over the cannula where it enters the skin, and see if it smells of insulin.

Just occasionally I’ve had sets which feel fine, but where insulin seems to be leaking back up to the surface rather than absorbing properly.
 
Well done @Lilmssquirrel , you have managed really well.

Glad that you will soon have access to the PDSN.
You are right that pumps bring a whole new set of la gauge, and another steep learning curve.

I hope that you can get some rest today.
 
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