Well, that explains the high sugars….

[Inka]

I’d reduced my basal and meal ratios because of hypos in this heat and all was going well - until today. My blood sugar suddenly went up a bit late afternoon for no reason, and then shot up madly. I decided it would be best to change my pump cannula just in case, and when I took it out, I found the most bent cannula I’d ever seen. It even left a purple line along my skin. It must have been practically horizontal in there. Arrghhhh!

I’m not sure if the photo shows it well but here we are:



The leg thing was the weirdest because it felt really uncomfortable taking the cannula out and the dark purple line under the skin looks freaky. Fortunately for anyone reading this, I didn’t manage to get a pic of that

Just as I was thinking I’d sorted the heat-related lows, the good old D throws in a mad high 🙄 Just hoping it will settle down a bit now as I want to go to sleep soon!

 

[nonethewiser]

Hell that looks nasty, hope things settle back down.

 

[helli]

Sorry this happened to you @Inka especially when you had just sorted out the lows.
I wonder how closed loop would have coped. I suspect it would have struggled. If so, this show be used as an example why it is not the nirvana some hope for and why it is important to understand how to manage diabetes rather than rely on tech to just do it.
if closed loop could cope, I am impressed.

 

[Inka]

Hell that looks nasty, hope things settle back down.

Thank you @nonethewiser My new cannula worked fine overnight and my leg looks better 🙂 Strangely though, I kept going Low overnight even though my last correction had been 9.30pm and had been a moderate one too. All I can think is that after the bent cannula had been removed, some ‘stuck’ insulin released itself bit by bit. I had 4 alarms on my Dexcom. Nothing too low though, as my alarm is set high enough to warn me.

Anyway, I’m feeling better this morning and very relieved the highs have gone, fingers crossed.

 

[Inka]

Sorry this happened to you @Inka especially when you had just sorted out the lows.
I wonder how closed loop would have coped. I suspect it would have struggled. If so, this show be used as an example why it is not the nirvana some hope for and why it is important to understand how to manage diabetes rather than rely on tech to just do it.
if closed loop could cope, I am impressed.

See, this is one of the things that worries me about looping. There’s no way the loop would have known my highs were caused by the cannula. Presumably it would have pumped out extra insulin to cope with it, but with a dud cannula the insulin wouldn’t have done anything so it would pump out some more. Then (see above post from me) I’d have risked crashing lows.

To me, looping sounds good in theory, but there’s so much that can mess up its cleverness that I don’t see the point really. It would also make me very nervous to hand over control to ‘somebody else’ after all this time. When I was first diagnosed, they were talking about looping even then and I thought it sounded great, but now, after using a pump for almost 20 years and seeing its weakness (the cannulas and absorption issues) I’m not keen. My Dexcom, on the other hand, is a fantastic piece of kit and has brought me improved understanding of my blood sugar patterns and peace of mind, which is priceless. I know no tech is perfect, but CGMs are pretty close.

 

[Sally71]

if you were looping you’d get loads of alarms going off from the sensor telling you that you were rising rapidly, either manually do a correction or see what the pump is doing, and if it carried on going up and not down you’d change the cannula. Or maybe you’d change it straight away, e.g. if it’s in the middle of the night. Same as for normal pumping really.

 

[Inka]

Wouldn’t the loop attempt to squash down the rise though? I don’t know - hence the question 🙂 I would be worried it would attempt to squash the high with lots of little doses of insulin before I’d realised there was something up. I did correct myself (with a pen) but only a moderate amount (because it was getting close to bedtime). I didn’t correct the initial rises, whereas I assumed the loop would?

Blood sugar is totally back to normal this morning, which is the important thing 🙂 Thinking about tech cures versus biological cures, I saw an interesting item from JDRF, which I’ll put in another thread. Yes, it was mice again, but sounded promising.

 

[helli]

I haven't looped but I would like to try it.
I wouldn't see it as handing over control. Apart from not believing my diabetes can be controlled, I think I am too much of a nerd who wants to have an input.
It's like driving. I have driven a manual for so long that I find automatics really frustrating.

And I am an engineer so I know things go wrong.

But I love the auto suspend I have today and can see the value of some automatic assistance when high. Maybe, taking the driving analogy a step further, I see the benefit of power steering.

 

[Sally71]

Yes the pump would try to correct the high, but if the cannula isn’t working you won’t get the doses, so you change the cannula and either do a manual correction or leave the pump to work it out for itself. The worst that happens is that you waste a bit of insulin and then have to keep an eye on things for a while until it’s readjusted. You never hand over control completely, you still have to monitor what it’s doing and tweak things from time to time when it starts to struggle.

Picture shows my daughter’s CGM trace from the last 24 hours. You can see the gap where she changed the sensor. When the new one came on line at midnight she was fast asleep and didn’t hear the high alarms; the correction was done entirely by the pump itself. I’d rather be looping than not!

 

[Inka]

Thanks for the explanation and informative pic @Sally71 🙂 Maybe I just don’t like to relinquish control. I think that’s a ‘me thing’ I do see the value of auto-suspend though. In fact, I was thinking about it the other day when any activity in the heat caused tedious and repeated drops.

Fascinating to see the loop in action so clearly on that graph 😎

 

[Sally71]

I can see why people are nervous, we are a bit resistant to change too and had doctors and nurses nagging us for 2 years about changing over to Control IQ; having finally taken the plunge last December though I’d never want to go back, it takes a lot of the work out of it and her HbA1c and TIR are better than they’ve ever been, but you can still take over yourself if you need to. My daughter is 17 now though so it won’t be anything to do with me for much longer!

 

[SB2015]

Sorry this happened to you @Inka especially when you had just sorted out the lows.
I wonder how closed loop would have coped. I suspect it would have struggled. If so, this show be used as an example why it is not the nirvana some hope for and why it is important to understand how to manage diabetes rather than rely on tech to just do it.
if closed loop could cope, I am impressed.

Closed loop is likely to have coped in a similar way as we would. Realised something is wrong and then asked for intervention.

I find that my system seeks my intervention fairly quickly if it is in any doubt. Sometimes irritating but it just shows how much it is doing for me, and not unreasonable to ask me to check things. If I don’t respond it puts me back into manual and I am in the same position as someone not looping. Cannulas are pump cannulas and looping doesn’t change the effectiveness of them.

When I first started looping I was very uncertain about it all, but realising that the pump is just the same pump mechanism and that it is the thinking that it does for me has helped. As it is taking on a big responsibility it is reasonable that it has lots of fail safes set in place and will ask for me help if in any doubt.

Looping is not the panacea but it certainly makes life a lot easier: reduces hypos, heads off higher readings more quickly, lets me sleep like a log, corrects miscalls of carbs, deals with fatty meals without me needing to splitting boluses. Like any system you develop work around to make it do what you want it to do. I am pleased that I made the switch, and can afford to do so.

 

[SB2015]

But I love the auto suspend I have today and can see the value of some automatic assistance when high. Maybe, taking the driving analogy a step further, I see the benefit of power steering

Perhaps looping is like a driverless car, but in this case we still have to be attentive and available to take over if necessary. It is only the basal that the looping is sorting, and we are still having to do meal times in the same way. This may be a thing of the past in the future.

It is difficult to let go of the control and we each work hard to get our systems to work for us, so handing over this to the pump is not easy. It took me a good month to really let go.

I say don’t knock it until you have tried it.

 

[everydayupsanddowns]

OWWWW!!!

Glad things settled after you’d swapped out the old site.

I used to get 90-degree kinks before I moved to angled sets (in my first year on a pump). There was a needle running through for insertion so I know they went in straight, but high BGs and a site swap would reveal a bent Teflon tube.

Which is weird - because have you ever tried to bend them??!? They just won’t stay bent.

I can only assume it was something like meeting a join between a fleshy layer and muscle or something? Hasn’t happened since on angled sets.