This has NEVER happened before...

[BrendaK]

I know you're not suppossed to do site changes before bedtime, but last night we did. Put Carson to bed at 121, with a snack and bolus at 8pm. When I took the old site off a bunch of insulin leaked out (oops) so I expected him to be high at 10pm

10pm check -- 447 :eek: Correction bolus through pump -- I expected him to be high

1:30am -- 445 -- Okay, maybe a bad site. Did an actual SHOT (only do that about once a year).

4:30am -- down to 159

7am -- down to 107. I figured the site was working okay because he didn't bounce back up after 4:30am.

9am -- School calls -- He's at 310. That's high, but I still figured he'd be higher if the site wasn't working. So I had them bolus for a snack

11:30am -- 340. This is where my mind should have said change the site/check the pump. But I still corrected and bolused for 10gcarbs through the pump. I wanted him just to eat something small to see if he would come down.

12:30pm -- 400 :eek: Okay, finally my rational brain kicks in and says we have to change sets. I give another shot for lunch. Change sets, then I took the pump off to look at it.

I started giving "fake" boluses through the pump and watching the tubing to see if any insulin would come out. NOTHING came out after about 10 units of bolusing.

Finally I decided to change the insulin, maybe it was bad or something. Apparently the luer lock on the tubing was screwed in crooked and preventing boluses. :eek: The pump was able to push out the insulin when I was priming the tubing -- I think because it had enough force to push out a unit every second. But there wasn't enough force to push out a bolus of 3 units over a 2 minute period.

So, after changing insulin and tubing, all is well, I think. At least I could see insulin coming out of the tubing this time!

I just feel horrible -- Carson does, too. Poor kid hasn't had a ton of insulin today. I need to check for ketones next.... But since he's had an actual shot of insulin, I wouldn't do anything now except give him more water if he has ketones.

Moral of the story

1-Don't change a site right at bedtime (although in this case it still took me 14 hours to figure this out)

And 2 -- Check the entire pump when there's a problem, not just the site :rolleyes:

[Hollyb]

Wow, that luer lock thing is something I would never have thought of. Thanks for passing it on.

[sammysmom]

Good reminder to check the actual pump for problems.....

shannon

[Treysmom]

Thank You for that information. Even though we are future pumpers its great info. I know you are happy to figure out the problem. Good JOB!

[BrendaK]

Thank GOD his ketones are only 0.3 right now. I imagined they might be a lot higher after 14 hours of a malfunctioning pump.

I think I'm going to take a nap now :rolleyes:

[Abby-Dabby-Doo]

You deserve the nap!
Good catch, and thanks for passing on the information!

[gsmom]

Glad to hear he is doing ok considering what you both have been through! Sounds like you DESERVE a nap - enjoy! Great job figuring out what was going on as I don't think I'd have ever caught that one! Sweet dreams!

[hold48398]

Boy, that was a short night!! Happy snoozing!! Great job checking the actual pump!!! Hope Carson is feeling better now.

[Traci]

Tuesday night we also had a problem with the connection from the cartridge to the tubing! Ds was low at 1pm, so I gave extra carbs and bolused him for lunch. He was high at 3, but I thought it was probably a rebound, so I just corrected and did not check for ketones. By 6pm he was 400 with mod-lg ketones! I corrected with a shot and disconnected him. I had done a site change that morning and it had been working all day, but I thought maybe the tubing had bubbles, so I did a "fill tubing" through the pump to try to flush them out. I felt like someone had punched me in the stomach when I saw that nothing was coming out of the infusion set. When I looked closer, I saw the insulin bubbling out of the cartridge top. Somehow the leur lock had broken off the top of the cartridge and was just cocked in there crooked. We did a complete site change again. He came right down, but it was pretty scary for a while! Check those leur locks!

[Twinklet]

WOW, thanks for posting this! I'll make sure ours is screwed on the right way!

I really hate those nights where you're up all night trying to decide if the site is bad, if the food bolus wasn't correct or what the problem is. Ugh. Glad you got a nap!

[hrermgr]

We do set changes in the evening and to me, the issues are there if they are done in the morning, afternoon or evening. We get highs after set changes a lot. We almost always do a set change before a meal so we can bolus almost immediately to be sure that the set is working.