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Pump HELP!!!

Discussion in 'Parents of Children with Type 1' started by KyleBugsMom, Feb 6, 2011.

  1. KyleBugsMom

    KyleBugsMom Approved members

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    I was just starting to like the pump - we're at just under 2 weeks. The last few days have been a dream with very consistent BGs. Then...BAM...

    Checked K at 1:45 this morning. 318, .4mmol ketones. It was my understanding that if they were getting their basals there would be no or very few (maybe .1mmol) ketones, and we had the basals worked out - was typically a little under 200 around 1a.m. to 2 a.m. (his overnight target is 200 since he is 4 y.o.) I gave him a correction through the pump and checked back 30 minutes later and he was coming down slowly. I checked again an hour later - still coming down slowly.

    He then woke up aound 5 a.m. SOAKED (which could also be b/c I let him have a little Crystal Lite at bedtime) He was still over 250, so I injected a correction. The tube seemed to be a bit twisted, so I untwisted it and put him back to bed - I figured with that correction, he wouldn't go into DKA before wake-up when we could change his site.

    Wake-up - 116! Great, but that begs the question if his tubes are getting a bit twisted overnight, is he going to be in danger at night?

    I am still going to do a sight change this morning, but how the HECK do I keep him safe at night when his pump/pack are constantly twisting around his body and twisting the tubing?

    Any advice is SOOO appreciated!!
     
  2. mandapanda1980

    mandapanda1980 Approved members

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    My daughter sleeps with her pump pouch on and most nights it is okay. It could have been his dinner...what did he eat? Maybe it was a delayed spike that just needed an extra boost to come down.. some foods, like hamburger/fries always need a double correction for us. I try different boluses and haven't figured it out not to spike yet.
     
  3. Amy C.

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    I don't think that twisted tubing stops the insulin from flowing. Also, .4 ketones is still trace to none -- it is a problem when up to .6.

    It is so hard to figure out what problem caused high blood sugar. It could have been one of several things -- air bubbles, incorrect carb count, just needed more insulin that night, etc.

    It is patterns you are looking for and this takes a while.

    Don't expect to figure everything out at once, but know you are slowly building up the knowledge of how your child's diabetes is treated with his pump.
     
  4. Sarah Maddie's Mom

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    Or a growth spurt. But probably not the tubing.
     
  5. Melissata

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    During out first pump demo, the trainer tied the tubing in a knot to show us that we need not worry about the tubing. Unexplained highs during the night could be many things, usually fat spikes for us.
     
  6. obtainedmist

    obtainedmist Approved members

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    When we went through the classes, we were told to correct with pen/injection for any unexplained # over 300 and switch out the infusion set. Also, the same for two unexplained #'s over 250 in a row. Though it looks like yours eventually kicked in, it's such a stressor (at least for us) to do that waiting game, lose sleep, and still not get the results that we want. I would recommend if that scenario happens again to do just that: correct with pen/injection and put in a new infusion set. The reasoning is that if the set is compromised, correcting with it won't really do the trick.
     
  7. hawkeyegirl

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    Yep. I agree that it's almost impossible to kink the tubing enough to disturb basal delivery.
     
  8. KyleBugsMom

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    Technically that's what we're supposed to do, too. I just couldn't stomach the idea of waking him at 3a.m. for a site change when waking him to pee on a Ketostick was about enough to do him in (this happened day 2 on the pump. I have since gotten some blood ketone sticks for the ketone meter.) I was willing to stay up all night giving him injections if it would keep me from waking him. Ya know?
     
  9. selketine

    selketine Approved members

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    William has worn a similar infusion set since he was 2 years old (he is 9 now) and twisted tubing has never been a problem. We've had broken tubing (new kitten bit through it once, he has pulled on it too hard and it snapped) but that is very obvious as the pump just comes off in your hand. I've never found a hole in the tubing or a partially broken tubing, etc. When he was 4 he used the shortest tubing they had to avoid it wrapping too much around him though.

    If he has some unexplained highs I'll always check the set and see if there is any blood around it or up in the tubing. Blood in the tubing ALWAYS means a bad set for us. Blood on the white adhesive pad that holds the set in usually means the set is completely bad or compromised (but not always). It is fairly easy to peak at his set while he is sleeping - you need a good flashlight though!

    We still get unexplained highs from time to time - some are just one-offs and some last a few days (or weeks). I can imagine how frustrating this is - and it seems like your child is prone to ketones (William hardly ever gets them) - but I think you will come to love pumping. I do think it wise to do overnight checks every night just in case you have a pump problem at night - this is the only way to catch it.

    I generally have not been too quick to change his infusion set if he is over 250 (or 300) unless he keeps going up. If something is wrong with the set - they will definitely start to skyrocket. With a steel needle set you don't need to worry about a kinked cannula - I'd say about any broken set I've had was really obvious (with the blood somewhere around it). You know his set is working cause he eventually came down - as long as you are on top of checking him I think you are ok to wait it out a bit.

    Have you considered a cgms? We have one and it is a game changer IMHO.
     
    Last edited: Feb 6, 2011
  10. blbrocky

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    You might try using the clip on the pump and attaching to pants or put it in a pocket. My son is older and just lets it lay in the bed. It has wrapped around him but never any problems with the tubing.

    If there are continued high numbers through the night you might want to do some basal testing to see what is going on.
     
  11. frizzyrazzy

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    For reference: we've been pumping since 2007 and we've only had maybe 2 or 3 TRULY bad sites. IMO, if ketones aren't bad and aren't rising, and the BG is not really going any higher, then changing a site at 3am probably isn't in anyone best interest. Also, since 2007 I have never once given a shot because I thought the pump wasn't delivering. Obviously, YDMV, but I just hate to see people stressed and resorting to needles or 3am site changes when most often things resolve.
    That said, Ian never gets ketones, so perhaps I'd do things differently if he did, but when we've had truly bad sites, the bg just skyrockets - over 400. Not just your random 250.
     
  12. obtainedmist

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    I hear you! I hope I didn't sound too matter-of-fact with my post and I apologize if I irritated you! I know that caring for toddlers and young children with D is a totally different world which I haven't experienced, but can only imagine.

    Our experience with the pump has been very positive, but unfortunately, we've had lots of problems with the infusion sets and so it's just been our first line of defense when fighting unexplained bg's. We've basically accepted the fact that Molly can only get two days max out of an infusion set...and that has helped us. It does get easier as you find your own grove! Hope things get better and better! :)
     
  13. KyleBugsMom

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    Two things - in the past he has opnly made ketones when he has been very sick - high fevers or stomach virus. So this is a new one on me!

    ObtainedMist - you did not offend me AT ALL! You did not attack and offered honest advice. I am so appreciative to everyone that has answered me!

    I think he is going to be one of those that HAS to have every-48-hour site changes, at least until we really get the hang of this.
     
  14. Marcia

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    As far as the tubing is concerned, we were taught that the tubing is double lumen-like a tube within a tube, you can't tie a knot in it even if you try.
     

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