What do you do when the meter reads HI?

DD just had her first HI reading ever. She washed her hands and checked again, and it was still HI. I wasn't here, but my dh changed her set and gave a correction. She was on her first Mio ever (6 mm, on her bum), and we suspect it went bad or pulled partway out; when he changed it, he put in a Silhouette, which is what she's always used before. I think he then gave a correction based on an assumed BG of 600. Checked blood ketones and head a measurement of 0.2, so no immediate problem there.

So here are the questions:

- If the meter reads HI, how do you calculate the correction?
- Do you do anything else besides change the set and encourage water?

 

For general highs that can't be explained by food or other problems we give a correction via shot first, then change set. I always think it's wise to KNOW the insulin is going in when that high.

We've not had a HI, so I can't help on the calculation part, sorry. Hope things settle quickly.

 

Correcting for 600 was the right thing to do, but it should be done via shot.. with .2 ketones that's a pretty good sign that the high is from lack of insulin. If something were to have gone wrong with the next site, you're setting yourself up for bigger problems if the correction through the site didn't work. Better safe than sorry in my book.

I can sometimes be symptomatic (nausea, headache) of having ketones at just .1 so I wouldn't immediately dismiss a low number as not being a big deal... to me it would be, because I don't normally spill ketones unless I'm missing insulin or I'm sick, so if I test and see any that's usually a sign that something is not right.

 

Highest I've ever seen was 594, never HI (on recheck it was 588). What I actually did in that situation was give a correction plus a meal's worth of insulin and check blood sugar every hour until it came down to the 200s, then ate. I think I also checked ketones and they were negative.

I think what I did was actually a bad idea. For people in DKA with really high bgs, the official recommendation is to aim to lower bg by about 100 mg/dl/hour. For that reason, if it happened now, I would correct as if my bg was 500 (the DIA I expect is 4, and I aim at 100), and I would take another correction every hour that I remained above 500.
In addition, for a blood sugar that high, I might call my endo, especially if I had ketones and it was daytime.

This is not totally relevant but something I think about when really high: http://care.diabetesjournals.org/content/24/1/131.full

 

We correct via injection and run it through the pump (disconnected) to keep track of IOB. Then, if we don't understand why, we change the site and insulin.

I then check two hours later and compare the pump's recommended correction compared to the IOB and go from there.

The problem is - the High might be a 601 or a 900 and you just won't know until you correct and then test later.

 

I agree that an injection makes sense. A "Hi" reading usually means over 600, so I would assume that is the BG for starters. Really high BG's can be stubborn and often need more insulin than you would normally calculate. I would check for ketones every couple of hours and check BG every hour. Hope you can catch a little sleep.

 

We don't get failed sites, so I wouldn't think anything of putting another site on and correcting through it. I wouldn't worry too much about overcorrecting. Jack is so insulin tesistant at high numbers that I'm sure I could double the suggested correction and it wouldn't crash him.

 

Thanks, everyone. She got the correction, had a carb-free dinner (cheese omelet), and went to her horseback riding lesson feeling cranky but otherwise okay. Her CGM wasn't registering a number, of course, but the ISIG on her CGM was 80+ when she went (!), down to 74 during her lesson so we knew she was at least heading down, and she was down to the 300's by the time she got home. Currently 290 with an arrow down. *phew* We're all feeling much better now.

Hawkeyegirl - I'm intrigued by your comment that "we don't get failed sites". Have you never had a failure? We don't get them often, but they've definitely happened before. What's your secret?

Here's hoping it's a quiet night.

 

With a 600 I would call my Endo and work with him/her. Double check that BG checks had been done on a regular basis before getting that 600 if the 600 was not after 8 hours of sleep. Truly As a long time T1 I think a 600 it is time to call the Doc or head to the ER. For me, as a 40 plus years T1, a 600 would be a really really high number. Call your Doc. :cwds::cwds:Ali

 

Our meter goes to 500, so thats what we would put in. For a HI we'd change the site unless we know why she's that high (being disconnected for a long period, like a shower, swimming etc or a missed bolus, or miscalculated bolus). LIke Lee said you don't know if the HI is 500 (or in some cases 600) or 900, so you have to go with your meter max. If we give an injection (only do that when we have ketones) we disconnect the pump and put that correction in the pump so we can keep track of the IOB.

 

I don't agree with the PP that 600 means a trip to the ER -- your child's life is not in danger or to call the endo.

The kid simply needs insulin.

I am with the others who calculate the dosage to correct for a 600 and then correct when you get a number that can be read.

 

I do the calculation through the pump and then I disconnect and run it through. This way I have a record of IOB for when I go to do the next check/correction (we are on the Ping so meter/pump are paired). We will also do an increased basal for a period of time too. Obviously, check for ketones.

Then, I will just do the correction via syringe based on what I just dosed through the pump. With the type of sets we use, unless it's a high for a reason(ie. illness, forgotten bolus, food type), I know to just swap out the site and start fresh. If there's a good amount of insulin left, I will run a prime to purge any air bubbles otherwise, I'll do fresh insulin too. Then I'll encourage water/seltzer.

If my daughter isn't responding to any of this, I will call and check in with the endo to see if they may have any other suggestions, but they generally will just say that we are doing everything they would do. Once they suggested we be a little more aggressive with our basal increase. But, a number like this doesn't mean a trip to the ER (obviously that's your decision to make and everyone responds differently).

 

Change the site - give a whomping correction (no injection), run a temp basal for a couple of hours, give her a glass of water. Test at 1.5-2 hrs, see if we're headed in the right direction.

 

This is the same for us. We've also always used Sils and had no trouble with them EVER so I would have felt perfectly safe replacing the site and bolusing through it into a site I would be almost certainly would work. Especially with .2 ketones (.1 and .2 being nearly default for many people). The only times we've ever had site issues is, coincidentally, when we tried MIOs as well.

 

I'm still learning things 5 years later....I thought (probably incorrectly) that when the meter we use with Omnipod says HI is means over 500.....when this happens, I use 500 as the correction number, and just check several times over the course of a few hours and keep correcting...Sometimes the cannula has come out, other times, she forgot to bolus for her meal...

Are all meters indicating over 600 when it says hi?

 

In my experience, once bgs get that stratospherically high it's going to take more than one correction and possibly a temp basal to beat back the insulin resistance so whether you correct to 550, 600 it really matters not. That first off correction probably won't be enough to do the trick all on it's own.

 

I should have said that we've never had a failed site on insertion. The only sites we've had that I would consider failed are ones that I've (accidentally) left in past 3 days. We use Sils exclusively, hand insert them, and have never, ever had one go bad that wasn't old.

Really, this is true for us once we get past 350 or so. If we were to get a HI, I'd probably correct at 600 AND do a whomping temp basal.

 

Yep. Historically with my daughter we have to correct via syringe since correcting with the pump at that point for her just doesn't work, even with a new site. Then, we have to do a 100% temp for at least 2 hours, correct again and temp again, but this time only 1 hour. The whole process can take several hours before we see a number around 200. At that point we have to let it ride as another correction will then head her into low country and the whole process starts all over again, but in another direction.

 

This has been our experience as well. Correcting via syringe is the only way to bring my son down in a "relatively" timely manner. :cwds: