Sarah Howard
Sarah Howard has worked in the diabetes research field ever since she was diagnosed with T1D while in college in May 2013. Since then, she has worked for various diabetes organizations, focusing on research, advocacy, and community-building efforts for people with T1D and their loved ones. Sarah is currently the Senior Marketing Manager at T1D Exchange.
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After how many hours of high blood glucose levels would you change your pump site or open a new insulin pen? Cancel reply
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Currently? I answered Never because sustained high BG levels rarely happen anymore since being on the Tandem X2 with CIQ. However, if I were to run sustained high BGs for hours I would (1) check & trouble shoot pump gear to ensure everything is working properly and (2) check for ketones.
Lately, the last 50 units of Novolog in the cartridge have been relatively ineffective, so I’ve been changing them at that point.
I have recently seen a post in a facebook group stating that the novolog at the end of a vial is booth less effective and also more viscous.
If there is no ‘logical’ reason for the high bg, then I begin trying to figure out the ‘why’ – Sometimes it can be as simple as a kink in the line, so I just make adjustments to it. I have found it is the rare time that it is actually a problem with the site. If necessary, until all is sorted out, I will supplement with the pen needle, and continue monitoring.
It really depends on if I know the cause. If I have eaten out and did not guess carbs correctly, that is not a reason to change sites. If I forgot to bolus, which is very rare, that is also not a reason.
Have high glucose level set at 150 so if it alarms and I cover it usually goes right down. If not would change pens.
A closed answer question – similar to asking “when did you stop beating your domestic partner.” The question assumes an answer of only 2 choices, displaying a bias of the questioner that totally negates not only the particular questioner, but all T1D surveys as well.
Would depend on whether ther were issues with bubbles in line or other factors e.g. health. Would probably initially increase basal.
One question I would like posed: how many people who use pumps supplement with a Pen or Syringe? I have never done that by I see others do. When I am on a sustained high it is usually because I ate out, like a pig, had dessert, fell off the wagon and have to wait for my body to recover from the abuse and get right back on. It’s a marathon not a sprint.
I carry a syringe with me to work because I’ve had my insert pull loose a time or three, and odd levels. I’ve also screwed up with the insert in the first place, AND I’ve used a syringe at work so I don’t waste what’s left in the cartridge and switch out in the morning (I can get by on 12-15 units in an average day at work so if I wake with 10 will bring a spare cartridge and draw it with a syringe if it’s not easy to just change cartridges. That way I waste little)
I still have to change my cannulas from time to time. Sometimes the site just doesn’t work. I will usually make several attempts to get my BG levels where they belong. But, considering the possible reasons for the high BG’s I will usually change the cannula and in injection site as a first step in the process.
Considering what insulin costs, I would not be throwing it out. At $50 a pen, I would check the carbs and adjust accordingly.
Secret option C: I’m off liquid meal time insulin…
I inhale and don’t have to trouble shoot those issues anymore👍🏼
Question should have read “…hours of un explained high blood glucose…”. Correction using an injection is tge easiest test to ID a bad site in addition to awareness.
As with most questions here on t1dexchange.org the answer is it DEPENDS. I don’t have additional detail as the other commenters have covered it.
Wouldn’t it be great if the number of variables in your T1D management were limited to your number of answer options in these questions?
#BeWell
Never ever have I ever had to do that and to top it off the expense of the infusion kits would make it highly unlikely that I would. Although now that I think of it I actually have but this was due to the excruciating pain at the infusion site fortunately my kit was a 90 degree steel and I removed and set at a new location. So this was a totally differently scenario but could be done if I ever ran into the situation asked.
I have only changed my sight maybe two times in years. That is what I like about the steel cannulas, —-that you can place them in a different area without wasting a cannula set.
The KEY word is missing from the question!!!
I wouldn’t consider changing sites just because of high BG’s. Only because of sustained UNEXPLAINED high BG readings.
Without the word “unexplained” in the question, that entire question is pretty much meaningless, pointless, useless.
I’ve only had sustained high glucose levels once, and by high I mean over 250. I did multiple adjustments, but nothing worked. On the second day, I was thinking bad insulin or site. It turned out to be the effects of a cortizone shot from my rheumatologist. She forgot to tell me it might make my BG go up.
I don’t use either a pump or pen, rather MDI. I change my vials at the first of every month, so regularly more than 28 days use but that doesn’t seem to cause problems over an extra 3 days use.
A pen can be considered MDI as I am taking a guess that most diabetics who use pens inject more than once a day.
When this happens and there is no reasonable explanation, the culprit is usually the canula at the infusion site has come loose and/or it is flattened against my skin.
I wish I could tell when my canula is not delivering insulin to my body.
Alas and alack, another bell-shaped curve around 3-6 hours with me being, again, a 3 sigma deviant at the tail end with >24 hours. Guess, I am just too greedy, stingy, parsimonious, tight (choose your adjective) to abandon perfectly good overly exorbitant pricey insulin. Funny, must be my bad habits – sacrificing health to the god of money. Must be an angel somewhere saying, “Tsk, tsk.” (ﾟ⊿ﾟ)
I chose 6-12 hrs. This is only if it looks like my glucose levels were not reacting to my pumps insulin even at an increased delivery and I have tested multiple variables.
My BG can stay high for a few hours after fatty or hard to digest meals along with many other reasons.
My glucose usually goes up after a site Chage most of time I get it under control within 3 hours.
I always try an injection before I would change a site. That works 99% of the time.
This question needed an “It depends” response, since the conditions for high blood sugars were not specified, for example, in the absence of illness or stress. If I rule out illness, stress, or carb miscount, and have given a bolus correction that is not working, then I will likely change out my pump right away.
“When in doubt, change it out!”
My response might change if the last meal was a heavy fat/protein meal. Expect an extended higher BG when a heavy fat/protein meal is on board.
Because Medicare limits me to 10 infusion sets and cartridges every 30 days, I cannot change sites more frequently (even when running higher) because I would run out of supplies. (Unless I wish to pay for an extra box of supplies out-of-pocket.) For 9 months, I have had increasingly higher glucose levels once I get into Day 3 of a site. I am in the process of changing endo because my old endo (I’ve been with him 13 years) has been unable (since July last year to provide the documentation needed by Medicare to approve a site change every 2.5 days rather than every 3 days. I’ve provided him with additional documentation over and above my CGM and pump reports to show that Day 3 readings and insulin usage exceeds the other 2 days.) On Day 3 of my site, while keeping the site in, I often resort to supplementing my pumped insulin with an injection until my full 3 days are up. This is SOOOO frustrating!
Just additional info. I am a Type 1 diagnosed in 1976 and have religiously rotated my sites from upper and lower abdomen to thighs to arms to avoid development of scar tissue but after 46 years, diabetes may have taken its toll.
I go with a (>130) high bg or go intermittently for 2 days with unusually higher bgs, before I realize something is out of wack. If I can’t figure out what caused them, I might try increasing my morning fast acting lispro, or getting up earlier or adjusting the overnight room temperature, or maybe realize I might have an infection and to expect other symptoms will soon follow. But sometimes I’m just baffled and bgs go to normal range without doing anything.
Tricky question as my BGs go up and stay up with stress, so a site change doesn’t help. Once, boluses do not bring down BG in 1-2 hours, then I start debugging the problem. “Fill Cannula” while not connected to be sure the tubing delivery is working, look for blood, soreness around the site. I even will moderately exercise to get the BG down and then see if the site again fails. At that point, I’m into 4-6 hours and will change the site.