Re: What do you do?

There are actually two ways to test ketones. One is with a strip with urine which is what is most commonly done but we also have a meter that takes a blood sample which is more reliable.  We use the urine strips (for lack of a better name) for general checks but if my son gets a cold or flu or just runs high for no reason we use the blood sample. The one fo blood sample is the Precision Xtr or something like that. It will provide a number that will tell you where you stand. The urine strips will have stages from none to high. 

When to test I have found varies with just about every person and it seems no one does it the same. Some say when you get to 300 to check. We have found my son will eat a and on occassion get to 300 and if we tested for ketones everytime that hapened we would be using strips by the ton.

Instead we watch for unusual things like flu symptons or things out the ordinary or especially high BG levels like 400 or higher.  After one of those we check and try to see what caused it (blocked infusion, something he ate and did not bolus for) and then see the frequency.

If we get a 300 BG reading and he feels fine, all previous numbers were within range or close we just treat the 300.  Its not the same for everyone but our Endo is fantastic and is actually the one who gave us this advice.  If we ever have a doubt anyway we just call the office. 

Elizabeth

I just recently started pumping, and my CDE said to always test my BG about 2 hours after a site/insulin change to make sure nothing's wrong.  For this reason, she advised against pre-bedtime site/insulin changes, since "best practice" would require waking up to test.

Seems like a decent policy to me.

As for handling a super high number and DKA, I'm too new at this to be able to be much help!

Hi Elizabeth, 

I had no choice I had to change the set before bed. We are human and sometimes it just happens that you have to do it before bed especially when you only have 10 units left in your pump. It wouldn't have been enough insulin to last me throughout the night. 

Gina

Moderate to high are when keytones are bad.  There's not much to do when you have keytones except lower your blood sugar and drink LOTS of water.  Don't use your pump to take the correction bolus, but take a shot since the insulin will absorb better in fresh tissue.  Within a few hours keytones should disappear. 

If you have high keytones for too long and/or if you can't keep water down, then you need to get medical help.  This is especially important if you get loopy or if you start having short, shallow breathing (this is your body's stress response to handle the poison of the keytones).  Doctors can give you intravenous fluid and insulin.   

Also, you can have totally normal blood sugars and have keytones if you eat a low carb Atkins diet.  Keytones are just created when your body  burns fat because there aren't carbs available. 

Gina

I had no choice I had to change the set before bed. We are human and sometimes it just happens that you have to do it before bed especially when you only have 10 units left in your pump. It wouldn't have been enough insulin to last me throughout the night. 

Gina, I certainly wasn't suggesting you "did something wrong!"  Merely passing on the education I was given very recently.  Really, it's that two-hour test rule that I think is the decent part of the policy, anyway.  The most useful piece of advice I got from her.

Lord knows I don't do this stuff perfectly, either.  My mom (a nurse) was recently horrified to see that I sometimes don't wash or swab my finger before a BG test, but will lick and wipe it instead.  I know this isn't the best option, but if I'm feeling low and there's not a sink nearby and I've forgotten to put a couple alcohol swabs in my kit, then I also feel I "have no choice."  (And heck, sometimes I just really don't feel like getting out an alcohol swab...)

Yep.  We're all human.  I was not judging, I swear.

Ketones are the worst feeling ever! Even a BG > 250 feels pretty crappy. As your BG gets higher and when ketones start to appear in the urine or blood, it takes more insulin than just the standard correction bolus recommended on the pump to get back into control. Plus, when I am high, there is no such thing as too much insulin. :) Getting back down and treating a low is a breeze compared to being high with ketones. :)

So, here is what I do: I take the recommended correction on the pump for high BG + 20% of my basal dose as a bolus for large ketones, +15% of basal for moderate, or +10% for small. Then I drink as much water (not diet drinks) as I can hold and chew on ice chips. If I don't know the cause (sickness, pump issues), I will yank out that infusion set and move the site. We are full of scar tissue that can hinder the absorption of our insulin. I rarely use a syringe to inject - just because I don't like it, but that is a great idea.

And I would check for anything >300. It is never too early to prevent DKA.

Gina, you might want to call Medtronic and let them know. It seems like there should be a setting on the pump to alarm if it hasn't given insulin in a certain amount of time or stays in prime mode for too long. Even if not, they should know you experienced this problem as they could consider it for something to fix in the next pump! (Speaking as someone who works in the medical device industry, we WANT to know when patients have problems!)

Hi Gina I feel your pain, I just had something like that happened to me on Sunday, I had just been wearing the pump for 3 days, but I have been type I for over 16 years, and never felt as bad as this past sunday. I changed the site on Sunday afternoon then went to a game of golf but didn't take with me any supplies or even the glucose monitor, so between 5 and 10 I didnt receive any insulin at all, of course my pump didn't alert me of anything, it looked like it was getting delivered, there was no insulin coming out of the injection site and I could see the insulin moving on the tubing. Anyway by 12am I was at 600!!! It was impressive!!! I had to give myself a shot of Insulin with my syringe and figure out what was happening, changed the site and took almost all monday to get back to normal. It was terrible, I wish you could tell if the injection site is ok or not and not have to wait hours to find out.

Saludos