I had an experience with DKA a few days ago. Fortunately I was able to deal with it at home. After my blood sugar came down from the stratosphere and the ketones were gone, I put my pump back on with a new infusion set, cartridge, and a fresh vial of insulin. Things seemed to be okay after that.
A friend of mine who uses the same kind of pump (twiist- I switched to that about a week ago, but that’s a story for another post), and the same type of insulin (novolog) had a similar experience several weeks ago. In both cases, a call to the twiist support line resulted in the conclusion that the insulin had gone bad. It seemed so unlikely to me, and made me wonder if some of the twiist cartridges are defective.
I spoke to my friend today, and she told me that another vial of insulin that she had from the same batch was bad, but she caught it sooner. I’m not entirely sure how she knows for certain that it was the insulin and not the cartridge that was the problem, but she somehow got novo nordisk to take back her batch of insulin for testing and give her vouchers for replacements.
It’s terrifying that a batch of insulin could potentially just be bad. It’s also infuriating.
This is where my thoughts went to as well – not just cartridge failure but the many other failures that pumps can suffer. I’ve lived with T1D for 42 years and worn pumps for 39 years. My only experience with bad insulin was when I froze it. Yet I’ve dealt with many pump failures, including infusion set/site occlusions and site inflammation leading to insulin absorption failures. I’ve also experienced insulin tunneling up the outside of my Omnipod cannula and onto my skin. Kinked cannulas are another failure category.
My personal experience would lead me to looking at the insulin pump because of the myriad of ways it can fail. Insulin failure has been highly unlikely to me.
Glad to read that you were able to overcome the DKA and deal with it in a timely way!
I think it very unlikely that the insulin went bad. Anyway, it’s easy to check. Just inject some of that batch of insulin via syringe and see if it works or not (keeping in mind that with very high BG we become insulin resistant so it may take a rage bolus to bring down the BG.) With the Omnipods for me it’s always an infusion site issue, either tunneling or malabsorption, never that the insulin has gone bad.
I should have clarified in the original post that I’m fairly certain it wasn’t the infusion site, which is why I was wondering about the cartridge specifically.
When my blood sugar first started to go up, I changed the infusion set then. That did nothing, and I just went rapidly higher, and at that time I disconnected the pump, and handled everything with shots. When I reconnected the pump later I had a new cartridge and new vial of insulin but used the infusion set that I had just put in previously and it was fine. That led me to think that it was either the insulin or the cartridge… or some other problem with the pump itself, I guess.
Did you use the original insulin for the shots or the different batch?
I’d say that for me with the Omnipod I’ve never experienced a pod failure that wasn’t alarmed but I have experienced site issues most of which surround kinked cannulas or, maybe, canula tunnelling (it’s difficult to tell the difference with the Omnipod).
twiist is no different in this regard; the pump measures the amount of insulin which goes through the canula but it has no way to guess where it goes after that. In some ways it seems to me that the twiist approach may be less reliable than the traditional approach, which measures how much came out of the cartridge, which should be the same as what flows through the canula, but tries to identify occlusions (within the canular or site.)
I also think it would be very rare for the insulin to go bad. As Terry suggested, inject the insulin. I have seen insertions fail for no obvious reason. I have had inserts kink soon after or on insertion, I have had reduced activity of insulin after being out in the heat all day. I try not to use an open bottle after 4-5 weeks. I also try not to back flush into the bottle to get rid of bubbles. Could the insulin in a cart go bad? Yes. I have been pumping for over 37 years, and I am running out of good sites. Older sites have enough scar tissue that insulin absorption is poor. And, I have had some good inserts that are partially occluded, and it takes a large correction bolus to get it open (with a big drop), and then works fine.
I used an insulin pen, so yeah, a different batch. I’m pretty sure I have a bag of syringes in a drawer somewhere too, but I’ve been using pens as my emergency backup for a while.
Yes, I struggle with this. I really think that my abdomen is over used and probably has a bit of scar tissue as it has always been the primary location for my infusion set and I’ve been pumping for about 28 years or so. The problem is that other locations are not ideal. I often find the lower back/upper buttocks uncomfortable and can get in the way of the waist band of clothes. My thighs don’t have great absorption because they are more muscular than the rest of my body. I’ll give it another try though. Arm is really not an option for a tubed pump, and anyway, that’s where I put my cgm. Oof. I’m only in my mid-40s, I have no idea what I’m going to do when I’m 60!
Yeah “bad insulin” is rare but when it hits it’s chaos, I had something similar and kept blaming my site until numbers just wouldn’t budge no matter what. First thing I do now if BG is stuck high is swap everything at once, new site, new cartridge, totally different vial, because troubleshooting piece by piece just drags it out. Also heat or storage can mess it up more often than people think, even a few hours in a hot car can wreck it. If two people hit the same issue from the same batch, I’d definitely report it, that’s not coincidence.