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.