Why do sites go bad?

[Chris]

@T1Allison

“Insulin Gone Wild”

Is that where you pay college age T1D’s to get into a party bus and inject insulin together, while a great thumping soundtrack is playing?

[T1Allison]

I was thinking along the lines of the 1987 film masterpiece “Innerspace”…where you go observe rogue insulin droplets inside the body and see the irresponsible things they do when they decide to not do their real job. But I did imagine the rogue insulin droplets to be doing jello shots or something irresponsible.

[LarissaW]

@TiaG

But I am still somewhat befuddled about where all the insulin went.

it goes back to our pancreases to dance on the beta cells’ graves

[TiaG]

I mean I agree insulin resistance can play a role but it wouldn’t cause him to require more than 2.5 times his normal TDD dose, with most of the extra delivered over just a quarter of the day, to bring down a big high. I remember one time Samson spiked to 600 early on, and even then it didn’t take so much insulin to bring him in range. When he’s sick we bump everything up by 33%. But this was unreal – i mean normally Samson takes 10 units and yesterday he wound up taking 25 according Loop. And as soon as we changed out the site it’s like he started going down according to the normal rules. We went out for Indian food, he ate as he normally does, I bolused for it as I normally do, etc., and he was totally fine all night long. So it really is as if the insulin simply just didn’t count.
And he doesn’t seem at all sick today.

For my novel, perhaps it will be called “The Mysterious Affair at the Infusion Site” or I could just repurpose a title and go with “The Secret Adversary” LOL.

[EdD]

@Momofm

I’ve been wondering this same question. My daughter has been spiking unusually high after lunch for a few days now. No new foods, a little morning exercise, but nothing especially different from the norm. I keep trying to nudge the numbers down with mini-corrections, trying not to stack on top of the lunchtime correction - eg, if she needs a unit to fully correct, I give 1/3-1/2u and wait a couple hours - but the numbers barely move - maybe 20-30 points and then plateau still high. Then late afternoon/early evening, her numbers just crash.

Hi @Momofm
When I see the pattern you describe for 2-3 days I temp basal a 15% increase starting 4 hours earlier. If that works for 2 days then I adjust the basal accordingly. Omnipod/G6
I usually stop the crashing numbers at 110 with 2oz milk and then with a small spoon of glucose if the milk hasn’t done enough.
I usually correct the full amount - if she needs 1unit to correct then I will correct with 1unit - in my daughters case 1u corresponds to 180. so at 300 I would correct 1u.
If I have corrected within 2 hours I consider that.

[Jim_YYC]

As Chris mentioned, syringes are your friends if you ever suspect your site is compromised. Don’t forget that if your site is bad, basals for the last few hours have been ineffective, so your syringe dose should account for that as well as whatever bolus’es have gone ghost.

95 times out of 100, the site will be bad. Some tissue (even virgin territory) is not suited for insulin infusions.

[TiaG]

yeah, we know that syringes are the best option but unfortunately our son hates injections so much that we really avoid them. We should just always do them after a correction or two don’t work, but realistically we only do them as a last resort.

[daisymae]

@Momofm

It would be great to have an IOB sensor to help avoid stacking.

just to chime in: i use the Medtronic Paradigm 523 pump. it has a function called The Wizard, which accounts for IOB and helps (not perfectly avoids) insulin stacking. but i do try and wait 2.5 hours between boluses. (obviously, though, there are times when i dont bother waiting to give another bolus.)

dreaming on…