Author Topic: Over-warm insulin?  (Read 662 times)

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Offline Pattidevans

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Over-warm insulin?
« on: 22 December 2016, 10:12:40 AM »
I mentioned briefly in Liam's thread that after having lovely straight lines overnight and great FBG whilst using the Libre sensor up to last week, this week I've been having FBGs of 8 & 9.  I did a full change of the pump on Sunday from a fresh vial.  Yesterday hubby went out with his mates and had a few pints in the afternoon whilst playing snooker.  So when he came in at 5.30 I put dinner on the table ASAP (it was probably 6.30 when we sat down) as he said he'd not had much lunch as there was little food available.  I'd had a toasted cheese sandwich at lunch time and hadn't tested since, because I was busy wrapping presents all afternoon.  So I was surprised to see my BG was 14.5 before dinner.  I had eaten some nuts whilst preparing dinner, but no more than about 5/6 Almonds and 1 Brazil.


Anyway, bolussed for dinner and BG just kept rising thereafter.  Dinner wasn't very carby, a chicken casserole with no thickening, two carrots and some onions.  Lots of spices and 3 tbs coconut milk.  Everything measured as I was trying a new recipe.  Some braised Leeks and about a tbs of peas as veg.  So I kept on lobbing in corrections as advised by the pump "bolus advice" function.  By midnight, which was long after initial bolus, I'd done 4 corrections and I'd risen to 24.5.  So I fished out a pen and cartridge and calculated that a full correction should be 5 and then discovered that the pen was minimum 1u, so bearing in mind that Sedge has always advised doing half what you think the full correction should be when so high I gave myself 3u.  Then I changed the pump completely, but I only had the same vial that I'd filled it from before as I'm waiting to pick up a prescription.  To cut a long story short, BGs started falling and by the time I went to bed at 2am I was down to 9.8.  At 4.20 I was 7.8 and at 9.15 I was 5.6. 


Been racking my brains since as to what could have happened.  The insulin was priming through OK.  I'd had no occlusion alarms.  It had just got steadily worse since Sunday when I changed... then I remembered that I've been socialising every day except yesterday and I've been wearing smart trousers instead of jeans and the smart ones have no pockets so the pump has been in my bra.  Could it have got so warm that the insulin had gone off?


I know this much, it put the wind up me and I shan't be so casual about not having a pen handy for corrections in the future!
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline sedge

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Re: Over-warm insulin?
« Reply #1 on: 22 December 2016, 11:06:53 AM »
Yes - it goes off PDQ when it does that.  I'm guilty of doing exactly what you did, too.
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Liam

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Re: Over-warm insulin?
« Reply #2 on: 22 December 2016, 01:30:28 PM »
My first thought was a bubble. I had a BG of 15 just before a change last week and was down to 10 units left. I couldn't think of a good reason for it so blamed a bubble for no basal for a bit.

I don't have any experience of insulin going off in the cartridge. The Vibe only takes 200 units and that doesn't always last me 3 days, so I always have fresh every cannula change. In the new year I'm hoping to do something to lower my IR. I know it is drug induced but I'm going to try to drop some weight and build some more muscle.
DX Type I 1994.    Novorapid Animas Vibe pump
HbA1c 3/10 10.2%, 7/10 8.1%, 12/10 7.5%.
2/11 7.8%, 8/11 8.6% 9/11 8.3%.
3/12 62 (7.8%). 10/12 67 (8.3%)
4/13 63 (7.9%) 6/13 59 (7.5%)
1/14 71 (8.6%) 7/14 59 (7.5%) 11/14 (6.7%)
3/15 56 (7.3%) 12/15 49 (6.6%)
Ramipril: 10mg Quetiapine: 550mg Metformin: 2000mg

Offline GrammaBear

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Re: Over-warm insulin?
« Reply #3 on: 22 December 2016, 02:39:58 PM »
I often wear my pump in my bra, but I put it in a baby sock so as to avoid moisture perhaps from sweating.  I have also had the same situation happen to me with high BGs.  I thought at the time that maybe it was the 'site' where I placed the cannula that was giving me an off reading?
Type 1
Tandem Tslim pump Oct 2015
Dexcom G4 CGM Sep 2007
A1C 6.5%~ Sep 2017

Offline Pattidevans

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Re: Over-warm insulin?
« Reply #4 on: 22 December 2016, 05:19:49 PM »
AFAIK I don't think I've ever had a bad cannula site.  Wouldn't that show up sooner than 3 days after a change?


I could hAve been a bubble that had travelled down the tubing, but the Accuchek is very sensitive to occlusions and I think it may have alarmed if there was a bubble.  It certainly primed through OK.  I think it was the lack of any reaction to the correction doses (you know, when it's like bolussing water) that made me think the insulin was off.


 Had a word with the Pharmacist when I went in to pick up my script today and he seemed to think the heat generated by direct contact with the skin would be enough to degrade insulin.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline Liam

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Re: Over-warm insulin?
« Reply #5 on: 22 December 2016, 05:27:12 PM »
I've had cannulas go bad after use but it was clear when I removed it that something was wrong. I mean a bruise or a lot of blood / insulin mix, then normally a bruise later.
DX Type I 1994.    Novorapid Animas Vibe pump
HbA1c 3/10 10.2%, 7/10 8.1%, 12/10 7.5%.
2/11 7.8%, 8/11 8.6% 9/11 8.3%.
3/12 62 (7.8%). 10/12 67 (8.3%)
4/13 63 (7.9%) 6/13 59 (7.5%)
1/14 71 (8.6%) 7/14 59 (7.5%) 11/14 (6.7%)
3/15 56 (7.3%) 12/15 49 (6.6%)
Ramipril: 10mg Quetiapine: 550mg Metformin: 2000mg

Offline Pattidevans

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Re: Over-warm insulin?
« Reply #6 on: 22 December 2016, 06:11:44 PM »
Nothing like that Liam.  All looked normal when I removed the cannula.  I had a good look just in case and examined the cannula to see if it had bent.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline Liam

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Re: Over-warm insulin?
« Reply #7 on: 22 December 2016, 06:42:12 PM »
I wasn't trying to suggest that this one had gone bad just sharing my experience and how you know the site was bad once you change it. At least I've always had a clue. I forgot to say about the ones that failed because they were bent but you checked that and it wasn't. For me the bent ones have always been bad from the start.
DX Type I 1994.    Novorapid Animas Vibe pump
HbA1c 3/10 10.2%, 7/10 8.1%, 12/10 7.5%.
2/11 7.8%, 8/11 8.6% 9/11 8.3%.
3/12 62 (7.8%). 10/12 67 (8.3%)
4/13 63 (7.9%) 6/13 59 (7.5%)
1/14 71 (8.6%) 7/14 59 (7.5%) 11/14 (6.7%)
3/15 56 (7.3%) 12/15 49 (6.6%)
Ramipril: 10mg Quetiapine: 550mg Metformin: 2000mg

Offline Pattidevans

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Re: Over-warm insulin?
« Reply #8 on: 22 December 2016, 08:04:44 PM »
I wasn't trying to suggest that this one had gone bad just sharing my experience and how you know the site was bad once you change it. At least I've always had a clue. I forgot to say about the ones that failed because they were bent but you checked that and it wasn't. For me the bent ones have always been bad from the start.
sorry Liam I was just writing shorthand and didn't think you were suggesting that at all.  I may be over analytical about why things go wrong.  On the other hand it's often far too easy not to see the wood for the trees and jump to the wrong conclusions.  The awful thing about D is that we can never, ever, be 100% certain WTF actually did go wrong!

Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline sedge

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Re: Over-warm insulin?
« Reply #9 on: 23 December 2016, 01:23:57 AM »
I've has a couple of weirdos in the last week.

First one was very rare for me, as I've always said, cos it's true.  An occlusion.  However the alarm firmly told me 'Change infusion set' - didn't even know it could tell you that one!  I said , well I will change it even though the absorption has been absolutely fine, cos it's hurt since I put it in and sometimes in fect often, it's absolutely fine from then on, and I thought this one was too.  Nope, the cannula itself was bent - but it had done that inside me, cos it came out with an angle in it.  Weird!  No blood, no bruise.

This morning I had a shower - not a remarkable event LOL  So, my MO is to undress almost to the skin or put my dressing gown on, then remove pump and underwear in the bedroom and into the bathroom go it starkers.  So my ablutions completed, I walked back in the bathsheet, dried my hair, finished drying all my little nooks and crannies, as we do LOL, bunged a new cannula in cos it was due, and picked up the pump again to reconnect and prime the cannula.

Briilliant sunshine and I saw the tube glint at me as I picked it up, so I put my specs back on and looked hard - a stray bit of glitter had migrated onto the tubing , about 6" from the pump!  So I flicked it off again and then noticed about 4" from the pump  an air bubble,  The tubing was full either side of it.  So obviously I primed it out again, re-inspected it and proceeded normally.

Exceedingly odd for me ! but not for other folk - which is really odd.  And both within a few days of each other, odder still.

Still - I seem to have had the run of 3 things now, so hopefully I'll be absolutely fine again for ages, now!
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline himtoo

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Re: Over-warm insulin?
« Reply #10 on: 23 December 2016, 07:58:53 AM »
I have had a couple of experiences over the last 6 months,  in the last 12 hours prior to a pod change ( the omnipods are fixed at a change every 72 hours maximum )

for no reason that I can understand my BG's have gone alarmingly high quite quickly ( like from 7-8's to 22's in about 90 minutes to 2 hours )
so I have changed my pod early and along with a pen correction single figures achieved again within a few hours

T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 06/2013 6.1 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Offline Pattidevans

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Re: Over-warm insulin?
« Reply #11 on: 23 December 2016, 10:55:30 AM »
Hmmm interesting to hear other's odd blips! 


None too sure what's going on right now, but had another "weird" day/night yesterday.  Had two slices of Burgen toast for brekkie (before brekkie @ 11.16 I was 5.9) with a smear of strawberry jam on one and copious marmite on the other.  After fighting our way round Lidl (bad enough that there's a rugby scrum of people, but the staff had left stacks of boxes in all the aisles, thus creating blockages and bottlenecks right by anything you needed to buy) I was 12.2 which was odd as supermarkets usually reduce BGs.  On to Tesco which wasn't really too bad by comparison and finally to Sainsbury's for Chestnuts that we couldn't find elsewhere.  Sainsbury's had no Chestnuts either, but we bought a ham on special, two other items we hadn't thought we needed and so on, I had come down to 7.5.  I thought this was very odd as normally I'd be comfortably back in the 4/5 range, or hypo even after 3 supermarkets.


Got home and just had a slice of Burgen with pate at 4pm.  Before dinner at 8pm I was 13.3.  So what's going on?  Doesn't seem like the insulin is working at all.


Since dinner I've been fighting down numbers in the teens all night, but it didn't go up massively after dinner, just stayed around 14ish for hours and hours despite corrections, but that I can sort of understand as we had a beef and aubergine dish which has copious quantities of 3 different kinds of cheeses in it.  We get to eat the other half of this dish tonight.  I just hope I can get the numbers down before dinner!  I may have to resort to the pen again.  I just wish I knew what was wrong so I could do something more definite, like use another vial of insulin..... or is it the pump.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline Liam

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Re: Over-warm insulin?
« Reply #12 on: 23 December 2016, 11:21:43 AM »
Funny shopping has just lately been given me hypos. I thought yesterday I'd be smart and -30% TBR for an hour just before entering Tesco. No such luck, 11.3 after.
DX Type I 1994.    Novorapid Animas Vibe pump
HbA1c 3/10 10.2%, 7/10 8.1%, 12/10 7.5%.
2/11 7.8%, 8/11 8.6% 9/11 8.3%.
3/12 62 (7.8%). 10/12 67 (8.3%)
4/13 63 (7.9%) 6/13 59 (7.5%)
1/14 71 (8.6%) 7/14 59 (7.5%) 11/14 (6.7%)
3/15 56 (7.3%) 12/15 49 (6.6%)
Ramipril: 10mg Quetiapine: 550mg Metformin: 2000mg

Offline sedge

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Re: Over-warm insulin?
« Reply #13 on: 23 December 2016, 02:14:05 PM »
Patti - it just means - assuming it was the same vial of insulin used for the cartridge that originally didn't work and this one - and assuming you've changed the site as well as the reservoir - that the insulin in the vial is off, it isn't the heat in your bra or the pump.

Bin the vial.

Incidentally - I always re-fridged the vial after filling reservoirs - never left them out for extended periods in between fills.  I've never carried spare insulin with me whilst away from home, unless travelling in which case its in a Frio.  Never 'at room temp' except whilst waiting to warm enough from the fridge to fill a cartridge.  Ditto prefilled pens and cartridges - straight out of the fridge with pens and pen cartridges and into me.  The Pump carts are out of the fridge, into the pump and into me.

Not found it makes a difference so far.  Except as I say, I did used to wait about 20 mins before filling the Combo cartridges, then obviously sort the pump and me out, and then stick it back in the door.

Just sling the vial and start again.
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Pattidevans

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Re: Over-warm insulin?
« Reply #14 on: 23 December 2016, 02:51:34 PM »
Yes, I think it might be time to sling the vial too!

Like you, I get the vial out of the fridge, stick it in my bra for 10 mins by which time it's warm enough to fill the cartridge, and then it goes straight back into the fridge until I need it again.  However, of course we don't know where the vial has been kept before we receive it do we?  I mean it's gone from factory to wholesaler and then to the pharmacy.  I have seen something somewhere that said it was OK during transportation for it to be out of a fridge for up to 24 hours.  You only need for that to have happened on two of the legs of it's journey and there you go!  I know the Pharmacy always keep it in their fridge until I pick it up when they go out the back to get it, but who knows the state of their fridge?

I've had trouble in the past when I have gone on travels and though it's been in a Frio, sometimes the bag the Frio is in is quite tightly packed, so I have wondered if the Frio has been unable to do it's job properly by not being able to condense to the air...
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans