Life dependent on a durable medical equipment can be tricky. I am reminded of this on a daily basis while completely everyday tasks, but none compared to what I experienced this past weekend.
I am a pump patient. That is diabetes jargon for I use an insulin pump to deliver my insulin throughout the day as opposed to insulin injections with syringes and needles. The insulin pump is an amazing invention. It is about the size of a pager. It has buttons to control its functions similar to that of a pager. Inside there is a battery for power as well as a reservoir the patient fills with insulin. The reservoir is connected to some tubing that is connected to an infusion sight on the patient. An infusion is similar to an IV in that it is a tube inserted into the body, except an infusion for insulin goes into subcutaneous tissue (fat) as opposed to the vein. The infusion is only changed out every few days so it has made the quality of life for insulin dependent diabetics drastically better.
Using shots required diabetics to schedule their entire lives around these shots. There are several different types of insulin that are absorbed differently and can be used for various occasions, but there is always peaks and valleys the patient has to work around. Meaning food is required during the valleys and activity should be done during peaks to insure the most natural and comfortable outcome.
An insulin pump, on the other hand, has the potential to eliminate or minimize these peaks and valleys. This is due to the fact that insulin is delivered in small doses throughout the day. As a patient with this technology we have the power to tell it what to do and how to do it. Patients know their bodies better than anyone. This allows us to live a little more freely, and have our medicine right at the touch of a button. As you would imagine, not everything is flawless.
This past Friday I changed out my infusion as well as my reservoir on my pump (Medtronic 523). To me this is always a good feeling because the insulin is fresh and I have the peace of mind knowing I will not have to mess with it for another 72 hours. This is increasingly harder for me because over the years patients develop scar tissue that can affect absorption in addition to my weight loss it is harder and harder to find good sights. This particular sight wasn't necessarily comfortable, but I thought I could tough it out for a few days.
A few hours past and I noticed my blood sugars creeping up. This is not normally a red flag. Blood sugars fluctuate all the time, especially in woman with hormones fluctuating as well. A normal blood glucose (sugar) reading is between 80-120 or 70-110 depending on who you ask. My normal average is in the lower 100s. By 5:00pm I was 300. I was definitely feeling it. My vision was slightly blurred. I felt very sluggish and heavy. My hands and legs were starting to get numb. All signs of high blood sugar. I told my pump to give me some insulin to bring it down. That process usually takes 2-4 hours. Two hours later I check and I am at 250. Another correction. An hour later I check, just to see if there is progress being made, and I see 245.
Ugh. This is very frustrating for a well controlled diabetic who is active and eats well. These numbers are not something I am used to seeing especially when I have been on point for several days with food, insulin, and activity. I won't bore you anymore with all the details that go behind it all, but some troubleshooting needed to be done.
I personally have people to contact in extenuating circumstances such as these to prevent a trip to the ER if at all possible. I am sure most pump patients have similar set ups. I checked with my professional and throughout the evening we worked on trying to bring my blood sugar down. Finally, a good old fashioned shot with a syringe and needle did the trick. We thought possibly the infusion might be to blame. Sometimes, rarely, the tubing can get kinked. Sometimes, again rarely, the infusion is in scar tissue and so the insulin is not being absorbed properly. Whatever the case, it is always safe to redo a sight if unexplained highs are occurring. That's exactly what I did that night, twice. Yup, you read that right. I changed my sight 3 times that day. Not a fun time, but doable if necessary.
The next morning I woke up in the 170s. On the rise....again. A good fasting blood sugar is below 120 for sure, and typically I am there. Why, then, if I have not eaten badly, I've exercised adequately, and I am not ill or menstruating, is my blood sugar so high? I checked with my professional again. At this point even she was at a loss so she advised me to call Medtronic. I did, immediately.
The representative on the phone was very nice. She began walking me through various troubleshooting options. None of which were panning out. In my head I am starting to think I am either too thin or have too much scar tissue........will I have to stop using the pump? No, please, no!!!! She decides to try one last ditch effort at solving our problem. She suggests I rewind (basically reset) the pump and start fresh. When I go to remove the reservoir from the pump I notice moisture. Droplets inside the reservoir as well as it's holding area in the pump. There should never be moisture in the pump.
Turns out, the o-rings in the reservoir are faulty. They are leaking. Imagine a syringe and how fluid is sucked up into it with a plunger. At the end of the plunger there are o-rings to prevent leakage from the wrong end of the syringe. Similar concept in the reservoir. So, when I was asking my pump to "push" more insulin into the tubing so that it would be "pushed" into my body for absorption the pump was pushing. As it was pushing, however, the insulin was leaking out the back end rather than being forced through the tubing. I went nearly 26 hours with very little insulin delivery.
My reason for sharing this story: I have been a pump patient for over 5 years. I have never had this happen before. My professional had not even thought to have me check the reservoir for problems. I imagine this problem is very uncommon but not impossible. I know that pump therapy has been amazing for me with very little hassle. I just want it to be known that these seemingly impossible flaws may be the cause of some unexplained problems.
Lesson learned here: keep a very open mind when troubleshooting. It doesn't matter how long you have been diabetic. It doesn't matter how well controlled you may have your disease. It doesn't matter what type of education you have or how much you know about your disease and the tools you use to control it. You may be missing something. And finally, when in doubt, call the manufacturer!!
Lucky for me this event, although scary, was not too bad. My blood sugar was high but not frighteningly. It stayed high for some time, but we caught it early. The worst part was the symptoms of high blood sugars, the stress and doubting on my own part, and the shocking realization that even my pump is not perfect.
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