Eliminating Variables

Sometimes, when blood sugars get out of whack, it can be pretty difficult to determine what's causing the problem. Diabetes is affected by so many variables: carbohydrates, fat, protein, exercise, illness, insulin activity. Then, you add the use of a delicate machine like an insulin pump, and you have to consider whether your insulin is still effective, whether your site has gotten clogged, or your site absorption is hindered.

Often, the reason for a high or low is obvious, like when it's Halloween and you've raided your infant daughter's bag of goodies, or when you bolus for a meal and then forget to eat it! It's those few and far between instances, when my blood sugar is running high and I cannot pin it on any particular cause, that really bug me.

It happened this week. My blood sugars were running high for a day and I couldn't figure out why. I wasn't eating particularly high-carbohydrate meals, (after a week or so of Halloween treats, I was sick of sweets by the end of the weekend!) My activity level wasn't drastically different. I washed my hands repeatedly to make sure I wasn't getting high blood glucose results because of sweet food residue on my fingers.

As I reflected on the previous day or two, a few potential causes occurred to me:

First of all, it was Monday and Sienna's first day at daycare. I don't experience a lot of "stress" typically, and if I do, it doesn't seem to affect my blood sugars too much. However, the occurrence of unexplainable highs and the underlying stress of having my little one in a new place with new people all day, surely could have been related.

Another factor: when I entered my infusion site over the weekend, I realized a second too late that I'd entered the new site fairly close to a site from a week or so ago. I could tell it was fairly recent because the little hole mark was still faintly visible. It occurred to me that this might interfere with the absorption of insulin, just like what happens when you leave in a site for too long.

Finally, I had a hunch that my insulin had gotten "bad" or become less effective. When I filled the reservoir on Sunday, I used up the end of a vial. The vial had been out of the refrigerator for several days and we've been experiencing days over 80 degrees in San Diego. Although it never gets all that hot in our place, it still seemed likely that after using the vial for at least a month, it might have become less potent.

On Monday I kept blousing several units to bring my blood sugar down, but it hovered in the mid-200 mg/dl range all afternoon. By the time I got home (with my weary daughter who really clung to me when I arrived at daycare!) I was tired and frustrated with my blood sugar. All I wanted to do was play and cuddle with Sienna, but the annoying highs were begging for my attention too.

So, to eliminate the first variable, I pulled the site, thinking I might see a pool of unabsorbed insulin emerge. Nope, the site was a little red, but no insulin was to be seen. Since I still had several units of insulin in the reservoir, I decided to bolus a few units into the new site to see if that made a difference. An hour or so later, my blood sugar had finally dipped down to 186 mg/dl. At least it was headed in the right direction, but I still felt the old insulin needed to go, so I changed the reservoir and tubing, replacing the suspiciously ineffective insulin with insulin from a brand new vial.