Infusion Site

Lack of Back-Up.

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I was in the bathroom at work when I first noticed it. A small, deep purple bruise was forming beneath the clear plastic window of my infusion site.

I was a little surprised, given that it had already weathered 24 hours worth of insulin boluses and a good night’s sleep. But I was also not surprised, given it was placed smack bam in the centre of my stomach where I have the least meat on me.

My mind wandered to the pencil case sitting on my desk, however I soon realised that the spare infusion set sitting in there belonged to my YpsoPump. Not a match for the late Animas Vibe I had replaced it with three weeks ago.

My mind wandered to the demi pen and needles that I carry around with me. However, I soon realised that there was no insulin cartridge in there because I’ve been feeling a little paranoid about insulin going bad until recently.

My mind wandered to the Chemist outside, which would probably loan me some insulin if I presented my NDSS card and promised to return with a script. However, I soon realised that it would be wasteful given all of the insulin I had in my fridge at home.

My mind wandered to the low carb chicken salad that I had packed for lunch. However, I soon realised that there were also amazing croutons in there that I had baked with the chicken juices. Not to mention that my blood sugar might also be a little high if the site was failing.

My mind wandered to the needle that was contained in my YpsoPump infusion set. However, I soon realised that there was no way that I would be able to macgyver it to reapply my failing infusion set into a fresh spot.

My mind wandered to my lunch hour, where I would probably have enough time to drive home and come back. However, I soon realised that even though I lived close enough, I could not be bothered rushing there and back and wolfing my lunch down afterwards.

My mind wandered to my Dad, who I felt super guilty for bothering, but who I also knew wouldn’t ever complain about having to deliver an infusion set to me at work.

It’s been a long time since I’ve had an infusion site fail on me well after placing it. I guess in the back of my mind I’ve been putting off updating my travel kit, telling myself it won’t happen. 

I bring my pencil case carrying all of my diabetes back ups with me almost everywhere I go. I hardly ever need to fall back on it when I’m out and about. And yet the one time I do, I don’t have the right stuff in there!

A Tumultuous Night

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I’ve never had ketones in the six years I’ve lived with diabetes. Until yesterday, that is.

I performed a routine site change when I arrived home from work – probably around 2.30pm. There was no bruising or bleeding around the old site, which was another confident step away from the occlusion nightmare of three weeks ago. My blood sugar levels were in range, and I was good to go in no time.

By 5pm, I noticed my levels beginning to rise closer to the 10 mark. Dismissing it as a delayed effect of the buttered ham and cheese toastie I’d had for lunch, I gave a correction bolus.

When I sat down to dinner at around 6.30pm, I was 13. I bolussed for what I thought was a pretty accurate carb count of my dinner, with a generous correction. I did my best to eat slowly and pick at the lower carb things on my plate first, so that the bolus would have time to kick in.

After a little OzDOC banter, my levels were edging close to 20 by 8pm. I was obsessively looking at the site I’d changed a few hours ago, but I couldn’t find any reason to rip it out. It looked clean, and the boluses weren’t stinging as they went in.

I added some more carbs to my dinner bolus – this carb count was now extremely generous – and set a temp basal of 100%. I let it run for an hour, while watching my levels continue to soar into the low 20s. With no end in sight to the upward trend arrows on my Libre and feeling the high in my chest, I began to worry.

At 9pm I grabbed the insulin pen from my contingency pack, and injected six units into my stomach. It was my first insulin injection in 7 weeks. I went to check the site once again, and saw small amounts of insulin leaking out of the edges – finally noticeable thanks to the crazy correction boluses and basals of the past hour.

I ripped out the site to discover this.

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The small piece of teflon that sits under my skin was kinked, which meant I’d had little to no insulin in my system since the site change six hours ago.

My BGL was 25, which was honestly the highest I’ve ever seen it.

I checked for ketones, which were present in the mid range of 1.3. At this point, I was very aware of the possibility of having to go to hospital if I became nauseous.

Once I had changed my site, I hastily grabbed my diabetes file from the bookshelf, sending two others flying to the floor in the process. I furiously turned page after page, looking for the cheat sheet my diabetes educator had given to me a few weeks ago. The cheat sheet that I knew had quick instructions for treating ketones in the bottom left corner.

I set a temp basal of 200% to get that basal insulin kicking in my system ASAP (not educator recommended, FYI). As per the handy cheat sheet, I bolussed for correction plus 10% of my total daily insulin dose. I then headed straight for the kitchen, completely filled up my 600ml water bottle, and skulled it down to flush out the ketones. I filled it up again, ready to skull down in another half hour or so.

Slowly, but surely, my BGLs began to decline. When my meter finally rang in with a reading below 20, I breathed a massive sigh of relief.

By 11pm, I was 14, Ketones were down to a negligible 0.3, and I finally felt confident in turning off my temp basal rate.

It was a tumultuous night. By far, the worst scenario that diabetes has ever thrown at me. I crawled into bed at 11.30pm, exhausted.

Only to be woken again by a 4.30am low.

Here’s hoping that tonight diabetes lets me watch Wimbledon in peace.