Infusion confusion

I've gotten quite of bit of advice, some of it quite useful, in the past week in regard to my infusion site problems (see previous post). Thank you everyone! I'm currently successfully using the Quickset in my upper arm, having learned that you really need to push the set into the insertion device, pushing down on the needle guard (with the guard still in place, of course), and make sure it clicks in. I had been following the printed instructions (silly me!) and the infusion set was flopping around in the inserter, not a good way to get the needle to go into the arm. So far, the set it sticking okay; fingers crossed!

I still need to be able to rotate sites more, and I'd like to get something to work in my "hip," where even the 13 mm Silhouette set doesn't work. I've got some Sure-T sets to try (where the needle stays in, and it's very short; used a lot in kids, presumably because they're skinny). Also, I will check out the Orbit90.

I still had trouble a couple of nights ago, when I found the 13 mm Silhouette in my abdomen wasn't delivering insulin well. It was evening, right before my daughter's dinner and bath. I gave myself a bolus, then fed daughter H. My BG was even higher a half hour afterward, so I gave myself a small injection and ate a smaller than usual dinner. Then, while hubby gave H a bath, I went through three different infusion sets; first, the 13 mm in the hip (painful! I just can't reach well enough to get the right angle, even with the inserter device). Then I put a Quickset in my arm, only to find that, once I'd disconnected it to get it under my clothing right, I couldn't reconnect. Finally, the third one worked. By this time, however, my BG was seriously low. Of course, I should have known that the combination of bolusing from my pump, plus the insulin from the syringe, would bring it too low. It was a panic bolus.

I've recently read about "rage" bolusing, in a post on Kerri Sparling blog Sixuntilme (a great site). Yes, I've definitely done that. But this was panic bolusing - fear than my BG was rising out of control, which can happen very quickly with an insulin pump. Unlike when you inject, where you generally use a long-acting insulin, usually in addition to short-acting, when you pump, it's all short-acting; if it stops delivering insulin, you can go into a diabetic crisis within a day, as opposed to within a few days. So when my BG shot up, and I knew it would only go higher, I over-reacted. Of course, by panic bolusing, I ended up too low to put my daughter to bed. She was NOT happy about that! Then I felt guilty; then I felt mad about feeling guilty. Oh boy!

When your blood sugar is fine, and you're thinking about how to calculate the right amount of insulin, and how to handle a problem like a conked-out infusion set, you can usually figure out what to do. But when it's the end of a long work day, and you're blind-sided by a sudden high, and trying to manage your child's needs, and just exhausted, it's not so easy! Know what I mean? I should have changed the set out right away, but I didn't have a chance to, because I had to take care of H. Maybe I could have waited a little longer without taking more insulin. Maybe I could have taken even less insulin by injection, or I could have eaten more. I just didn't have time to think it through rationally.

And how about panic eating? I use to do that more before I went on the pump, especially at bed time. It took me a while to trust that my BG wouldn't go low overnight, like it did so often before I went on the pump. I still do, esp. when I'm running low. I've gotten better about that one, though. Pregnancy helped train me. I use glucose tablets more often, instead of food or juice; and OJ is usually right out, because it's far too sweet and contributes to rebound. Apple juice is better, when I don't have glucose tablets. Still, sometimes I just get too hungry to resist - especially when a low happens at meal time. When you're starving already, and then get a low (which makes your body truly believes it's starving), it's nearly impossibly to just eat a few glucose tabs and sit waiting. Often, I end up with a more-prolonged low (followed by a rebound), precisely because I ate more than just the sweet stuff.

But then, sometimes just when I think I've eaten too much and I'm going to get a rebound, my BG ends up fine. Like last night, after I'd treated the low by drinking a big glass of OJ (I know!) and eating a banana, then ate a sandwich and bolused normally just for that, I ended up with a BG of 93. And no rebound overnight, either. The glucose gods must have taken pity on me.

Have you ever panic-bolused? Or panic eaten (if that how you say it)? Do you have strategies that help?