Hyperglycemia has Become Difficult to Tame

I am relatively new on this site and I am enjoying reading and learning as much as I can. I was diagnosed in 2008 and retired last year. Soon after my last appointment with my endo I started having odd problems with my blood glucose usually running high and sometimes unexpectedly dropping low. I know that my pump is working and that insulin is getting through the tubing and cannula. I have been on the phone with my endocrinologists’ office and will see her next week. I have been diagnosed (recently) with EPI and I am also on antibiotics for an infection. Since my BG problem started before starting the enzymes for EPI and the antibiotics for the infection.

I know that my endo will review my pump settings. Unless something else is learned I have been told that my endo is considering the addition of another medication and/or moving me from U-100 onto U-500 insulin. I suspect that my insulin will be increased unless another cause is found. I currently use 300 units every 1.5 – 1.75 days or a vial every 5-6 days.

I am looking for information and/or studies about any possible causes of hyperglycemia other than an incorrect bolus, incorrect bolus timing, dehydration, or an infection. Has anyone else had anything similar or have any ideas or suggestions? I thought that I would try to learn as much as possible before meeting with my endocrinologist. I want to get as much as possible out of my next appointment.

On a side note I was looking for more information about hyperglycemia when I found an interesting study comparing 90-degree insets versus 30-degree insets titled “In vivo investigation of the tissue response to commercial Teflon insulin infusion sets in large swine for 14 days: the effect of angle of insertion on tissue histology and insulin spread within the subcutaneous tissue” at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6904176/pdf/bmjdrc-2019-000881.pdf. After reading this study and observing the data showing the pressure differences along with the “…acute inflammatory response…” from cannula insertion into the body. I plan to ask my endo about trying different inset angles while I’m in the office.

Yes Glenn @Composed, I can direct you, your physician, to literature that would assist in diagnosing your condition. This is in addition to the treatment needed to help clear the infection - personally, infection has always caused me to need additional insulin, and I have a programmed pump Profile/Pattern that handles this. In addition to the infection, it appears to me as if you may have a combination of different types of diabetes; a Classification I and Classification II.

The documentation to which I refer: The American Diabetes Association “Standards of Care” for professionals - ADA SoC.

I used to use mostly the 90 degree infusion sets but would switch to the angled ones now and then for a change of pace. This may not have been scientific at least at the time, but it occurred to me that switching the angle might help avoid scar tissue - what were the chances I would hit the same spot over and over🤔?
Wishing you all the best in your search.

Thank you for your input Dennis and Dorie. I met with my endocrinologist and they gave me some samples of insulin to try. Time will tell whether my insulin will change or we will need to do something more. One step at a time.