I recently had a pump patient who suddenly started having a problem in the morning with hypoglycemia, 30 minutes after arising but prior to taking her bolus for her breakfast. We recommended she change her infusion set and insertion area however there was no improvement and she continued to have hypoglycemia 15-30 minutes after arising and taking a shower. We reviewed the information on the pump and did not see any problems….
We then had her go over everything she was doing step by step and everything was correct. I contacted another pump trainer educator out of frustration and explained to her what was occurring and asked if they ever had experienced anything similar. She mentioned that she had a similar situation and it had a very unusual answer to the problem. She had me ask the patient if she slept on a heated water bed and when I questioned her she did.
We had her try sleeping on a regular bed for a couple of nights and the problem disappeared. Although the set manufacturer did not have a reason this happened I came up with my own idea.
The insulin pump set has a plastic tube that is double-lined and somewhat rigid to prevent crimping. Since the waterbed was heated this meant that as the night went by the tubing became warmer and was able to stretch a little bit, much like a garden hose lying in the sun There was still insulin going thru the tubing so the alarm never went off. When she awoke and the tubing had a chance to cool down it compressed and then she received the insulin that had been in the tube and this was causing the hypoglycemia.
Lesson Learned: We are often quick to blame the pump, the set or the insulin when it could be as simple as sleeping on the other side.
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