Hope you all are enjoying your holiday weekend (here’s hoping you have the day off, too). Our girls had a “five-day weekend” thanks to those former leaders of our nation being honored today. So we honored those guys in the all-American tradition of taking a seven-hour road trip to the country’s favorite theme park:
Greetings from Disneyland!
We sure had fun, but man, was it crowded! One big swarm of bodies and baby strollers under the warm, warm Southern California sun. Too warm for my San Francisco wardrobe, in fact. Which not only made for a sweaty day, but for a very itchy infusion site as well.
Which brings me to the less happy news. I’ve been having a series of SUS (Sudden Unexplained Surge) blood sugars this week. I’ve also had several occlusion errors and VERY irritated skin around my sites. I’m quite sure my insulin is fresh (tried different vials), so it’s gotta have something to do with infusion/absorption. Darn my stupid skin for being so oversensitive! Maybe if I had a bigger body and more “real estate” to work with…?
Coincidentally, smack in the middle of this frustration fest, I received an email from a woman experiencing very similar — equally mysterious — infusion site issues. (I reprint it here in the hopes that some of you may have tips or wisdom to help us both out):
Dear Amy,
I’m 29 years old and I was diagnosed with type 1 diabetes three years ago. I’ve been on the Animas pump for two and a half of those years. I generally keep really good care of my body and my health. I’m 5’4″, weigh 115 lbs and exercise regularly. I watch what I eat, cooking a lot of my own food, and staying away from anything processed. Accordingly, since my diagnosis, my sugar has generally been well-controlled, my A1C ranging from about 6.1 to 6.5.
Unfortunately, I’ve been struggling more and more with my levels lately and I’m at my wit’s end. I’m just looking for any help I can get…
It all comes down to my insets. The problem is two-fold: The first is just getting an inset that works at all. It takes anywhere from two to ten attempts sometimes. Sometimes I put it in, and it immediately gushes blood, filling the tube. Other times, I get sharp pains, like the needle is still in there. And others, the pain is dull. I’ve learned over time that if I keep one in that hurts at all, I don’t get any insulin. Three hours later with sugar at 250, I’ll take it out, and it’ll immediately gush blood. Over time, this process has gotten worse. It seems harder and harder to find spots to use, and I find myself tossing so many insets in the trash that my prescription now states that I change my site twice a day.
The other problem is how long a good inset lasts. Initially, I could keep a good one in for four or five days. Now, even a good one won’t go a second more than 48 hours. And many ditch out before that. I’ll be fine when I wake up in the morning, maybe 125 instead of 100. And after breakfast, 350, out-of-nowhere. When I share these numbers with my doctor, she agrees that they’re definitely pump related. My diet is so predictable, my care so attentive, that really, it’s the only explanation at times (there are of course days when I’m not sure when it’s food or the pump–which is actually even more frustrating, because correcting can turn into a 6 hour ordeal).
I tried to ignore this problem for awhile, but it’s getting to the point where my sugar is in the high 200s or 300s several times a week. And it’s always terribly inconvenient–because I can’t just change my inset when I’m out or at work. Not to mention, it kills my eating and exercise schedule. In short, I’m getting desperate. I don’t think I have any other spots on my body to go to, and even if I did, it would only be a matter of time before those dried up too. I’ve tried being more meticulous about working my way through inset sites too–so that spots have time to recover before I go back to them, but the problem is getting worse faster than my solutions are fixing it.
Animas has nothing to say about it, nor do my doctors. I can’t possibly be the only person this is happening to. Do you have any ideas? Have you seen this problem referred to anywhere else?
I’m really looking forward to hearing back from you…
Best,
Shawna
Ugh. I wonder how I should counsel this woman? Is the only option to go back on injections? Or is there something she (we) can do to improve our infusion site comfort and absorption?
If you have an idea, please share it here. Shawna thanks you. I thank you. Mickey Mouse thanks you. (Well he would, if he could 
)
I may be missing something here, but no where in the article is a discussion of trying different types of infusion sets. She doesn’t indicate whether she’s using the regular insets or the inset 30′s. I hated 90 degree sets and had lots of irritation with them. I am not an Animas user so I’m nor familiar with the names of all the infusion sets. But she should try something like a Silhouette, an angled set, or even the Sure-T that a tiny metal needle instead of teflon.
Maybe that won’t solve her problem, but the article makes it sound as though everyone else is just saying “doh” and not working on solving the problem.
I need advice on this too. My daugther is 4, and has very little “real estate” and really only wants us to you her tush. We’re trying the other infusion types, but nothing is as comfortable as the quick set. But we’re getting terrible control now.
I use an Animas pump too. I agree with the first commenter that Shawna should try different infusion sets. Animas should be able to send her samples of everything they’ve got. Her local rep might also be able to hook her up with samples right away. I used the Inset 30s for a long time and am trying the Insets now (the SHORT ones!). Maybe she’s got the longer ones and they’re going too deep.
When I first started pumping, I had some issues with high BGs. Turned out I was turning the tubing/cartridge connection too hard. I eased off just a little on my definition of “finger tight.”
Also, Shawna, there is a pump mentor program at Animas that I was part of for a bit, but I moved and lost track of that. You could sign up foe it or, if you want an unofficial something like that, feel free to email me. auntlyh (at) gmail (dot) com.
You can use the medronic quick sets with lure locks, with the anmias pumps. It made all the difference for us not long ago. Worth a shot.
Good luck!
I wonder if leaving sites in for 4 or 5 days in the past caused scar tissue which is contributing to her current difficulties? We were told very explicitly not to go past 3 days to prevent scar tissue. Usually we regret it if we try to go 4 days, and our philosophy is to change the site BEFORE the numbers go bad. also, she should definitely try the different types of sites available. One of the advantages of animas pumps is the fact that they are not proprietary and you can use any type or brand of sites that might work for you. One last thought, some people try to put some tegraderm down on their skin before they put the site on. Also, site preperation? IV Prep? Alcohol swab? Just soap and water? Maybe the skin prep is the thing that is having an adverse effect?
Have any of you tried another insulin? I experienced similar problems pumping and they were solved by using Novalog. I also tolerate Aprida but saving it in case I have problems with Novalog.
Apparently I’m allergic to the preservative in Humalog.
What infusion set are you using and where are you using it? Hitting blood vessels and nerves should just be a very occasional happening (based on bad luck only) provided your using places on your body that have subcutaneous fat deposits. For example, I use maybe 120 sites per year and I don’t think I have more than 2 or 3 problems with hitting a nerve and even less with blood gushers. Poorly absorbing sites is another story, however. Maybe 1 out of 6 are poor absorbers. My understanding is that that is fairly typical.
I submitted an idea for something to try and manage this problem for last year’s Diabetesmine contest. Think its worth submitting again?
http://www.youtube.com/watch?v=P3muE39ETtU
-Roman
I run into this problem, too, from time to time, and it is very frustrating. It seems, in my case, as though all is well for about 1.5 months, then I suddenly have problems with every other site. I never leave my cannula in for more than 2 days. I had far worse problems when I used the OmniPod than I do with the MM Paradigm 522 with CGM. Why? Because the OmniPod offers only one infusion set, built-in, at a particular angle, AND because the Pod is relatively huge in terms of the adhesive part that covers the skin. I seem to be more sensitive to the Pod adhesive than I am to whatever the MiniMed adhesive is. MiniMed has just made available the Sure T infusion set with 32″ tubing, so I’m going to experiment with using them in my arm. I live alone, and do manual insertion of the Silhouette infusion set. I can’t get them into my arm alone, but I will be able to with the Sure-T’s. The nice thing about the Silhouettes is that there’s a little window. If you hit a blood vessel, you’ll see blood in the window. While you’re both experiencing mega problems, my advice is to always take an injection when the site seems not to be delivering (or absorbing.) I also had luck with gaining a few pounds (though a little kid can’t do this.) I am 5’5″ tall, and weighed 119 lbs. when I started pumping. I now weigh 125. My endocrinologist told me the best place for insulin infusion would be into the portal vein, but obviously that’s not possible.
OmniPod needs to try an alternate adhesive, which they should use on the new Pods that they’re working on (smaller surface area.)
I guess all the pump companies would do well to keep on creating new types of infusion sets (anyone listening out there ????) Another solution (if you’re desperate) is Dr. Steve Edelman’s “Untethered Regimen.” (Google it.)
Hi Amy & Shawna,
This comment is based upon my personal observations and experiences of using pumps for over ten (10) years. I have used metal and teflon and have had success with each. The following is what has worked for me:
1. Change insets every two days or every 48-52 hours.
2. Have a rotation pattern. My pattern is such that it can be as long as 25-30 days before I cycle back to the first location of the inset. Before placing a new inset, it is positioned so that there is a separation from the one that will be removed after the successful load of the new inset.
3. It is my humble opinion that the greatest challenge is any force or torque on the inset. So how do I handle this?
4. Use IV prep for a better attachment of the inset to my skin.
5. Place IV3000 1-hand over the inset in such a manner that I am able to disengage the line from the inset.
6. *** I wind the extra line and “tape” it down with a second IV3000 1-hand. In the event that I drop or have the pump “fall out” than the force is placed on the extra taped line and NOT on the inset.
I hope that these suggestions give you some thought regarding the placement and handling of your insets.
AS always have a great day.
Dan
My daughter, 9 years old – diagnosed four years ago, has similar problems. Her endo and Animas act like they’ve never heard of such issues. We did switch from the straight Inset to Inset 30 and have had much better luck. However, the Insets 30′s seem to leave a more substantial and longer lasting scar so I don’t know how long we can keep going with Inset 30′s. Occasionally, I fell like going back to shots because of this so I am interested in any advice.
Shawna doesn’t mention consulting a diabetes educator. I’ve found the educators are usually much better resources than doctors for practical problems related to pumping. They’ve also had good contacts with the pump suppliers and have been able to easily get samples of different sets to try.
I know people that uses Animas pumps too. I work at
Sandal Club and I agree, she should try different infusion sets. God bless you all.