infusion set issues

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HelenP DAFNE Graduate
Queensland Diabetes Centre, Brisbane, QLD
219 posts

Hi, I have been on a pump now for about 10 years (on my 4th or 5th pump). When I was initially put on a pump the Diabetic Educator put me onto a manual insertion infusion set as I was not needle phobic. I accepted this and have continued to use this or latterly the Medtronic equivalent. Searching the Medtronic site I came across advice that the infusion set I am using (Silhouette paradigm) is designed for young, lean or athletic frame. I am not young, athletic nor lean...

I experience a rise in BG immediately after the change of sets.. Advice to date has been deal with evening meal (6:00pm) and then after about an hour change the infusion set and do not eat anything until morning. If you wake (which I often do) correct then and hopefully it will be almost back in range for breakfast. So before meal it can be around 7, deal with dinner and it can be 9 after an hour or so. Change the set and then at midnight it can be 16...if it is over 15 I usually inject as I need to have it come down, but sometimes the system clears itself and the pump can suspend before I wake. Is the fact that it is unreliable for about 12 hours out of 72 good enough? Similarly if I let the infusion set go for the full three days BG often starts to slowly rise. This I believe is because the site is healing over.
On my own volition I have now changed to the recommended infusion set for the non young, non lean, non athletic and experienced some (little) success but it is probably too early to tell. Any advice? I am now using the Mini-med quick set (manually inserted).
Helen

marke Site Administrator
South East Kent PCT
662 posts

sorry to disappoint you , but I have used the quick set for about 3 years ( my pump is due for replacement at the end of the year and they change them in the UK every 3 years) and I tend to get an increase in BG when I change the set. Not as big a rise as you but definitely a non-normal rise. This I believe is what you would expect to happen. This is because when you insert it, it drip feeds insulin into you. This insulin needs to pass through tissue to reach the blood and become effective. With injections you put a relatively large dose in all at once and it does the same thing, but because the pump only puts small amounts in, there is less of an 'absorption' area so it takes a while to create a 'flow' from the set to the blood. In an ideal world you wouldn't change the sets and the flow would always be there. Sadly this is not possible as people who inject manually know, the area of injection hardens and if you use the same sites for injection they become less effective, the same is true of pumps. One day they will probably work a way around this if stem cell research doesn't make it all redundant, we can only hope Very Happy

HelenP DAFNE Graduate
Queensland Diabetes Centre, Brisbane, QLD
219 posts

Thanks, Marke. That is what I understand also, but it is very frustrating and to his credit the endocrinologist registers that for me it is a problem and probably accounts for at least some of my HbA1c (hovers around 7.0). We have tried flooding the site with a breakfast dose (to clear it) but I then get into trouble as the actual dose getting through is difficult to assess. I have also tried injecting for a breakfast dose. I have been a diabetic for over 40 years so there have been a lot of injections before the pump as well. Helen

HelenP DAFNE Graduate
Queensland Diabetes Centre, Brisbane, QLD
219 posts

OK me again.
Yesterday was a nightmare.
All good until about 12:30pm (infusion set had been on for 3 days less about 10 hours). Was going to theatre so decided to leave in place until after theatre. Got to 12.6 a 2:00pm theatre...corrected and down to 8.8 at the end of show. Phone call from son, could I please babysit from 6:15pm. Sure, raced home had a salmon and tomato sandwich on lo-cal bread (25g CHO) + correction. After sandwich changed infusion set. Arrived at son's house at 6:15 still under 10...but 4 hours later (and no food) after stacking corrections reached a peak of 18 (theory NO insulin was getting through). Drove home with plans for an injection. At home pump indicated that the BG was going down so decided to leave it. Went to bed. Woke up with pump alarm. Theoretically no insulin on board but BG falling fast (3 arrows) and approaching low. Took a hand full of jelly beans and lay awake waiting for the fall to finish. About an hour later, the fall had finished and still with no insulin on board I went to sleep. More alarm, more approaching low, pump suspended and a low reading of 3.2. It was now about 6+ hours since last insulin correction so decided I would let the pump do its thing. Woke 2 hours later and BG was 6.3.
Medtronic's suggestion change infusion set type...have done that about a month ago. Anyone any ideas? Helen

HelenP DAFNE Graduate
Queensland Diabetes Centre, Brisbane, QLD
219 posts

Hi me again...it is the location of the infusion sets. Appears that after a while the sites wear out (even though the endo checked for scar tissue etc) so have now resorted to the outside of my thighs and miraculously have had little (minor) problems with the uptake of the new infusion set. Now a new issue I usually disconnect the pump from the infusion site when I have to hand over the pump for downloading at the doctors. The other day I saw a guy simply disconnect the reservoir from the pump and hand the pump over and then reinserted the reservoir when it was handed back...it would certainly save a bit of processing to get the tubing connected to the infusion set when next I go to the endo! Any comments?

marke Site Administrator
South East Kent PCT
662 posts

hmm no I would never do that , I would say you risk damaging the pump doing that potentially. The pump pushes up against the bottom of the reservoir using a rotating screw mechanism. When you change the reservoir it pushes up to the bottom and senses it and stops pushing. If you remove it and don't suspend the pump it will keep pushing up and when you replace the reservoir its going to apply more pressure than normal to lock the reservoir back in place. I guess it depends on how long its removed. Me I just detach the infusion set like I would when I have a shower and let it leak a bit while its off.
I understand completely the lypo's issue ( or as you call it scar tissue). Problem is I never tend to notice it happening but the DSN does immediately and warns me to rotate sites better Crying or Very sad

HelenP DAFNE Graduate
Queensland Diabetes Centre, Brisbane, QLD
219 posts

Thanks, as the infusion set is now half way down my thigh it will be interesting to see me reconnect it in a public waiting room. I usually wear pants... I am thinking I may suspend the pump, hand it over, replace and then see what the endo says. It would certainly make life easier. I do not know whether or not the guy suspended his pump. Someone told me they put a sharpie circle around the last site and then watch where you intuitively put the next couple... seems there are areas we favour.

HelenP DAFNE Graduate
Queensland Diabetes Centre, Brisbane, QLD
219 posts

Mark, Interesting discussion with the endo...Yes, current practice is to disconnect at the pump, not the infusion set. More hygienic and in many cases easier. No issues so long as it is not out for too long, probably best to suspend but no real problems if you don't. On the future he says they are working on an "apple" type watch that you will simply tap and it will read your BG (no pin pricks) and my wish, an app where you take a photo of your plate of food and it will estimate the number of carbs. The site on my thigh seems to be more reliable...but after switching to the Sensor 3 I have had to adjust a few settings.

marke Site Administrator
South East Kent PCT
662 posts

hmm, not sure I would agree that it is safe and more hygienic, but hey I have never been one to take medical experts at their word :-) Partly because I have been lucky/unlucky enough to be in rooms and meetings with them where they all disagree with each other. I guess there is no right or wrong answer to a lot of things relating to Diabetes. With regards to new techno gizmo's, the problem is the time it takes to get them to the public due to the need to have tested them endlessly. You can't use a device that is not 200% reliable, we rely on BG readings to manage if we go unconscious or not , so it can't give us the wrong information. There is also the complication that this type of device doesn't necessarily measure the blood directly so are potentially not as accurate. But I would love a device like that regardless. I know what you mean about app that can work out the carbs on a plate. We would ALL like one of those, wouldn't we :-) All these years and I still don't get it right when eating out.....