Site Change Musings.

Okay, that title is a little whimsical for such a mundane subject. But I did an infusion set change last night, and it brought up a lot of questions for me:

How often do you change your sites? Where do you place your sites? Do you have a specific trouble spot? If you have trouble with a site, how long do you wait to change it? Do you have a favorite site?

Let me take those one at a time. First, How often do I change my sites? The answer is that I (usually) change them when my reservoir goes dry. How long it is between site changes is then determined by a number of factors: how much insulin was in my reservoir to begin with; how my diet has been since the change, and how that affects my glucose; and how much I exercise between changes. Sometimes that means a site will last four days. Sometimes it will last six. My all-time record is seven days. But let me tell you, a site gets mighty sore after seven days. I try to keep it at four to five days.

An additional question: Why four or five days instead of the suggested three from manufacturers and the FDA? The answer is simple: As I’ve said before, I’m consciously concerned about real estate. How much usable real estate my body has, and how long I’ll be doing this pump thing, and whether I might run out of good infusion sites are all things I think about every time a new site goes in, and I take a look at the previous site. I don’t know if going an extra day or two is really helping to preserve future infusion sites, or if it isn’t. But my gut feeling is that it’s helping. I plan on being around for a lot more years, and I don’t want to have problems when I’m 80 because I ran out of decent places to insert a cannula.

Where do I place my sites? I generally rotate them between six places: My right side, my right leg, my stomach to the right of my navel somewhere, my stomach to the left of my navel, my left leg, and my left side. In that order. That means at four days per site I’m using a given area every 24 days. At five days per site I’m using an area every 30 days. I haven’t tried using my arm yet… I don’t know what I’d do with the tubing, or if I’d have enough. And I haven’t tried the back of my midsection or my bum. Mostly because I can’t see around there, which I realize is a completely ludicrous argument. But there you have it.

Do I have a specific trouble spot? That seems to be my belly. Especially lately. I don’t know why. But I’ve had some stubborn highs the last few times when it’s been in there. Even though I move it around a lot between high, low, a little to the left, a little to the right, etc. It just doesn’t seem to be working great there right now. Maybe it’s the extra baggage I’m carrying around right now.

Since this is getting a little long, let’s stop right here for now. I’ll pick up answering questions about infusion sites later in the week. Until then, feel free to post your answers, or any additional questions, by leaving a comment below.
 
 
 

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Comments

  • Scott E  On January 14, 2013 at 10:58 am

    I generally change my sites every 3 to 3 1/2 days, occasionally 4. I’ve gotten in the habit of not filling the reservoir entirely, because then it just leads to irritable sites. I use the Sure-T, which is a very fine needle (yeah, they call it a cannula, but it’s just like a teeny-tiny pen needle; much thinner than a teflon cannula) but when I used the teflon cannula I found the really irritable sites took a long time to heal. So wearing it for a shorter time, meaning less irritation, allows you to re-use the same site sooner. Irritation and the build-up of scar tissue also tends to lead to stubborn highs, I assume because the insulin can’t get absorbed as easily.

    For the most part, now, I use my lower back. It;s not subject to the twists and bends as other parts of my body so it seems to work well. Also, since the Sure-T is very low-profile (pretty much flat) at the infusion site, it doesn’t get in the way. The pigtail wraps around my side and the connection is in the front. Occasionally I’ll switch back to the old Silhouette and use either my abdomen or my backside just below the waistband.

  • Mike Hoskins  On January 14, 2013 at 11:23 am

    Thanks for the post, Scott. These are questions I ask myself all the time, and actually have led to my taking pump breaks a few times during the past few years. Like you, I go longer than the 2-4 days – sometimes a week isn’t uncommon. More real estate concern than anything. And I like my abdomen and stomach areas more than other places (CGM sites go best on my arms, though!)

    • Mike Hoskins  On January 14, 2013 at 11:23 am

      Duh… I meant Stephen. Sorry, dude. My bad. :(

      • StephenS  On January 14, 2013 at 5:03 pm

        Not a problem Mike… I’ll answer to almost anything.

  • seejendance  On January 14, 2013 at 12:22 pm

    Oddly enough, I can only keep the sites on my stomach, back, and hips. I’ve tried the arms and legs, only end up with blood sugars in the 400s. (Never doing that again.)

    Sometimes, I don’t make it past 2.5 days. Other times, it’s just more convenient to change the site while I’m home before heading to work when I know that I would be hitting the 3 day mark in the middle of the afternoon. (Less things for me to haul off in the morning.

    I rotate to the left or right side every other month. (Generally on the Monday of my sugar pills for my pack of BCP.)

    • StephenS  On January 14, 2013 at 5:08 pm

      Fascinating Jen… I’ve never done a site change at work either. More a fear of “what to do if there’s a gusher” than anything else. I don’t have any extra storage at work for another dress shirt, tie, suit, etc., so that would be difficult. And I’m pretty sure my co-workers would freak out, though they’re generally very helpful. Thanks!

      • seejendance  On January 14, 2013 at 11:26 pm

        Oh I have done them at work before. I don’t like to, but its not unheard of in a pinch. (I.e. I overslept.)

  • scully  On January 14, 2013 at 7:54 pm

    I’m going to write my comment in a post all my own :P

  • blood, sweat and...  On January 15, 2013 at 3:43 pm

    The places I use the most are stomach and buttocks, with the buttocks as my favorite. Not really sure why. I use the silhouette set and do the insertion by hand. The insertion “tools” are just scary to me. lol I also change my site on Sunday mornings and Wednesday evenings. This gives about the same time frame for each site. I do sometimes go longer, but I stick to this schedule regularly. I’ve changed sites in many different places. It all depends on the situation. I’ve never had a gusher before.

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