Category Archives: Pumps

The inevitable downslope.

June 6, 2013 – 9:34 am

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This is why changing infusion sites in the evening worries me a little.

I changed sites last night around 8:30… Great. I was primed and ready for the #DSMA Twitter chat. About halfway through the chat, The Great Spousal Unit brought me a small bowl of strawberry ice cream with fresh strawberries on top. There were more strawberries than ice cream, but when they’re fresh, I don’t mind at all. Now, where was I? Oh yes… the infusion site change.

So often after site changes, I’ll have a… What do you call it? A phenomenon? An anomaly? An unexplainable variance in The Force? It seems as though the site isn’t working at all for a while, which is why I got a high alarm around 11:30 while I was fast asleep. I’ve been through this kind of thing before, so I knew better than to do a correction bolus at that time. And my BG just kept on climbing, up into the neighborhood of 250 mg/dL at around midnight.

From that point on, however, I started dropping. Again, this is without a correction bolus. Certainly, the ice cream and strawberries had lost a lot of their oomph by then. But I just kept getting lower and lower until I was awakened by a low alarm at around 5:00 a.m. No big deal, because that’s when I get up for work (if I don’t go to the gym first). But I just don’t understand why, at least half the time I change sites, all of the insulin I’m pumping seems to be worthless until all of a sudden it’s not worthless anymore. And then it makes up for it with a vengeance over the next few hours. I’ve seen others write about this, so I know I’m not a weird statistic. But I don’t have a scientific explanation for it yet.

Just to be sure it was the new site and not the dessert that caused my glucose to skyrocket last night, I may have to try the ice cream and strawberries again this evening. You know, just to be sure.
 
 
 

By StephenS | Tagged , , , | Comments (2)

Site Change Musings, Part 2.

January 15, 2013 – 11:21 am

Time for part 2 of our discussion about infusion sites. Lots of super comments after yesterday’s post. Let’s see if we can answer a few more questions today.

If I have trouble with a site, how long do I wait to change it? That depends. Didn’t expect this to be a simple answer, did you? Mostly, how long I wait is in inverse proportion to where my blood glucose readings are. If my BG is hovering in the 200-250 mg/dL range for a while, I’ll try to do my best to get that number down. Drinking lots of water, avoiding almost all carbs, exercising, etc. If I’m still not coming down roughly 18-24 hours later, I’m moving on to a new site. But if I’m stuck in the 300+ range, I’m waiting only about 8 hours tops. I should also mention here that this kind of thing doesn’t happen very often to me, so I don’t have a lot of experience. And I hope I don’t get a lot of experience with this, if you know what I mean.

Do I have a favorite site? Yes… that’s definitely my leg. Never hurts going in. It always feels like it’s out of the way (except I sometimes forget it’s there when I take my pants off… #TMI). In fact, I’ve been known to time my site changes or switch around the order temporarily just so I can have it in my leg for long bike rides. Always seem to get a smooth delivery of insulin, maybe because there’s less fat there. If I had enough space, I think I would have it in my leg all the time. By the way, before finding the Diabetes Online Community, I had never even heard of using any space other than my midsection or my butt. Thanks DOC. My second-favorite site? On either side. It just feels comfy, though it’s much more likely that I’ll rip the thing out from there than from anywhere else.

And a final bonus question… thanks Jen for making me think of it: Will I do a site change anywhere? Only at home? Okay, two questions. I’ve only done site changes at home or in a hotel room (once without an inserter). Never at work. Never on a day trip somewhere. At work I’m just worried about getting a gusher when pulling out the old cannula. Which I suppose I could handle by waiting to pull the cannula until I get home. So maybe I’ll try that in the future. Otherwise, I don’t know. Can’t think of a reason not to do a change somewhere, other than for sanitary reasons. I think my hang-up (and it’s really my hang-up) is the whole my comfort with doing the change versus someone’s discomfort watching me do the change thing. I don’t really have a problem, but I don’t want someone else to feel weird about it. In the greater sense though, I think it would be helpful for people to see things like this that we have to do all the time, so they can be reminded that diabetes is real and it’s not a simple thing to live with.

Once again, feel free to post your answers, or any additional questions, by leaving a comment below. It’s been a great discussion so far.
 
 
 

By StephenS | Tagged , , , , | Comments (3)

Site Change Musings.

January 14, 2013 – 9:47 am

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.
 
 
 

By StephenS | Tagged , , , , | Comments (9)

Don’t try this at home.

December 10, 2012 – 9:55 am

Mostly (at least in my mind), the day revolved around this:

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Sunday was our annual holiday open house at the homestead, with nearly 40 guests, a kitchen helper, and a piano player all crammed into our little house. With all of this bolus-worthy goodness in front of me, I decided before the start that I would set a temporary basal rate to help me manage the BG’sus out of my glucose.

Sometimes, I know just enough to be dangerous.

I’ve set temp basals dozens of times in the last couple of years. They always worked out well too. Set for just the right amount of insulin, just the right amount of time. Mostly for workouts, where I set the rate for an hour or an hour and a half at 0.575 units per hour. That’s a little less than half my average basal. Once in a great while, I’ll set one that’s higher than my normal basal rate because I know I’ll be eating a bit more than usual over an extended period of time. This was one of those times.

The problem is, when you’re hosting your own party, you don’t get much of a chance to graze at the buffet. And that’s where my trouble started.

Instead of eating my way through the afternoon and being helped along by my over-basalness, I was greeting people, taking coats, taking out trash, refilling drinks, but not eating. A couple of hours in, I realized I had made a mistake.

I realized I was going a bit low (spoiler alert: nothing to worry about in the long run), and I had to cancel the temporary basal rate then get something to eat. Only… all of my temporary basals had worked great before, and I never had to cancel one early. So I didn’t know how! Never even had thought about it before.

Fortunately, I found it rather quickly, right next to the option to set the temp basal. Crisis averted.

Don’t try this at home, folks. Read up on your pump settings before you start to freelance.
 
 
 

By StephenS | Tagged , , , | Comments (4)

The Best of Intentions.

November 16, 2012 – 3:43 pm

The Great Spousal Unit and I went to a play last weekend. It was fun, a light-hearted look at three aging World War I veterans who hatch a plan to escape from the retirement home they’re living in circa 1960.

I knew the insulin in my reservoir was getting lower, and when I checked at about 8:00 that morning, I saw that there were just over 30 units left. I thought I could probably make it through the day with that much and change my site that evening. But… remembering the “Please turn off all of your cell phones and other electronic devices” speech that’s given before every live performance, I decided to do the site change before the 2:30 showtime so I (and the rest of the audience) wouldn’t hear that Low Reservoir beep during the show. Smart thinking to plan ahead, right?

So we get to the theater, an intimate, 200 seat venue that produces great plays all year long. We’re in our seats, the show begins, and… during a quiet moment in the first act (it’s always a quiet moment)… beep BEEP beep!

Low Battery Alarm.

To make it worse, it was the first time in 2 1/2 years that I had let my battery run down enough to cause an alarm. Not that anyone in the audience really cared about that in that moment.

Fortunately, the performances in the play more than made up for my lack-of-planning faux pas. I heard this phrase once, and it seems appropriate here: “Someday, we’ll look back on all this, have a good laugh, and plow our car into a tree.”
 
 
 

By StephenS | Tagged , , , | Comments (1)