Tag Archives: infusion site

It happens to all of us.

If you’re a pumper, chances are you’ve seen something like this before:

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The story: I changed my set on Friday night, about 2 hours before bed. When I woke up in the morning, my #BGNow was 174 mg/dL. Higher than I would like, but I can deal with 174. I had a smaller-than-normal breakfast, and a fair amount of both coffee and water throughout the morning.

When I checked just before lunch, I was at 286 mg/dL. I was meeting a friend for lunch, and I just dealt with it… sometimes, new infusion sets just don’t seem to take right away. I had a very small lunch, enjoyed my time with my friend, and headed home.

Just before dinner, my BG test resulted in a 266 mg/dL. Okay, I’m getting some insulin, but something is clearly wrong at this point. What to do? Do an injection and wait it out some more? Or make the decision to change my set and start over?

I opted for changing my set, but not changing my tubing. If it was a bad cannula (pictured here) or a bad site, the tubing wouldn’t matter. If it was bad tubing, then a site change wouldn’t change anything, if you know what I mean. I’m the kind of guy who likes to know the cause of something, so I didn’t change the tubing, knowing I could do it later if I had to. As you can see in the photo, there was no need to because somehow the cannula got kinked. Which almost never happens to me, which is probably why I waited almost a day to change out the set.

After making the change, I did a correction bolus and ate a nearly carb-less meal. When I checked almost three hours later, I was at 84 mg/dL. Problem solved.

Just another annoying, stupid thing. Freakin’ diabetes.
 
 
 

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Endo recap.

Can’t believe that I’ve let almost two whole weeks go by without mentioning something about this. Too busy with other things, I suppose.

Here are some random moments from the appointment with my fabulous endocrinologist a couple of weeks ago:

– Hemoglobin A1c was pretty good. I’m again in the range where she’s worried that I’m encountering too many lows. It still feels weird after so many years of “Your numbers need to come down” to hear “This is a little lower number than I would like to see”.

– After reading about my adventurous week in January, she asked if I’m still eating gluten free. Umm, no… I’m not. But I do dig the pizza that I made, and the bread, and I felt pretty good that week, so if I can afford it, I’ll probably be doing at least some gluten free meal making in the future. Also, I’m eating a lot of salads right now, and I’ve been looking for gluten free salad dressings (Wish Bone makes some good ones).

– We talked about infusion sites. I had a stubborn high BG episode a few days prior to the visit, and we talked about whether it might have been site-related. I’m convinced that it was insulin that went bad after five days hanging on my hip. But I finally remembered to ask her opinion about whether sticking to the FDA-mandated 3 day limit to infusion sets would cause me to have too much scar tissue over time, as opposed to what I do now: keep the thing in until the insulin is gone (usually 4-6 days). Her opinion? If I’m careful about rotating my sites, I shouldn’t have to worry too much about changing out every three days. And there’s no evidence that keeping a set in longer is doing me any good anyway. I may have to rethink my position on this one.

So in conclusion: I have to tweak my basals ever so slightly, and stop aggressively blousing at every opportunity. I like eating gluten free, but haven’t moved all the way there yet. And I should consider going back to site changes every three days. Oh, and my other lab work came out okay too. No liver, cholesterol, or thyroid issues. I’m good for another three months!

Of course, I still have plenty to work on in the meantime.
 
 
 

Hating the highs.

All things being equal, yesterday was a pretty good day. Only things were not all equal… diabetes doesn’t play that way. Okay, well, maybe it wasn’t just the diabetes. Let me explain:

We woke up early (for a Sunday, anyway) at about 6:00 a.m. When I reached the kitchen, I did the normal stuff… make coffee, let the dog out, feed the dog and cat, and check my BG: 81 mg/dL. Great start to the day, right?

I promised to take The Great Spousal Unit over to Blackwater National Wildlife Refuge near Cambridge, Maryland on Sunday. So after breakfast, we took off for Maryland’s Eastern Shore– a little over 2 hours away by car. By the time we were nearly there, we stopped for gas and I also needed to make a pit stop (badly). I should have guessed something was going on.

So we go off to the refuge, and it’s beautiful even though we didn’t see much compared to most trips there. After we finished, I decided to make a quick side trip over a public road that goes right through the middle of the preserve. It was there that Maureen spotted the only bald eagle that we saw all day. Wish I had a photo, but he flew away before I could snap it off. After that, and an equally quick sighting of an osprey, we headed off to Cambridge for a late lunch.

Again, I really had to go, but I didn’t think too much of it because I knew where my BG was in the morning, I knew what I didn’t overdo breakfast, and I bloused accordingly. Also, my infusion set had already been in for going on four days, and it had been working well. It was surprising when I checked just before lunch and found a 237 mg/dL on my meter.

Okay, I’m frustrated, but again, I bloused accordingly. I made sure I would be good by about 5 o’clock at the latest. Wroooong.

We took our time coming home, and the way back over the Bay Bridge, through Annapolis, and up to Baltimore wound up taking about 3 hours. When we arrived home (and after I ducked into the bathroom), I checked my glucose again: 249 mg/dL.

Now I’m mad. I almost never have a consistently high day like this. I’m ready to bolus the living daylights out of anything that moves. But I regained my composure and decided to change my infusion site instead. After changing, and to be sure I’m getting all of my bolus this time, I decided to do an injection to cover where my BG was sitting, plus the very limited amount of carbs I was ingesting at what was really more of a grazing than dinner. At this point, I’m absolutely sure that everything will be fine, even with (or especially because of) a new infusion set. Wanna guess how that came out?

I wait until 8:00 to check, and whaddyaknow? I’ve hit a new high for the day! 331 mg/dL. This is where the term “rage blousing” comes from. If it weren’t so late in the day by now, I probably would have rage bloused my behind off. Instead, I decide to do two more things.

One was to do another injection, right away. I figured this still had to be my best option to bring my glucose down.

The other thing I did was something I should have done much earlier in the day. Instead, I waited until I tested again at around 10:30, and saw 348 mg/dL on the meter. When I changed my infusion site earlier, I did not change my reservoir. I had about 100 or so units left in there, and I didn’t want to just toss all that insulin into the trash. So I changed my site and hooked up the old reservoir. But by now I’m thinking, maybe the insulin is bad somehow. I don’t know how this happens… I can’t remember it ever happening before. But, of course, now I’m ready to try anything, so I filled a new reservoir and hooked it up. I know this isn’t how you’re supposed to do these things, but hey, sometimes things don’t go according to plan. Once this was complete, I had pretty much given up, and I went to bed.

And gloriosky, when I woke up this morning, I was right back at 81 mg/dL all over again. Fiiiinnnnaaalllly. Hmmm…. Bad insulin. Who would’ve thunk it? But then again: When you consider this diabetes beast we’re all fighting against, it seems to make perfect sense. In a crazy, don’t count on anything, not gonna play fair kind of way.
 
 
 

Site Change Musings, Part 2.

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.
 
 
 

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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