Hello pumping gurus (and any one else who fancies chipping in),
So I started pumping with my Veo 8 weeks ago and apart from the usual swings and arrows and all that – ref to @Tim‘s blog post there! ;o) – it’s starting to settle and the pump bit is all good…. my very definite weak link in the new set up however is sets and sites….
My thighs and tummy are already pretty lumpy from 23 years of injections and I’m fast running out of suitable spots to ‘hit’. I started with the 6mm Quicksets but had a few problems with the cannula bit of it actually going in and with slow absorption problems, so was advised to try the 9mm instead. When used in my tum, these are now working fine – yay!
The lack of suitable space on my tum is however something my nurse is very keen to address to ensure I have other options in the longer term. So I’ve been experimenting and trying some ‘fresh meat’ sites (I’ve never injected in either my hip or butt). The 9mm Quicksets were drawing blood in these areas so I tried both 6mm Quicksets and Silhouettes, but every time I have tried either my levels have rocketed up to 15-20+ and I’ve had Ketones on a few occasions too. Not nice.
So I change back to a 9mm Quickset in the tum and spend the rest of the day fire fighting my level back down to somewhere sensible. To add insult to injury, more often than not I then find that however much I tried to pump into my butt/hip earlier, finally decides to absorb and I hypo through the floor later on.
I went to pick up some Sure T sets from my nurse today, which she told me was the last option of an alternative set. So I popped one in my hip (about 9am) and crossed my fingers…
10am, 9.0 – ok, not great but possibly just a post brekkie spike
11am, 8.0 – lovely job maybe these things are working then
12noon, 9.8 – …oh dear….
1pm, 14.5 – 9mm Quickset promptly inserted in the tum and a bolus taken….
1.20pm – 9.9, phew!
a) is it ok/normal/acceptable to only use your stomach for sites, possibly forever?
b) am I the only one that has this problem?
c) any other suggestions of things I could try?
Afraid not @stephen, I usually do lunch around 1pm, but didn’t have lunch, or have a meal bolus, till after I wrote my post – infact I’m just polishing off my lunch now (yum!) – I was waiting for it to get down to somewhere sensible before eating, to avoid an afternoon of fire fighting a high from a non working meal bolus. So the 14.5 was definitely just from non absorbing basal and the drop from the correction bolus.
You are right though – it is quick. I’m very insulin sensitive. (carb ratio 1:20, correction 1:6 and TDD of 24-27)
When I started pumping I attempted to follow the advice of bolusing 20 mins before eating – yeah, a few lucozade apéritif’s later and I decided to knock that idea on the head! now I just add it in with the food in front of me and seem to hold fine going by my post meal levels.
@bellebe What a nightmare. I don’t have much useful stuff to offer as the only problem I’ve ever had is Quicksets kinking when I use them in my stomach so I use Silhouettes there instead. Have you tried your thighs or back (roughly the same places you’d use of your stomach, wherever you can pinch a bit of fat) I use Quicksets in them a lot and get good results.
Much as I’m loath to send anyone to any site other than the wonderful ShootUp, http://www.insulinpumpforums.com is a brilliant, friendly forum populated by lots of Americans, Canadians and a few Brits. There’s often threads on there about infusion set traumas and you generally get some good responses so it might be worth a try -but make sure you come back to ShootUp eventually
My diab nurse told me to just add 1 unit bolus when inserting new cannula. This I’ve increased to 1.2 units and works for me. No one ever mentioned changing the needle type but every one is different. After 34 yrs of injecting my tummy is useless and so are my thighs but I think the cannulas should be better for us diabs. I don’t think I’d fancy having my pump attached to my arm.
Went to the gym a few years ago and observed this woman who had what looked like a pump on her arm. I’m rather shy and I considered asking her about it. Thank god I didn’t because a few minutes later I noticed her taking some ear phones and attaching it to said arm. It was her MP3. I am a very Simple person! Sheltered life!
thanks for all your suggestions guys!
The eating lots idea sounds good @Tim but I’ve spent the best part of my life attempting to decrease the size of said tummy and while big round tum may help with space for siting infusion sets it will prob bugger up my ratios and I’ve only just got them sorted, so I’ll stick with little tum for now I think.
Haven’t tried arms @stephen, got to admit I don’t really fancy it and there’s not a lot of ‘bingo’ to my wings, but I’m willing to give anything a go!
@mustard – you wouldn’t necessarily have to wear the pump on your arm . In the winter if the cannula bit is on the upper arm under a sleeve, the tubing could go through the arm hole and the pump could sit in it’s usual home in my bra, (or clipped on a belt fellas!). Not sure I’d like the site on show in the summer if I was wearing a vest but hey – there’s a potential 6 months of arm siting available (more like 10-11 given we live in the UK!)
I do wear it strapped on my arm in the gym – with my mp3 strapped to the other arm, the equal weighting helps to equally tone the arms! – I’ve had a few curious looks and some braver approaches enquiring if it’s a heart rate monitor or a GPS! (gps in a gym?? no, really, I can find my own way to the treadmill thanks!)
@alison, I haven’t tried my thighs as they’re pretty lumpy too and vain as it is, I kinda think the Quicksets might stick out a fair bit in skinny jeans too?!
How do you see what you’re doing, putting it in your back???
My hips and bum definitely have plenty of pinchable fat – which is why I really don’t get why the sets aren’t working. @mustard, I do generally try to do a correction with the alt set/alt site to really give it a chance rather than just taking it out at the first sign of a rise so I’m pretty sure it’s a more longer term not getting basal in there over a few hours thing than an insertion thing.
Will give all suggestions a shot though! Damn these pesky cannula’s – they will not beat me!
Thanks for the link too @alison……I’m off over there then….
@bellebe – I also have problems with cannulas not working as well in my thighs – I often find that there end up too close to a vein (thats what my DSN suggested it was) so it doesnt work, and then later on (after changing site) all the insulin/corrections I added to try and make the first site work starts to kick in and I go hypo. So you are not alone!
No meat on my hips, things a bit of a dead loss, not tried my bum yet, that’s one to try when I’m not going out in case they also act like my thighs (likely, I think), couple of areas I could try on my back as long as I’m not wearing a waistband (as that’s where the fat is – not much available!) although I’m wary of that (not sure why though). Arms is one to try also, although I’m not overendowed in the bingo dept either…
So my tummy generally gets the hit. But my DSN didnt seem worried when I mentioned it to her, as long as I rotated the sites around my tummy – I dont have too many lumps, luckily!
@bellebe For my back I started off doing it in front of a mirror, but now I just reach round and do it blind. With the Quicksets you only need to position the inserter where you want it and press the button so its not too hard. I wear my CGM sensors on my back too and can put them in myself but am often lazy and get the husband to do it which is much easier.
My husband backs away whenever I get anything diabetes related out (cannula inserter, cartridge change,etc). I have to force him to do a fingerprick (on me) every 6months or so in order he remembers how to in case of need, and even thats a struggle. I put it down to medical phobia (I have to take him to have his flu jab, he’s petrified of it, and also to his regular asthma checks, where there’s not a needle in sight). He still married me though
By trade the husband is an IT geek, but I must admit he has developed into a top notch diabetic assistant when needed. He’s been able to do a blood test if required for years, but it was only when I got the pump that he became really involved. He came to the training with me, the theory being if two of us went through it we stood a chance of remembering most of it between us. Its really just laziness, but I quite often ask him to put my sensor in my back, its so much easier than struggling to do it myself and its quite nice to have someone to share the load!
Ladies and Gentlemen, I am pleased to announce that after taking on board lots of tips and advice from your good selves and those over on t’ other side of the pond on the insulin pump forum…
I’ve had a silhouette in my hip for 4 hours, I have eaten a meal, taken the appropriate bolus, and my post meal BM is….. (drum roll) …… 5.3!!!!! Wahoo!!
For the benefit of anyone scouring the web for help on this kind of issue here’s what I did…
1. Insert the Silouhette by hand without the clumsy inserter thingie. You have much more control so you can choose the insertion angle easier and it makes it easier to pinch your skin up too. I found it far, far less painful to insert it manually than fire it in with the weirdy shooter thing too.
2. When you change sites leave the old cannula in for an hour, that way any basal (or bolus) that may have been going in or pooling around the old site has plenty of time to absorb so there is no risk of some of it leaking out as you remove the old cannula.
3. Try @mustard‘s suggestion and over prime. If you’re pretty insulin sensitive don’t go too mad but instead of priming the Silhouette by 0.7 I did 1u. I figured if I was going to be monitoring my sugars after anyway it’s less hassle to have to have a sweet/biscuit/swig of lucozade if you drop a bit. I’ll experiement with this to work out what is the right number for me but this time 1u seemed to do the job.
4. I also waited 35 mins between when I gave my bolus and eating. After my meal bolus I kept checking my sugars every 10 mins and figured as soon as it showed any sign of dropping I’d eat. It stayed very steady for 25 mins then then dropped from 7.0 to 5.6 in 10 mins so I figured I’d better get my brekkie down me (and I was proper hungry by this point too!)….
It ‘s stayed at 5 somethiig since. I think this probably means I have a much longer absorption rate in my hip than my tum, but as long as I know this I can just leave longer between bolusing and eating whenever I site in my hip – will continue to monitor.
Thanks so much for your help and support – it’s just nice to know that other people ‘get it’ when you have a bit of a moment! The moral support was enough to make me step back and give it another go rather than give up all together on trying alternative sites.
Just gotta keep my fingers crossed it stays like this now!
My arms were just two big lumps really – the skin didn’t look abnormal but I only ever injected my quick insulin in my arms and basal in my thighs. My thighs have always been fine. This after 30 years of diabetes. I have had the pump about 10 years, i have always put it in my thigh, so my arms have had 10 years to recover – and I’d say they’ve recovered about half way – the skin still doesn’t really move naturally over where I did all those injections. I’m not sure they ever will. So I’m very careful to always put the pump in a very different place each time, and on opposite legs each time.
i never thought about how to stop that little bit of insulin leaking out when changing over.
My problem is forgetting to eat after I bolus, or forgetting to bolus before I eat. I think I am brain damaged somewhat after all these years of hypos, my concentration is shot. If I start doing something, I forget what I was doing. There’s probably something in the kitchen and in the lounge right now that i was in the middle of before I came on here…