Infusion sites...?

[Dogen]

Is it possible for an infusion site that had been working fine for two days to stop? My blood sugars have gone crazy today. I can get my numbers down a little - 10-20mg/dl - but then they just climb right back up, whether or not I eat. My basal has never been a problem, normally, and I'm having a difficult time coming up with an answer that works for a T1 that doesn't involve my infusion site (basal rates needs shouldn't change overnight, since I know I make no insulin).

So, can infusion sites "go bad" after working for a couple days? I don't know how else to explain this - my BGs have literally been hovering around 200 all day. I've taken upwards of twice my TDD, to little effect... I'll drop to 160, then check it 30 minutes later and be 180 again. Ugh... so nauseous.

[Subby]

That's what I find... a set can certainly "bite the dust" prematurely. I have come close to DKA that way for the first time in 18 years really, when a set stop working. In that case the lack of insulin was very sudden and unexpected. A hefty correction bolus by injection and a new set and I was back to normal. I have not had that happen again, but I have also had a few that just didn't work that well or didn't really last the distance but limped on.

As for basals overnight, just a note that reqs can indeed change under certain circumstances (such as being sick). You are right that in a completely insulin deficient body there is not a question of variable internal contribution - but all of the other factors such as gluconeogenesis and hormone induced insulin resistance, can have a strong influence on your basal requirements, and circumstances can vary these influences at times. That brings up the second possibility - that you are getting sick and are not quite aware of it yet. But I would go with changing the set in the first instance.

[Dogen]

Well, I've just changed the site, so here's hoping that solves my problem. I switched to injections as soon as I figured it out, so I'm going to keep an eye on my blood, make sure the new site is working (somehow, all it's giving me is basal rate, and my BGs are dropping...), and try really hard to be everything but nauseous.

[Dogen]

*sigh* looks like the good numbers were from switching back to MDI for 12 hours - I put in a new infusion set and as soon as the insulin I injected wore off, I'm back in the 200s. I've taken about 30u total (in various boluses) for a meal that should have required 15.

I'm switching back to MDI until I can get in to see my endo and/or DE. Two days in a row of this has me wrecked. I feel sick as a dog (nausea, from the BGs, no fever), I can't eat. It's ****. I've been pumping for 17 days and my blood sugars have never been worse.

[Gordonm]

You have only been at it for 17 days, I'll bet your basals are not set right. It took me 3 to 4 weeks before I had them down real good. Yes I ran high and low for a few weeks but I kept at it. Once you have them set up you will be fine. It took my body a week just to get used to running on the pump. I felt the worst I had ever felt in 33 years of Diabetes the first week. It gets much better.

[sarahspins]

I've been pumping for 17 days and my blood sugars have never been worse.

This sort of describes me recently... I went through 12 sites in 13 days... a couple we lost due to accidents (tubing caught on doorknob, etc), but I wasn't a happy camper. I switched to Apidra yesterday and so far things are going better.. but it's too soon to make the call for sure.

Are you having any site irritation? I did when I first started pumping (2002) with Humalog, and now when I started pumping again, I had worse reactions with Novolog.. my sites would get itchy, then swollen, and then just fail.. I didn't get a single one to make it to 48 hours, and towards the end, I had 3 in a row fail (with insulin leaking) at just 36 hours.

Right now I'm at 30 hours on Apidra with some minor soreness at the site, but I have a feeling that's due to where it is, and not from the insulin, because it's more of a pokey feeling than a sore inflamed feeling.

[SCC]

Some of my sites routinely "poop out" during the third day, and I need more insulin to cover food. I've had them fail and had the "run up" too. For a while I switched sets every 2.5 days and that worked better. I imagine that is one reason there is a recommendation is to switch sites every 48 - 72 hours. Until things are really stable, maybe you could try switching a hair more often?

[JJM335]

Some of my sites routinely "poop out" during the third day, and I need more insulin to cover food. I've had them fail and had the "run up" too. For a while I switched sets every 2.5 days and that worked better. I imagine that is one reason there is a recommendation is to switch sites every 48 - 72 hours. Until things are really stable, maybe you could try switching a hair more often?

I have given up trying to get more than 48 hours out of a site. My Bg's will usually climb on day 3, sometimes gently, occasionally spectacularly. I now change the infusion set routinely after 2 days (although I keep running the reservoir till it runs out, typically after 3+ days). I have noticed that with a 2 day rotation, the red spots where the cannula was inserted fade out after about a week. When I was leaving the sets in for 3 days, I used to get big red bumps that took weeks to fade. This makes me suspect that the problem was that the sites were getting irritated.

Joel

[AngelKitty]

I agree with all of the above.
I had to change 3 sites in two days over the weekend and now it has been less than 48 hours and I have had to change site again (sigh) the hazards of being a diabetic on a pump I guess. Like everything in life there are pros and cons. Even with all the hiccups of pumping I wouldn't go back to MDI, I have much tighter control of my D on a pump.

[SCC]

I remember recently in another post where someone mentioned the preservatives in the insulin can be an irritant and that can cause some of the bumps at the site.

I remember on MDI that sometimes I'd take insulin and it would just seem to "disappear" and be unaccounted for. Or it might act somewhat later.

Nature of the beast, I think :)

[Dogen]

Thanks everyone for the suggestions - it's amazing how different pumping is from MDI. I thought it was going to be the same old thing, just with fewer pokings... well, that'll show me.

So far I've not had any problems with my sites - once I learned to tape a half-loop of tubing to my side so tugs would pull on the tape rather than the infusion site. Thanks to the RNs I work with for that one ("duh," she said, "haven't you ever noticed IV tubing is taped down?"). I get some burning if I give myself a big bolus... but I mostly just ignore it. I'm on my 6th infusion set and have only had problems twice - once I tried to put it a little too high up on my hip (noticed it pretty quick - it felt different), and the other was the time that caused me to start this thread.

I've been underestimating my insulin requirements... my main problem is forgetting that a big part of my TDD is my basal - which is new for me. I thought of humalog and lantus separately, and I was slow to realize my TDD of humalog was going to jump up as much as it has. It made me resistant to dosing an extra few units when I knew I should have. I sat down, did the math, and things have been better - though I'm still working out this whole fat-makes-my-humalog-needs-skyrocket thing. I'm trying to figure out a low carb, low fat diet now... umm... fruits and nuts, all day everyday?

[SCC]

Glad to hear you are settling in...it does take a while for sure. I was with you, thinking it would be pretty straighforward.

Turns out it's really interesting too. Funny...first insulin would "control" diabetes, then they got different types of insulin. Then the pump. And we are all so different, there is NO one way. I love sharing and and learning from this forum.

[butterflykisses]

I get some burning if I give myself a big bolus... but I mostly just ignore it.


My solution to the burning/stinging that Animas pumps seem to be "famous" for is to use the combo bolus. I just set the "normal" portion to 0% and the the "extend" portion to 100% and the duration to .1...that way it delivers it over about 6 minutes instead of within a few seconds.

[sarahspins]

My solution to the burning/stinging that Animas pumps seem to be "famous" for is to use the combo bolus. I just set the "normal" portion to 0% and the the "extend" portion to 100% and the duration to .1...that way it delivers it over about 6 minutes instead of within a few seconds.

Ooooh, now there's a good trick :) I may have to try that... since switching to apidra I haven't had any stinging unless I bolus more than 4u at a time, but the bigger boluses can burn at the end.

[sarahspins]

Ooooh, now there's a good trick :) I may have to try that... since switching to apidra I haven't had any stinging unless I bolus more than 4u at a time, but the bigger boluses can burn at the end.

ETA, okay, that seemingly did nothing? I put in a 6u bolus for dinner, over .1 hours and 0/100% and it waited a minute or so, and gave me 3u at once, and then 3 minutes later it gave me the other 3u? I don't thing that helps, really..

[telizas]

You know the Ping has a "slow" option for delivery, right? It will slow down how fast you get a bolus. I think from 1 minute per 5 units to 4 minutes per 5. I could be wrong on those numbers, but its something like that.

[sarahspins]

You know the Ping has a "slow" option for delivery, right? It will slow down how fast you get a bolus. I think from 1 minute per 5 units to 4 minutes per 5. I could be wrong on those numbers, but its something like that.

When I tried it with normal boluses, it only delayed the time inbetween each unit by about 3 seconds.. it didn't slow down the actual delivery at all. Since I was having a TON of site irritation using the slow bolus mode made the stinging worse by prolonging the time I had to endure a bolus. So I switched back to fast... thinking that if it's going to hurt either way, I figured I wanted it over with as fast as possible. Since then though, I've switched to Apidra, and that fixed the site irritation that was causing the stinging... I've been on Apidra since Thursday and I've had no more irritation and I have effectively cut my TDD in half - that shows how much insulin was being lost to irritation/immune response as well as leakage (happening very quickly.. I'd have sites fail to leakage within 36 hours, and I don't think it was related the only the amount of insulin being injected since I remember being pregnant on a paradigm pump and practically having to change reservoirs every day and I still never had site failures).

Anyways, as I said, I tried the .1 hour for the combo bolus, and it just broke the bolus up into 2 parts... I got 3u about a minute later, and the other 3u about 3 minutes after that. Would it have done it differently if I had the bolus delivery set to slow?

[butterflykisses]

ETA, okay, that seemingly did nothing? I put in a 6u bolus for dinner, over .1 hours and 0/100% and it waited a minute or so, and gave me 3u at once, and then 3 minutes later it gave me the other 3u? I don't thing that helps, really..

It works for me. Sounds like it might be insulin that is the problem for you though??? With 6 units I would have actually delivered part of it immediately, like 2 units immediately and then rest over the .1 (6 minutes) I think 2 units is about all I can take at once without stinging most of the time. but then I also do a lot of combo boluses over .5 too...just seems to work better. I think you might be right about the irritation causing absorption problems. I have been using Humalog for a long time, used Novalog too. I never had the sting with Minimed and nor did I with the Cozmo, although the Cozmo gave the option of extending a bolus over 5 minutes. I am curious about the Apidra now? So no stinging with it? Hmmm? Makes me want to try it and see what happens.

[butterflykisses]

You know the Ping has a "slow" option for delivery, right? It will slow down how fast you get a bolus. I think from 1 minute per 5 units to 4 minutes per 5. I could be wrong on those numbers, but its something like that.

I don't think those numbers are right. I have mine set to slow and the delivery is within a few seconds. A typical bolus for me might be 3 units and those 3 units are delivered within seconds. :confused:

[butterflykisses]

Anyways, as I said, I tried the .1 hour for the combo bolus, and it just broke the bolus up into 2 parts... I got 3u about a minute later, and the other 3u about 3 minutes after that. Would it have done it differently if I had the bolus delivery set to slow?
I'll have to pay more attention next time I bolus? Since I don't feel it I would have to listen for it to know how much time is passing. You have me very curious about several things now.