I'd like to lose this burning sensation.

[Dogen]

I've been pumping for 31 days now... and I'm finding that my humalog - which I've adored until now - really irritates my infusion site. It's gradual, being fine the first day and getting worse (tender, slightly swollen, red) until I change sites, and it definitely seems to impact my insulin needs. By day 3 I'm taking easily 30% more insulin than on day 1, which sucks (especially guessing what my I:C is at any given meal). So, I need suggestions... I saw someone mention apidra for this specifically, and of course there's novolog, but I don't know if it would be any different than humalog. I know people have complained of this before and I was wondering if those of you who had could share with me what helped?

[Subby]

Hey Dogen, I've tried the three rapids on myself and found they all have different side effects for me and different levels of efficiency.

It seems different for all, the only way to find out is to try yourself. The loss of action over time and increased irritation sounds to me like it is well worth swapping your insulin. Humalog was significantly different to me than Novolog/rapid. They may be very similar insulins but whether that translates to a similar action and experience seems very much a case by case basis. Apidra again had a whole set of different issues that had me off it for good within a few days. I seem very sensitive to allergies to the ingredients. Luckily Novorapid I can live with.

Are you using angled sets? I just wonder if you might try affixing them a little more if so. I find that I need tegarderm (HP preferably) laid underneath, and even better a sandwich, just for the act of holding the actual cannula more firmly at the point it enters the body. Without the tegaderm, it is getting red, sore, less effective, by the second day - even if the rest of the set is sticking well.

[Dogen]

I'm using straight sets (regular insets). I wonder if I can get samples of novorapid and apidra from my endo... hmm. I never think to ask them for stuff, but they gave me my meter (Breeze 2, which I loved and miss now that I'm using the ping).

Thanks for the idea, though, Subby.

Anyone else have experience with this?

[telizas]

I think Subby has some good suggestions - I'm using the Insets too and the more I bump it and rub against stuff, the more irritated the site gets and the more it stings. Making it less likely to move around and irritate your skin might help.

Also, the Ping as a "Slow" option for delivery, so if the normal option is stinging, try setting it to slow and see if that helps any.

I did get less stinging with the Orbit sets - I really like these, but you do have to self-insert which can be a little daunting!

[butterflykisses]

Yes! I do have that problem. But I'm not really sure whether its Humalog or not? when I first started pumping almost 7 years ago I started with Humalog. The sites were just like what you describe, okay the first day, second irritated, third day I couldn't wait to get it out. My trainer suggested IV2000, which I had already tried, that was it. She just told me that my skin probably just doesn't like having something stuck in it...kind of like having a splinter...and that I could change sets every other day. :( I lived it with for a while but then changed to Novolog and that seemed to be better. However an insurance change forced me back to Humalog. The thing is, I didn't have as much trouble? Until changing to the Ping. I can't figure out whether its the way it delivers, its an allergy or maybe a combination of both? I do know that if I deliver more than two units at a time, which causes the sting, my site gets irritated much faster. Or if I just use more insulin than normal...say at a party where I'm eating more than usual...I will end up changing the site sooner because its so irritated.

The only thing that really helps me is using combo boluses for anything over 2 units. Sometimes I will use the combo bolus over .1 duration and 0%/100% split. Or I'll adjust the percentages so that it will give me no more than 2 units up front.

Another member switched to Apidra and it helped her so I'm going to ask my endo about samples when I go in this Thursday.

[Dogen]

I think Subby has some good suggestions - I'm using the Insets too and the more I bump it and rub against stuff, the more irritated the site gets and the more it stings. Making it less likely to move around and irritate your skin might help.
My first inset got bumped a lot, and I've learned from that... since then I've been a lot better about where I put them and how I run the tubing (I tape a little tubing to me, for instance). It helps, but only with the surface pain. The burning comes from inside the infusion site and follows each bolus (it gets worse with each bolus, but never fully goes away until I change sites). It's also worse in area that compress when I move (stomach) than areas that don't (hips).

I'll try throwing a tegaderm over the site next time and seeing what happens.

Also, the Ping as a "Slow" option for delivery, so if the normal option is stinging, try setting it to slow and see if that helps any.
I'll try this. I'll try anything once. :) Combo boluses like Katherine mentioned might help, too. I've done some of that, but my boluses are a lot bigger (like 10 units), so breaking them up over a half hour is still 3 units a minute... if I pushed back when I ate and bolused over an hour it might work. We'll see.

I did get less stinging with the Orbit sets - I really like these, but you do have to self-insert which can be a little daunting!
I've ordered a sample of the orbits, but never heard back from them... their site said they had to contact my endo to send them to me, I wonder if the ball got dropped there. I might get a box in my next reorder, just to try them.

[sarahspins]

I had pretty bad irritation with Humalog back when I started pumping in 2002, and more recently, with Novolog too. Since switching to Apidra, I've only had one "stingy" site and I suspect that one was just an oddball that was placed next to a nerve or something, but no real site irritation. It was weird though, it only stung with the first unit of any bolus.. after that it was more of a mild feeling of fullness, not stinging.

My irritation was so bad with Novolog recently that I would have sites fail, with insulin leaking out back out along the cannula, after only 36 hours - the tissue around the site was so inflamed and irritated that it just could not absorb anything at all.

I actually have a funny TDD graph from my first 10 days on the Ping that I showed my CDE.. you can clearly see the "bad" site days, as well as a general climb in insulin requirements, almost as if pumping had accelerated whatever reaction I was having, which resulted not only in site failures, but increasing IR as well. I switched to Apidra and my TDD immediately dropped by 30%.. and I had 2 nasty lows in the 5 hours following the switch. After I got my basals adjusted though, I need no more insulin on day 3 than on day 1.. it's almost like magic, but then I think, "this is how it's supposed to be".

I am really liking Apidra.. it does seem to kick in a tiny bit earlier, but what I like more, is that the action seems a lot "smoother" overall - I could tell when I had the dexcom on, that when my BG dropped on Apidra, it was a more gradual but steady drop, but with Novolog I could sometimes go from 275 to 100 in less than an hour, after waiting a while just to see the insulin doing "nothing" which was often a little scary. So that aspect has been a great improvement. I also don't seem to need to "overcorrect" to bring down really high #'s any more.

Anyways, if the issue is irritation, and not just stinging, I'd absolutely recommend trying other insulins.. Apidra has no phenol in it which I think is the difference for me.

[butterflykisses]

I have my pump set to slow...it doesn't do a darn thing for me. :(

[telizas]

Regarding the Orbits - for some reason they sent them to my Doc's office... I would call your doc and see if they sent them there.

[sarahspins]

My Orbit samples went to my doctor's office too.. it didn't take very long, I was surprised to get a call that they were there.

[Dogen]

Awesome stuff. You guys are great. My to do list for this week:

1. Call endo.
2. Ask if orbits arrived.
3. Ask if they have any Apidra samples.

I'm having a rough time with pumping, but intellectually I know why it should be awesome... it's just not so far, and I think it has to do with site issues. I look at my TDD history and you can see it... 98, 123, 150. Over and over.

Stupid IR... if I took less insulin, I'd probably have less of a reaction. Well, one thing at a time - get the insulin sorted out, then think about metformin some more.

[sarahspins]

Dogen, if it makes you feel better, on a particularly "bad" day just a couple of days before switching to Apidra, my TDD hit 97 one day. I hadn't seen a total that high since I was full term with my daughter!

Since then, it's rare that I hit 60... most days I am in the lower 50's or upper 40's.

[Subby]

Dogen, you may have read me mentioning that instant boluses cause major holdups in my insulin action (which in turn causes highs (and instability), which in turn causes more corrections and higher insulin needs). It also meant my sites got red and sore a lot more and a lot faster. I made major headway in moving to all squared blouses (or duel waved, with small instant component), for me that means the minimum of half an hour on my pump.

I think I get this pretty bad, but I see no reason to think it could be similar issues that can be problematic for other people too, and what you describe sounds in the ballpark. It sounds like you might be getting localised reactions and the amount and way of delivering insulin might be a factor. Your mission, if you choose to take it - you could consider trying just square waves for at least a day or two to see if a better pattern emerges, both of TDD and site happiness. Start on a fresh working set that is not already traumatised. Trying it for one or two boluses may not be enough to show indications.

Another test that is interesting. Put an extra set in sometime, you can even prime it, but don't pump on it, or chose a level of insulin delivery that you want to test. Leave it in for a few days, and observe what kind of reaction you get at the site. OK so there is one factor which is the "tugging" of the pump you can't really replicate, but apart from that it may help you discern what effect is purely the set itself, and what effect is that of forcing insulin in and the body's immune response to insulin over the days.