Used pump fine for five months and life was ‘normal’, then the problem developed. Paradigm pump + CGMS, 23 year old 160 lb 5’10" male. Tried different locations on the body, different types of sets, talked to Minimed, two doctors, a Minimed nurse came out to make sure I was doing everything right, etc. Everyone seems to agree that for some unexplained reason my body does not go to 100% absorption rate until about six hours after the new site is put in. During this 6 hour period it takes about 30 units (I’d normally use 8) to cover lunch and that only keeps me around 240.
Everyone seems to agree I have an absorption issue, but opinions differ on what to do. Some say to take 3 shots of humalog 2 hrs apart every time i change sites (what a pain in the butt). Not what I’d call a long term solution.
Anyone had this issue or have any ideas?
Note: I already have tried putting the new site in and letting it sit for 6 hours before switching over–but the new site clogs because insulin isn’t running through it during that time. Doctor suggested trying one of the infusion sets with a needle instead of plastic cannula, but this does not sound appealing to an extremely active person who receives lots of ‘blunt trauma’ to the area where the site is.
I’d give it a try, I guess, but I have heard a LOT of negative things about Apidra from various medical professionals, even though I have talked to several diabetics on Apidra who seem to like it a lot.
Most of the negativity revolves around it’s sensitivity to heat (especially a problem on a pump).
Any comments on that? (I kind of doubt switching insulin types would fix the problem since humalog DOES go to 100% effectiveness once that area is ‘saturated’, but I’m pretty much willing to try anything at this point)
I wouldn’t listen to anybody who doesn’t actually use Apidra. I’ve used it since I started pumping and the only times I have problems with higher numbers due to insulin is if I’ve gotten to the bottom of a vial that is too old. I fill my reservoirs with about 6 days worth of insulin and wear my pump in my bra so it stays pretty warm throughout the day (and I live in Houston where it’s always hot, well, until October!).
You may have an issue that the initial trauma of the insertion is affecting the absorption - in which case I would just insert the set a few hours before needing to actually pump insulin through it.
I already have tried putting the new site in and letting it sit for 6 hours before switching over–but the new site clogs because insulin isn’t running through it during that time. Doctor suggested trying one of the infusion sets with a needle instead of plastic cannula, but this does not sound appealing to an extremely active person who receives lots of ‘blunt trauma’ to the area where the site is.
I live in Houston, TX and have had no problems with Apidra and the heat. I carry the bottle I am using right now with me in my purse. I am typically in the A/C so that helps, but even if I am outside for a bit I still haven’t noticed any trouble.
I really like Apidra and it seems to have made a huge difference for me.
Have you tried different areas of your body? I know that certain areas of my body (my upper abdomen for example) won’t absorb, so I can’t use that area.
Tried several areas on my body and all have identical results. It’s weird that everything worked fine for several months, then gradually over 2 months I started to have the problem, and now every insertion has a problem.
This may not be a solution in the strictest sense, but have you tried using either a higher temp basal rate or an extended bolus when you change your site? While it is basically the same as using more insulin when you may not want it, it might be a simpler way to get around the absorption issue with minimal brainspace occupied as a result.
What do your typical basal rates look like? If they’re fairly low, maybe the cannula isn’t getting cleared because there isn’t enough volume flowing through it?
One thing that I’ve taken to doing is giving a 3 times bigger than recommended “fill cannula” bolus. This clears the cannula very effectively and I rarely have “settling in” problems with new sites.
Hope your problem gets solved in any case…
I’m on a 1.4 unit basal. Definitely enough to not clog. Also I’ve tried as large as 10 unit initial fixed primes to be SURE that nothing is clogging.
I have tried to do a lot of basal/boluses to compensate, but it’s not enough. Like I said I’ve tried dumping over 400% of normal dosages and it will not bring me under 250 or so.
I’m sorry that I don’t have anything to say that will help, but I can tell you that you’re not alone! I’ve been pumping for 4 months now, and I have the same problem with every new infusion site.
My pump nurse suggested that I change infusion sites strategically before a meal so that there will be a large enough bolus to get things working, but that just means that my sugars jump up due to the food. It also takes me about 6 hours of correcting to get the sugars back to a happy place.
I find that the problem is proportionate to where my sugars are before. If I am at target when I change the site, then it doesn’t jump up as much, but if I’m at 11 (198), then my sugars are sitting at 400 for the next few hours = I am not a happy camper.
Please do keep me posted on what helps other people. Having realized that it is not site specific was a good thing, such that I’m not avoiding other sites, but I wish I knew either the cause or the solution…
how long have you been diabetic, how long have you been using the the same type of insulin, are there any knots or redness around site, tried moving site to another spot?
Same exact thing happens to me everytime I change my omnipod (every 3 days). I think it’s an absorption issue also. First I tried adding a small bolus, that didn’t work, then a bigger bolus, which didn’t work either. Now I set a temp basal rate of +40% for 4 hours. For some reason that keeps me pretty stable. I also noticed that if i work out hard immediately after I change my pod i dont have any problems at all. So maybe try a temp. basal rate for 4 or 5 hours, just be sure to check bs every hour.
