With a recent site change for my son, it seems the site was fine for his basal needs but not for his bolus insulin. I’m wondering if that’s happened for others? He had a few days of highs after meals, but his overnight numbers were good and he stayed steady once we got the highs down, so I felt like his basals were fine and didn’t think the site was an issue. I had about 3 days worth of meal data and was planning to start tweaking his I:C ratios, but, after a site change, his bolus ratios seem to be just fine again.
Is it possible a site could be just fine for the steady drip of basal insulin, but not allow proper absorption for the larger bolus doses (generally in the 2-3 unit range for my son)? We rotate sites religiously, but this particular site was a little higher up than usual and in a less fluffy area.
My first thought was the same as yours - too much at once for proper absorption. Can you do an extended bolus, say over 15 minutes, so it's going in more slowly? Or maybe even split the bolus 1/2 & 1/2, 5 minutes apart?
I think you're likely right about the absorption. I wore my pod on my calf and my thighs a few times, and while it worked for basal rates (although I had to increase them about 25% more than normal to get them to be successful), it did not work well for bolusing at all. I would sky rocket. And it would take about 3 times the amount of correction for me to come back down. And then once I was back down, the basal worked fine again.
I definitely think if there's not adequate "fluff", you'll possibly have some trouble with insulin absorption.
I change my site and my bloodsugar will seem fine but when I go to put anything in my mouth I will shoot up to 13mmol on a bolus that worked the day before eating the same food! I also have that problem. My basal bloodsugars would be normal but upon eating is when I notice a site issue, or when I pre bolus and my sugar doesn’t come down.
I have an issue with my sites that took me a long time to figure out. My site can handle 150 units max. So basically 50 per day.
After that I’ll get slow absorption or sometimes it would seem like it wasn’t absorbing at all.
Makes sense that the basal is ok because it’s the overwhelming of the site that causes the problem. The tissue just can’t absorb the bolus and it’s probably just barely able to handle the basal.
I don’t know what his limit is, but you cal look in the history of his pump and sort of notice when it happens compared to how much insulin the site has absorbed.
I did a few things to lower my insulin needs
Exercising after meals
Switched my diet to mastering diabetes diet
Eating less because I was starting to gain weight.
I got my daily dose down from almost 60 to about 40 and my sites stopped having absorption issues.
I take a small dose of lantus once a day just 5 units, it makes a difference and also prevents a spike I get when changing sets.
Also a protection against DKA if my set comes out which has happened a few times. With cgm now, I would know it much sooner though
If his skin just can’t take it, and he’s not getting large doses, then maybe switching sets every 2 days
One last thing, are his sites inflamed when you remove them, and is there a lump? Because he could be allergic to the adhesive and there are ways to mitigate that.
I use only about 12 units for TDD. I am on the 780. My skin has gotten thinner since I have gotten older. I am only 57. I started pumping when I was 42 y/o. I am only 90 lbs so I can’t afford to reduce my food intake. I eat about 100g of food a day.
