Bad sites

How long, on average, does your child’s infusion site last? Grace uses 6mm insets with the Animas Ping, and twice in the last two weeks, after several hours of mystery highs, when I change her site there’s blood in the canula. One time it was only 12 hours after her last site change. She just went on the pump in September, and at first we’d change her site every three days. But now it seems if we wait longer than 48 hours her BG starts creeping up for no reason. She’s very skinny and we can only use her butt - not enough fat on her stomach or thighs. Any advice? Are there different infusion sets that would maybe help? Can I even use different sets, or are these the only one’s that fit the ping?

My 4-year-old son is also very “lean”… almost all muscle on that kid, he’s also a ping user but we use the 45 degree inset (not sure what length). Are you using the 90deg or 45deg inset?

We also can only use his butt areas. I found about a month ago while going through about two weeks almost exactly as you describe them right now that I went too far over to the “edge” of his butt when switching “sides” of his body and was regularly hitting some muscle mass areas and didn’t really realize it. He was also complaining more about pain during these times… should have been a red flag to me but it was during a time my wife was in the hospital (long story).

ANYway… yes, you’re not alone… this is very hard. If you’re near the edge - try moving further into the butt.

It also never hurts to call for help from Animas! You may also consider re-posting this in the “pumpers” forum.

My daughter has used the Omnipod since November and I have found that she can usually go 3 days, but there are times when we have to change after 2 days for the same reason you found- BG goes up for no reason. Only once did we have a bent canula with blood in it. We have also had a couple of pod failures (which I assume are similar to the infusion set failures you are experiencing) after only a few hours. We use tummy and back above her butt. On one side she has a lot of pain so we avoid it (maybe not enough fat or we are unlucky and keep hitting a nerve). Check with your endo and see what he/she thinks. I know with the Omnipod we have her Rx written to have it changed every 2 days because for some people that works best.

My just-turned-6yr old son is also a Ping user, since July. He is tall, thin and muscular too. We usually can go three days, but if his bg’s are getting high we sometimes change sets earlier. We use the comfort infusion sets (manual insertion at 30-45 degrees). Our endo will only let kids his size and age start with these. They told us that if we used the straight sets that there was a higher possibility we would be hitting muscle instead of fat and his numbers would be more unpredictable. More possibility that the sites could be causing the highs or lows because of poor absorption, etc. The manual insertion was a little rough to start out with (we use Emla cream for every site change). We have pretty good results though with the “comfort sets” and it allows us to use his stomach, which he prefers. With such a little body, I am happy to be able to move sites around as much as possible. The nurses tell me that some people really do better with every 48 hours. Good luck! I hope you find a good solution.

I have a lean daughter as well. 7 years old and only a couple of pockets of fat that we can use – her butt and a little on her belly. We also use Animas ping with the inset 30 and had a lot of similar issues with frequent highs and blood in the canula. Then we found a great thread on the tu diabetes animas pump site that covers site insertion and I felt really useful because it is more practical than the trainers advise. You should check that thread as well.

We give Abbie a full hour with lidicaine/emula cream on the site before doing a set change. You really only need a little fat to make the set work, but without the lidicaine, it’s very sensitive for a lean child and we were not getting the canula fully inserted into her tissue. After a full hour, we’re able to do the set insertion with more pressure on the site – and hold the set in place while dealing with the adhesive strips-- without any discomfort. It’s been a big improvement. We still have times when we do a one or two day set change (usually be because she’s hit the set while playing), but it’s greatly improved the process.

Also, not sure what you’re using to keep the set in place, but until we came up with a good adhesive, we had problems with the set moving out of position. So, now we’re firm believers in the skin-tac, set, IV cover layers which keeps everything in place–important especially for an active kid.

Good luck!

CH

Hi Pam. My daughter 9 years old uses the Animas 2020. She uses the Unomedical insets 6mm. I notice her blood sugars creeping up into the 3rd day. I usually try to change her site every 2 days or so but sometimes we don’t get to it until the 3rd day. She is also very lean and we only do sites on her bottom and stomach. Also, make sure that you are frequently rotating site areas. I used to do two or three site changes in the same area but now I do one on the right of the buttock, then one on the left side of the buttock and then moving onto the stomach area. This seems to work well and it allows the skin to heal better. I apply Vitamin E oil to the areas that are not being used and it has helped dramatically with her healing process. We also use Skin Tac from Animas. It’s the best adhesive we have found thus far. One more thing, there is another infusion set called Cleo which I have been told is very good. I do not have any experience with it but maybe you can ask your daughter’s endo to show you one and see if you like it.

Hi… Ella is 3 and we used the Omipod system. We have now for about 7 months. We tried to go 3 days but it rarely works. Her doc prescribed changing sites every 48 hours and so far so good. We still get blood in the cannula or something odd will happen with the site. She is also little and lean, but there is just enough fat on her tummy for it to work.

Good luck and glad you are being vigilant. Pumping does get easier with time. It is a live and learn thing.

my son, ben, is 3. we use the animas 2020 (not on the ping yet) and use the ‘contact detach’ infusion set. we have had a handful of times when there is blood in the tubing. if i am not able to flush it with a quick bolus of .05 units, i do a site change…of course i check his sugar first or give him a small snack to cover the flush…

as for sites…we use the top of the butt cheek, occasionally the thigh, and bens favorite spot is the backs of his arms. this is my favorite too…since i can put the site on and position it so the tubing runs down his back and therefore we have less ‘hanging’ with the tubing…

also, what i love about the contact detach is that it has a disconnection spot. great for bath time or a quick dip in the pool…

Pam,

David will soon be 17 and he has always had the problems that you are describing with Grace. It is very unusual for a site to last three days for David with bleeding or a bend in the canula often causing a rapid rise in his BG. We have tried the 6mm quicksets and 13 mm silhouettes. David’s problem is that he is simply too lean. For about half a year the quick sets worked well in his thighs but he has built up too much muscle there, so after constant site bleeding, he moved on to the silhouettes to use his stomach or butt. The silhouette inserts at an angle, so a little more effective for someone with his build than the short quicksets that are popped straight in.

Our endocrinologist suggested that a change every 48 hours is not uncommon in children, particularly if they are fairly lean or have sensitive skin. So until he gains a little weight he will continue to be vigilant testing to watch for a rising BG.

Cheryl

Hi Pam,
I have a 3 yr old and she;s been a pumper for 16 months. We first started with the angled insets but we had tons I mean tons of problems with kinking on the canula. So our Dr. recommended the 6mm straight insets.
What I do is the following:

  1. I use IV3000 with Lidocaine (EMLA) cream to numb the place where I will be going to insert the site
  2. 45 minutes after she doesn’t feel anything so I take out the IV3000 and clean the site with water and a tissue
  3. I use Alcohol to clean the place and after it dries I wipe the area with IV Prep (this makes her skin sticky)
  4. I wait till it dries out (if you touch it with your finger ypu’ll feel it’s not wet but sticky)
  5. Insert the 6mm INSET the ones that come with the device to insert it
  6. On the old site I use Bactroban cream to help it heal quickly

She can go 3 days perfectly and even while swimming. If I let her 4 days the site is still perfect.

The blood you got may come from hitting muscle. Make sure you insert it on the places with more fat.
If you use a lot of times the same spots you may get high numbers, so it’s really important to rotate the sites.

I use the top and middle of the butt (around an inch from the line), sides and middle of the cheeks.

I tried with the 6mm on the stomach area but my dr told me it’s better to use the angled canulas for the stomach area.

My daughter prefers her butt so we have been using it since she started on the pump.

She’s on the Ping too.

Good luck !!!