My son Matthew (5) began pumping in Nov '08. Our first six months went very well, sets lasting 72 hours, A1C’s of 6.1 and 6.1. During the second six months we couldn’t get a set to last longer then 48 hours, and when we tried, we’d experience the random highs you’re having. A1C’s reflected this and were 6.5 and 6.3. We thought it may be the summer heat, but it didn’t get any better as we rolled into winter. In the last few months it had gotten very bad and we experienced many spikes and early set changes, often less then a day. It was frustrating and his last A1C a few weeks ago was 6.7, his worst on the pump (his standard deviation had really gone up too, that telltale sign of poor control, even with a decent A1C).
In the past few months we’ve tried changing insulin, different infusion sets, different sites, and even exchanged our pump (MM Paradigm).
In the end, we ended up where we started: MM Paradigm, Quickset 90’s, 6mm (similar to what you are using) and Novolog, but he has been doing much better recently. Indeed, we’re back to 72 hours per set, with only occasional early changes required. I attribute this to two things.
We are now using his stomach and not just the butt as we had been, providing more site availability. I think that after only having used that area for over a year he may have developed some scar tissue, inhibiting absorption, although it has gotten much better with less use.
We elevated his basal rates slightly so there is a higher flow of insulin. I think the higher rates may prevent some clogging/crystallization. Of course, that is an option for the daytime, but obviously there’s not much you can do at night. The difference in basal rates may be why you’ve never experienced this, but your son has.
Additionally, the number of times we test per day has gone up compared to when we first started on the pump as a result of trying to head off the random highs. This has had no effect in avoiding early set changes, but has provided indication of pending failures and kept some numbers lower then they might have been.
There were several days we considered putting Matthew back on MDI. It was difficult seeing the 400’s pop up and knowing we had more consistency and better control with shots. I’d keep experimenting until you find a combination that works for your son, keeping in mind that it may be awhile. Matthew loves his pump. For us, it’s been worth the effort.