Blood sugar spikes after infusion site change

I’m type 1 with a Tandem Tslim pump using fiasp and Dexcom g6. Every time I change my infusion set, my blood sugar spikes—from 120 to 250 in less than an hour. It goes back down after bolusing and waiting about an hour, but still…this shouldn’t be happening! I prime and fill the cannula just like the pump instructions say. Is anyone else having this kind of problem?

Perhaps your site change is taking so long that your spike is due to lost basal?

Try infusing 25% of hourly basal pre-removal of site

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I have had this problem in the past. When I tried the Omnipod system, post pod-change highs dogged me. I tried many tactics to mitigate it but gave up after a few weeks of many experiments. I was taking both pre-change and post change insulin to pre-empt the expected BG climb and I never tamed it. My pod/site change insulin dosing rose to 7 units without delivering any expected change.

What I learned from this experience is the most likely culprit in this is the sensitivity of the tissue that the insulin is placed. I am a long term pumper and human nature being what it is, I favored certain sites because they weren’t painful and I got good BG results from them.

Unfortunately, this has its limits. Overused infusion sites can develop scar tissue and be stubborn about absorbing insulin. When I moved to virgin territory, I found good control with no post site-change highs. I used my “love handles” to the rear and above my hip bones.

What you’re experiencing is a common problem. What sites do you use? When was the last time you’ve used an infusion site you’ve never used before?

Another thought - when I had this problem, I experimented with many different styles of infusion sets. If you’ve been using, for example, 90 degree 6mm depth plastic cannulas, it might be that the 6mm depth in your tissue has developed scar tissue. You could solve this problem with using a 9mm depth or even using an angled set.

Many people have solved this problem using a steel infusion set. The steel sets have the added advantage of never kinking the cannula, something that does happen occasionally with plastic/teflon cannulas.

Perhaps giving your favored sites an extended rest, like 6 months to 1 year, and trying a different infusion set might be your solution.

I used to have that trouble when using cannula sets. No more similar issues since switching to a steel set (Tru-Steel for Tandem pumps, Sure-T for Medtronic).

I tend to get highs after infusion set changes with my angled teflon sets. I’ve heard that it can be related to the “trauma” of the insertion and some people insert the new set, fill the cannula, and then go back to the old set for a couple of hours. When I have followed this technique, it does eliminate the post-insertion highs. But it is kind of a PITA.

With TruSteel sets, the insulin absorbs well immediately and that is one reason I am starting to like these sets more and more.

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Thank you everyone for the great advice and ideas! I am using the 9mm cannula - will talk to my doctor about other options and different infusion sites

I would hope that Tandem would send u samples of other sets, before you get a new Rx for a particular type of set. That is precisely how I switched from Quick Sets to Sure-T’s for my Medtronic pump–I called tech support and they immediately sent me a number of Sure-T samples. I loved them and THEN I asked my doc to change the Rx for the sets so that at my next 90-day order, I’d get the Sure-T’s instead of Quick Sets.

ie, I think you are going about this backwards–unless your doctor’s office has set samples! Your doc isn’t going to know what set works best for you–your BODY will tell you that.

Did you mean to write Medtronic, not Dexcom?

No, I meant to write Tandem! (fixed)

Good idea, thanks!

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I also use this set. I found that increasing the amount of insulin to Fill cannula helped resolve this issue.

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