Lately I've been trying to pay a lot of attention to factors *other* than food, exercise, schedule, and stress that might account for why it seems impossible for me to get consistently good control. Aside from hormonal cycles which I've started documenting and have a HUGE impact on my control, the other thing I'm noticing is site location/absorption.
For example, yesterday I changed sites and moved from my stomach to my arm, and my readings today have been significantly higher, especially after eating. I woke up at 7.0 (126 mg/dl) which is okay, but after breakfast I spiked to 12.7 (229 mg/dl) and after lunch I spiked to 13.5 (243 mg/dl). Yesterday with the exact same food and activity level my after-meal readings were fine. I limit all my meals to about 25g of carbohydrates, and also use a higher I:C ratio at breakfast than the rest of the day, which usually works.
The only thing I can think of is that insulin absorption is better in the stomach than it is in the arms. I've been paying attention to this for a few months and it seems to be pretty consistent that I get higher readings when using arm sites than stomach (I haven't really paid much attention to leg or hip sites yet).
How do other people deal with this? I already use significantly different pump settings (basal rates, I:C ratios and ISF) during different parts of the month. The thought of having to use different settings for different site locations is not at all appealing to me. I also use temporary basal rates around exercise and food, and I feel like I'd be changing my pump settings literally daily if I had to change for sites as well as food/exercise as well as hormone.
I have always heard, Jen, that the stomach has the best absorption of any area. That having been said, we can't always just use our stomachs.
I definitely think absorption is a factor. I don't know if you remember a few weeks ago I was posting about having regular highs that were very unusual for me, culminating in a bad low followed by a day even higher than usual. I'd been using my hips, which are my favorite and switched to my stomach, and bingo! Problem solved! (Not that I don't still get highs and I've also done some increasing of basals, so I think I might have had an absorption problem at the same time as increasing needs for whatever reason!).
I don't have any clear idea which is more a factor, the need to rotate sites, or the relative efficacy of different areas. I think for me, it's probably the rotating. But I had pretty much stopped using my stomach because sites there annoyed me. Oddly they no longer do, so I guess I'll be able to compare when I go back to another area.
It definitely sounds like a pain to have to vary settings for sites - the alternate basal rates (not sure how many your pump has) wouldn't be as hard as the I:C ratios. But I know you've been struggling for awhile to get better numbers. And the bottom line, if it was me, and I found the sites made a significant difference, I'd do it. Perhaps you could stay with one site for a week or two or whatever worked before shifting or make the stomach your "primary"and only shift away periodically to give it a break. If there were just two sets of numbers, "stomach"and "other", that wouldn't be too crazy.
I’d always heard the stomach is the best spot too, somewhere a doc or someone mentioned the stomach works because the steady motion of breathing aids the absorption process? I used to use my legs for shots and run up and down the stairs to make it work faster.
I heard somewhere that the faster absorption from working muscles only works with the older R insulin and not the analogues, for some reason. Of course, exercise would still help you come down faster, but with that it doesn't matter where you inject.
I've been noticing the same thing,it seems like when I use my legs lately my numbers go out of wack. Problem is there is only so much real estate on my stomach to negotiate the CGM and the infusion set.
