Highs after site change

Does anyone go high after EVERY site change? Know how to avoid it?

I can’t figure out how (or why!) this happens. It doesn’t matter if I leave the old site in or not. After a site change I always go high after my first bolus. It’s like the insulin takes a while to kick in. It’s very irritating, especially because I never know whether a site is “bad” until hours later, since the first reading will always be high.

By “high” I’m meaning in the high teens. Today after a site change and two hours after breakfast I was 15.0 which is on the low end of how it usually goes. Yesterday after the same breakfast I was 6.8 at two hours.

It seems to happen to my daughter during warmer weather and some kids all of the time. I give my daughter a little extra insulin after filling the cannula. Last year she needed an extra .70 units (I live in the US.) This year she just needs an extra .30 units. I give it under the “fill cannula” heading on her pump rather than the “bolus” heading so the pump does not figure it in as insulin on board. Try it out. You’ll have to play around with the right amount for you.

For some reason I didn’t even think of doing this. Thanks! I’ll try it for sure.

I do, I bolus an extra unit and it usually helps

Years ago, this used to happen to my niece when she first started pumping. No longer happens. We were told to leave the old site in for about two hours before pulling it; that there may be insulin in the “depot” (skin surroumding set) still active. We now are careful to do the site change before a meal, if possible. We can then remove the old site because there is no active insulin in it and the larger bolus gets the new site started.

Yes. I do a fixed prime of around 1.5 units once I put a new set in. That’s more than the manual says is necessary to prime the canula but if I don’t give that bit extra then i will end up high.

When I used a Quickset, I put in the infusion set, disconnect the infusion line, fill the line and connect it again and then I do a fixed prime of 2.5 u to cover the change. Physiologically the insulin works best when there is a “pool” of insulin in the skin to distribute enough to have it be absorbed interstitialy. This is a trick that I have been using for 15+ years and have no rise or lowing of BG when I change my site. I experimented for a while, listened to a knowledgeable T1D CDE and found the exact amount that works.

I does vary with different kinds of infusion sets.

It is absolutely necessary to load the pool to get the insulin infusion site to work effectively as Tom noted.

It’s hit and miss with us, Most of the time the site change goes seamlessly with good BG readings after changing but a few times a high after the change, some long enough to make us assume a failure on the site and change it out, but a few have come around later…trick is mentally managing that fine line between waiting to try and save the set and worrying about keytones/DKA in the kids

Jen ,
I add a fixed prime of about .5 u even with my Sure-T’s for the reasons mentioned ( contrary to what the manual says ) . And I remove the previous set after about 10 hours .Worthwhile experimenting with the size of fixed prime Jen for you .

Yes. Although in my case I don’t seem to go as high as you indicate.

There seems to be a few hours after most site changes when the insulin does not appear to work. My first thought was air bubbles, but I check very carefully.

It is still a mystery to me.

I do and I bolus an extra .80 before the change

I have followed S Woodwards process and it has worked Great. Numbers aand values have been very Flat after site changes.

I do my son’s site changes first thing in the morning, at least an hour before he gets any breakfast boluses, and I’ve never noticed any difference in his blood glucose the days when he has a site change versus the days he doesn’t have a site change. I wonder if the immune response to the “injury” of the site insertion prevents the insulin from passing into the blood stream? I mean, it would make sense that the inflammation and clotting factors that are mobilized by the act of inserting the new site would trigger a response that might get in the way (temporarily) of the passage of insulin. So then maybe the way around this is to do the site change either well before you bolus for your meal and see if that makes a difference, or alternately, change the site after you eat when the bolus is already working? OR, you could insert the new site, prime the cannula, but then continue using the old site for an hour or two before switching over. Any of these would give the immune response a little time to settle down, so that if that’s what’s preventing the insulin from getting under the skin, you’ll still have the insulin in the system while the immune response works it’s way out. It’s worth a little experimentation to see if any of those strategies makes a difference.