How do I tell if I have scar tissue?

Hello all!

New to the forums and have questions for you pump users. Ive been using a 6mm cannula with the minimed quick set ever since I first had a pump (about 7 years). I have also constantly used my abdomen as my main site for my sets. Although, I do rotate every 3-4 days, as insulin runs out. About 4 months ago my sets started to get a lot more uncomfortable when injected. Sometimes at a set change, I can go through 2-3 sets due to massively uncomfortable sites.

The second issue is erratic blood sugars. Sometimes the set isnt painful, but my insulin absorption is for the birds. All this leads me to believe my absorption is waning in particular areas of my abdomen, but is this due to scar tissue and how do I tell?

Thanks for any help.

Good question…and I have the same. I suspect scar tissue is from both the insulin and plastics of the infusion set. Given I react to many of the adhesives and plastics of former infusion sets…suggests that I may have scarring in the tissue from there use. I remember having thickened areas in my upper thighs even on MDI…but, that was over a decade ago and seems to have healed (not hard or lumpy), but how do you know if there is any residual effect on absorption (interstitial scarring)? So I would add…does scar tissue ever heal? I have heard a variety of things (and actually nothing from my endo) …so, as a result I am doing a little experimenting on my own…my basals and bolus ratios have gone up quite a bit in the last few years…I am going to switch sites to more novel (never used on me) sites and see if my requirements change any…if they “really” go down…I suspect I have a fair amount of scarring (T1 30 years) and need to give those original areas a real rest and have a chat w/ my doctor about what if anything can be done.

Thanks to the posts of others here on Tu, I realize there are more places (skin beachfront!) that I could be and should be using:). It is an long term issue we should all think about…those injecting and pumping. Insulin delivered in a more natural way (not into subcutaneous tissue) would be ideal…correction, a cure would be ideal:)

I am now barred by my endo from using my lower abdomen. I pumped with a 9mm cannula there for 8 straight years. After avoiding the area for a solid year, I got cocky and slapped a pod there (I’m a podder now). Sure enough, my blood sugars rose to 160-180 and would not come down for two days. As I’m pregnant and supposed to be lower, I freaked out and called my CDE. She told me no more abdomen, I put a new pod elsewhere and voila, came down.

Sounds like the resistance you’re feeling, the discomfort, and the erratic blood sugars are big flashing red lights. Also, any insulin seepage or bleeding upon removal of the cannula or needle can be a sign. If you change to your rear, your thighs, your back, your hips, etc, and your blood sugars are lower and you’re not as uncomfortable, you’ll know. I now use those areas as well as my upper abdomen (from below the boobs to my belly button). If my experience and others’ here are any indication, you might need to avoid an area for a year or more before it is viable real estate again.

Thanks for the reply and information, Patricia. Couple of questions for you…

When you say “.I am going to switch sites to more novel (never used on me) sites” what do you have in mind? I had the same situation on my upper thighs from injections that appears to have receded after my 7-8 years on the pump. My sets usually are placed on my stomach from about waits over, naval to ribs.

These additionaly places that you speak of, are we talking upper thighs? Or are there additional spots I can move to? Im a bit weary of moving around to the lower back as I dont think it will be comfortable in any way, shape, or form.

yeah, a cure would be nice…

Hi Melissa,

Hmm, I get the blood trickle sometimes as well. when you say rear, were talking buttocks? how is that not uncomfortable? Also, is there enough fatty tissue on the lower back for a 6mm cannula? I was under the impression that upper thighs didnt absorb insulin as well as the abdomen. Has this been your experience? Also can you link me to some info on the pod?

I, too, overused my lower abdomen. Have now switched to the area Melissa mentions: below boobs to bellybutton and as far toward back as I can reach.

Hoping that if I’m really vigilant about rotation in that area, won’t have to venture out to uncharted territory (at least for pump infusion sets–used MDI in various areas for years) the back of upper arms, thighs, buttocks, and—gasp—boobs that I’ve read as suggestions on this site.

But, because I plan on living with diabetes for another 36 years, I probably will have to pioneer some new ground.

Good luck with trying other sites and seeing if you get better absorption. I do credit my better site rotation with some of the drop in my A1C.

PS: Patricia: Have you looked at type of rapid-acting you’re using, especially if you’ve used it for years and years? I switched to a different brand and it may have helped (although who knows how much to credit to that; site rotation, more after-meal checks, and fine-tuning of basal/bolus may have made more of a contribution to my control).

I use as far down as halfway down my butt. Just started using that last year and I love it. When you think about it, only the lower half of your rear actually “sits.” If you’ll apply the site while seated, you’ll see what I mean.

As far as the 6mm cannula, yes, the pod cannula is a 9mm (angled) and I used to use Animas insets (9mm 90-degree). The 6 should be no problem.

As far as thighs go, watch for scar tissue from previous injections and keep the site out of the muscle tissue. Go for fatty, further around the sides toward the back.

Here’s the website for Omnipod.

Weird diabetes antics: Groping my backside to see how much actually touches the seat … Should probably not do this in open-cubicle office environment.

I have been using the same rapid acting for over ten years…had not thought of immune reaction…something to consider. I use Novolog because it has the least amino acid changes to make the analog…meaning most like real insulin…so, should have less immune reaction to it. When I switched, it was because I got a few crystallized lines w/ Humalog and also liked the quicker peak absorption I got w/ Novolog but, would also be willing to try something new:)

Thanks for the specifics…I have had all of those symptoms on my lower abdomen. Frustrating. Thanks for sharing your experiences and has certainly spurred me to trying new sites and tracking effects.

Well…I am pumping into my inner upper arm today and blood sugars are GREAT:) I hate the back of my arms and used them a bit while injecting so I am avoiding them. Have been using upper abdomen (UP= “upper belly”…big smile to northern MI!) for years and it is an area that usually is painful for me…so, going to give it a rest as well. I am willing to try back side of my hip, lower back/ribs (fleshy parts are game), upper buttocks, backside of outer leg…I draw the line at boobs:)

I will let you know how things go. So far the set is staying in place, blood sugars are in the low 90’s before and 1 hr after meals but, does not look like I will have to reduce my basal rates. I have been trying to do everything (low CHO) to lower my total daily dose but, my basals are still 2x what they were 10 years ago. I am not certain if it is a component of insulin resistance given my weight gain or something else. It is only 1pm here…so some time to go before I get a whole days worth of bgs.

Can I ask a favor from you all? What sets (degree / angle, cannula length) are you using with these crazy sites? Yes, I called them crazy - it justifies my usage of them! =^D

Oh, and thanks for all the wonderful responses. I feel fortunate to have stumbled across this site.

I wonder if hormone production could have anything to do with the higher dosage. Im under the impression thats the reason you need less insulin at night (less hormone production). So, it would makes sense that if your producing more hormones, you would need more insulin.

Wow! Ive never left my upper belly, not crossing the belly button line =^). Ive heard about the lower back, but again the thought scares me. Maybe Ill just have to try it for that reason. Im going through 2-3 sets each time I move my site, so using 1 on my back / arms / etc shouldnt be to much of a waste if it works.

Im sitting now and you’ve got me prodding my body parts for new sites. gets odd looks from coworkers

thanks for the link!