How do you deal with rising blood sugars with new infusion sites?

My daughter has been pumping for 3 months. I just wondered if any pump veterans out there would care to share some tips on how to combat the poor absorption on a new site. It takes a good 8 hours for the site to start working as it should. We have been consistently correcting as she climbs higher, but wondered if anyone has any words of wisdom.

I use older Medtronic 723 pump, with Quick-set infusion sets. Through trial and error, I adjusted the amount of “fill cannula” prime, after insert, to avoid BG spike. For me, 1.5 units works for 9 mm cannula.

Are rotating the sites? I’ve never encountered this issue. It sounds like a scar tissue problem.

Likely not scar tissue. The current one is in her upper arm. No scar tissue there.
I just disconnected from site and gave a correction by pen so the pump iob is correct. It doesn’t matter where the site is we always have the same issue.

Strange. I’ve always used my abdomen for my infusion sites. What cannula length are you using?

13mm angled Teflon - the inset 30.

That’s pretty long to be in her arm. I’m just throwing out suggestions here, maybe try a 9mm or even a 6mm.

The angled sets are longer than the 90 degree ones. The other size is 17mm in the angled style. She’s 17 and an adult sized body so she does have some flesh on her arms.this is the first time we’ve tried the arm. She usually uses her abdomen too

I just researched it a little bit. The arms are not recommend to use for infusion sites by the pump companies. I would imagine there’s not a lot of insulin absorption happening.

I either do a startup bolus, or put it on right before a meal and do a meal bolus. Doing a bolus when you put it in helps to get it going.

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I use quickset 9mm and I use 1.0 U on my leg and 1.10 U on my abdomen. I understand the issue because I often had the issue for years. I found that I lost weight this got much better. I went down form almost 10U to the current just about 1.00. Now to be fair i lost 170 pounds so it was completely out of proportion.

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Some spots for some reason just don’t absorb as well and I either put up with it or sometimes pretty quickly lately I decide to just put on a new one. It’s better than having days of poor response.

I usually give a shot to make sure I am getting some. Either when my BG is staying higher and not budging or if I am switching it out so I can make sure I get some insulin.

I see a similar time delay sometimes when replacing an infusion set. I use 6mm stainless steel sets “Sure T”

  1. leave old infusion set in place for a few hours.

  2. use “fill canulla” to prime a new site. For me .2 units.

  3. Always check bg more frequently after a change and do corrections.

  4. be more prepared to do another site change if you are not getting positive results in a couple of hours.

Sometimes my bg numbers just stay flat across a site change and sometimes NOT. This issue has been more unpredictable for me than many of the others variables affecting bg.

I use temporary basal settings all the time. Each site is different with me.

@Sprocket1 I normally will infuse 0.15-0.20 units as soon as the new site goes in. If that impacts BG over the next 2-3 hours I’ll use a lower basal rate to compensate. It’s much like the first 24 hrs on a new Dexcom CGM = often flakey :crazy_face:

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Yep, that’s what I was saying, the “Activation Bolus”. But if I start it right before a meal, the meal bolus takes the place of it. And if I do it before a meal, I don’t have to worry about the low that happens after.


If I did change a site immediately before a meal I’d be inclined to inject my bolus (better safe than sorry).

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Okay, I see so you’re kind of priming the site. So I wouldn’t just change it, load cartridge and fill cannula but actually give a small bolus to help things along?

So #2 is not actually filling cannula, but giving a small bolus to nudge it along?

I have never had this problem and been pumping since 1990. Over the years I have used different infusion sets and have finally come back to the metal ones that were the only ones available when I first started. And I always went from the 9mm to 6mm. You might ask your pump rep for different infusion sets to try each kind out. This could be an easy fix. I don’t think it is overuse of sites as she hasn’t been pumping for that long. But I would recommend to rotate, rotate, rotate! That was drilled into my head back in the day. I use my thighs, stomach(upper and lower), hips and buttocks and arms. Anywhere I can find and reach is fair game. Good luck!