I think it was acidrock23 who wrote in some other discussion that he used to either bolus or adjust his basal (this I can´t remember) when putting in a new set based on some theory that the change in itself will cause stress that will elevate your blood sugar for a couple of hours. I also think he had found this tip in a book by a female(?) writer.
Does this ring any bells?
And do any of you experience that some more insulin will help when changing your infusion set?
I think you need to be careful with that. If you wear a CGM and noticed your arrow going straight up, you might want to add a little to your bolus. But I would not assume that your BG is shooting up just because you’re changing your set. Better to do a correction later, if necessary.
I agree with etta. You need to wait and see. Ive read where even a 10 minute disruption in basal (because youre changing your pump/infusion set) have caused some people's BS to spike a bit. I personally never a spike more than 30 points, but that was a couple of hours later, and may have not even been from the changing.
I say wait and play it by ear and see how your body adjusts/reacts to changes. I certainly wouldnt assume youre going to spike and give a bolus in anticipation for it.
OK. Thanks for your concern and advice, etta arny.
Thanks, Dan. I thought it could be a bit like the dawn phenomenon,- if you get enough insulin early on the spike will be prohibited. I used to pump for 20 years and I´m going back to pumping again tomorrow. The most stressful moments I remember having on the pump was to wait and see if the new infusion set was a successful one or not. Mostly it wasn´t, so this time I want to be prepared and have my tool box filled with good advises when something happens.
I got a comment from acidrock23 and he wrote this which is the answer to my question:
I usually turn up my basal to 200% if I perceive a site change isn't quite going well. I have a CGM so I can tell what's going on going into them pretty well and haven't been doing it as much lately as things are running smoothly. If I think it's going or might go up, or perhaps if it's painful or a few wierd spots, like over my hipbones, pretty far out there, maybe not an "official" spot on the chart, I'll crank it up to 200% basal to get it going. I heard from one of my FB friends, Ginger Vieira, who's also here @ Tu and has written several books (of which I've read one, Your Diabetes Science Experiment, which was very good...) who put up what I guess would be a theory that the trauma of the insertion causes inflammation slowing the rate of absorption. It makes sense to me. I'm sure doctors wouldn't recommend it because 1) taking insulin is super dangerous and 2) who cares if your BG is 180-200-etc.?
I opt for the bigger-than-suggested cannula prime, because I was getting consistently slightly high numbers an hour or two after site changes. I think I currently use 1 unit instead of the suggested .3, but with a basal rate of generally 1.3u/hr thats still not a very big increase. (I guess thats about the equivalent of 175% for one hour, now that I finally decided to do the math!)
I've also heard that a big bolus can help clear any obstructions at the tip of the cannula, so changing right before a meal bolus enables you to shove a bunch of insulin through in a legit and non-problem causing fashion.
Another option though is to insert the new site, and continue to use the old one for a few hours until the new one has "settled in". I've not tried this, but I see the usefulness of it if you are organized enough to remember to switch over a few hours later.
I have heard the theory of the actual insertion of the infusion set causing inflammation to the area which hinders absorbtion, and I agree that from what I've seen, it makes sense. I also know my sites are generally happiest on day 2, so I'll buy that theory even more.
Thanks for the reply, Skye. You reflect all my thoughts and my experiences. I think I might have had extra strong inflammations from the infusion set because of the teflon in itself. That´s why I try out the steel cannulas this time. So far it seems to work much better than teflon. One more thing with steel cannulas is that you don´t need a cannula prime. What I do is to put in a new set before a meal and hope the bolus will do the job with flushing through and clear any obstructions. I will keep in mind that putting my basal to 200% for 1 hour can be a good idea if the bolus in itself is not enough.
And I got a really useful tip from earthling who writes:
"Site-wise I have noticed that nerves and blood vessels seem to go together. When I am inserting my set, if I gently touch the needle tip here and there in the area I want to use, then choose the spot with the least pricking sensation, my set lasts the longest and I rarely get bleeders."
I did this yeaterday and it worked really well.