Increased failure rate of infusion sets recently

Hi all,

I have for a long time had bad luck with sites lasting the full 3 days, but recently every site has failed early, usually before the 2 day mark. The sets in question are the Tandem AutoSoft XC (9mm). I thought it was perhaps a bad box, but the issue has continued with those from a new box as well.

Before my issues were related to hard tissue buildup from many years of using a pump and putting the sites in the same relative area, but I have branched out and us more areas now without the tissue buildup and that helped considerably. Even before then it was maybe a few a month that didn’t last 3 days, now it doesn’t seem to matter what I do or where I put it every single one fails prematurely, and much more prematurely than usual. I’ve had 2 in the past week that didn’t make it a day. Mostly what happens is they start leaking, but I have also had it where insulin just isn’t absorbing.

Has anyone else been having this problem, or does anyone have any ideas I could try? It is about to drive me crazy as I can no longer rely on my pump to work reliably. I have had to start taking syringes with insulin with me any time I am going away from home for more than a short time which really defeats the purpose of a pump :slightly_smiling_face:

Sometimes that means the cannula got bent on insertion. When I first started Tandem with XCs, I had this happen. I watched the training videos and followed them better. For me, pinching up my skin helps. The video shows it, but not mentioned. Also, forgeting to do the twist on the needle cover can mess up the insertion too.

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I have been having the same problem with pods lately. Although I seem to have more of an issue with certain lots.

But in talking to Insulet, their suggestions were to make sure the pod is secure, even though they don’t come off of me. I guess the more movement the cannula can make, then tunneling can then occur. So for me to try securing it with Skin Tac. That didn’t seem to make a difference for me. Also besides pinching up the skin for when it inserts to also pressing down on my pod. And I was told to try totally new areas. Which I was starting to do.

I have also been told that certain insulins are more likely to clog pumps. Humalog being one I guess that might. I have also heard Fiasp might.

I know I wear pods, which are different, but just in case it helps. In my case I am back to the latest lot of pods and not having any issues. In my case I still haven’t figured out what is causing my issues!

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I have a couple of suggestions. I also have site failure issues.
I figured out that my sites can only absorb 50 units per day max, and sometimes more And my sites fail.
I started taking 10 units of lantus per day and this allows my sites to rest and not be overwhelmed.
It’s working nicely, and it also helps me during site changes, which usually causes me to spike after a site change but that no longer happens.
I changed my diet to eating lower fat and high carbs only no processed carbs and my insulin use has reduced to about 40 units per day but I still take the 10 units of lantus because I stay more stable. Reducing me to 30 units of pumped insulin per day.
My sites always last 3 days now.

Secondly you are using long cannulas. Those have always cause problems for me I use 6mm and I insert manually on an angle and I have better luck with less tunneling and leaking.

There is no one way to skin a cat. You will figure it out if you try different things.

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I never thought I would say this but a recent test of the Tandem Tru steel has me ready to switch to that. I have tried the XL and the Varisoft slanted manual inserter. The latter leaves a big hole that scabs over, otherwise I like it also. I use the Tru steel for 4 days with no problem. And the hole left is tiny and heals quickly like my Medtronic quicksets did.
I use 3 rows across my abdomen and I have long rows so I have no problem with tissue healing, at least not now that I am back to inserters that don’t leave insane holes in my tissue.
I am fortunate in that I don’t have issues with skin allergies that cause me to have to remove it. And the trusteel should not have any blockages. my two cents.

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I also use only 6 mm (XC). My initial free samples from Tandem had 6 and 9mm, and confirmed 6mm worked best. (May be longer if using the slanted sets.)

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I never had problems with kinked infusion sets when I was using Medtronic/Minimed pumps and was using Teflon sites for the later years. Switched to Tandem and started having kinking problems. First got some samples from my trainer with shorter length and it was still a no go. So I made the switch the TruSteel. I hated those first metal sets from back in the day but these are much easier to use. I use the 6 mm length and am very fortunate to not have to use a lot of insulin and have been very fortunate to have no absorption issues even after 32 years of pump.
It really doesn’t matter how great a pump might be. The deal breaker is always the I fusion set. And so frustrating when you find your perfect one and it gets discontinued! I do recommend trying for some samples of the different ones out there.

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This was me… only I was changing daily! I actually think my issue was my job (yoga teacher). The deeper I got into my yoga practice the worse my sugar got. I believe I was pulling on the cannula even though it appeared to look fine I was no longer getting the insulin. My doctor said I was crazy… after 14 years I came off my pump and went on Tresiba and the issues stopped. I do believe for some of us the sets are a nightmare.

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I used quicksets with Medtronic for most of my use with Revel and Paradigm pumps. Was less waste due to the separate inserter device that was reusable. To me, that was perfect!

I am a T1 for 32 years. Went from multiple daily injections to a Tandem pump 2.5 years ago with no problems, great improvement in my TIR when combined with a Dexcom (over 90% TIR) in, . Until a few months ago I was changing infusion set every 3 or 4 days, no problems. But a few months ago my infusion sets stopped working after 1 or 2 days. Usually after a bigger meal my BG would just stay constant, no matter how much insulin I pumped. Since I use Tru-Steel infusion, I was able to pull the needle out, check to make certain my insulin was getting through to my body, (no leaks or air) even though it did not change my BG. But I found if I reinserted the Tru-Steel needle back onto another site, my BG would quickly go down. I tried the other Tandem infusion sets, and they had the same problem though of course I could not reinsert the cannula after pulling it out. So I am using a TruSteel infusion set, and check my BG pretty often to make certain the insulin is working as expected, If it isn’t I pull the TruSteel needle out, put it into a fresh site (not a never-used site, just one I have not used recently - when I find a “never-used” site and try it out, there is no difference . and watch my BG. Usually the effect is quick and large enough to see clearly. BG goes down, previous insulin injections have just “disappeared”. So for now I use the TruSteel and re-insert (without changing the cartridge or tubing or anything else except the insertion site) and that works. Still searching for a good solution (maybe switch from Humalog?) but this works for now. Otherwise I will go back to MDI.

You have a similar problem that I have. I decided that each site can only absorb 150 units of insulin. And that means 50 per day. If I go over that the site will crap out no matter which set I’m using.
I started a new WOE and it brought down my insulin needs, and I also started taking a small shot of lantus once a day.

My infusion set sites are back to normal lasting 3 days with no hard spots or irritation.
I really feel like too much insulin is bad for us and I’m trying different things to reduce my insulin requirements while also staying in range.
I exercise after every meal if I can.
I switched to low fat diet
I eat 2 meals a day instead of 3 where I essentially fast 12-16 hours and night and morning combined

So now I’m using around 40 total units and about 30 pumped.
I’m trying to figure out ways to reduce it more if I can.

I only take 30-35 units/day which i believe is a relatively low amount. My suspicion has been that the size of a shot may matter, as I get ‘failures’ most often after my main meal of the day (though it does happen at other times, so …). Also, before I switched to a pump, I tried using FIASP and found my first shot of the day (2 or 3 units) worked immediately as advertised, but for the rest of that day it had no effect on my BG no matter how much I took or how often. Coincidence possibly. In any case, I suspect I will switch back to using pens soon if I can’t find a solution. Barry.

I suggest trying TruSteel cannulas AND also try moving away from the center of the areas where you have been most often inserting.

I had many problems with the Autosoft XC, but it wasn’t the cannulas. It was my body, The random, but frequent, hard fat deposits and scarring from previous injections and infusion were blocking the flow out of the soft plastic cannula.

My Tandem trainer gave me a carton of TruSteel sets to try out. I stopped having problems- even when I cautiously moved into the fringe of the area where I’d had difficulty with Autisoft. The TruSteel needle seems to cut right through any obstacles.

I contacted my Medicare supplier about how to change the reorder to all Trusteel. and explained why. They offered to immediately exchange any unopened cartons of Autosoft.

I haven’t had an infusion site problem since switching to Trustel. (I wish that were true of the Dexcom sensor sites. The G6 sensors only always work in areas where TruSteel cannulas do.

The only legitimate reasons I can see for Autosoft existing are user squeamishness over sticking a needle in, or clumsiness. I doubt that anyone who has been using syringes for more than a month is still squeamish . I’m clumsy and have peripheral numbness in my fingers and haven’t had trouble with insertion.

I don’t believe the suggested 48 hour site change frequency of TruSteel is based on objective testing of the actual product, but was “grandfathered” from testing of older products with thicker longer needles used as catheters. I’ve stuck to a 3 day change +/- 8 hours based only on remaining supply and meal timing.

Besides site reliability, I found a lot of advantages to using TruSteel.

My experience is that once I got the knack of holding the wings to insert the Trusteel cannulas the insertion is overall less painful than injection because I can’t accidentally move the needle at an angle once it’s through the skin. The extra hold-down makes it easier to detach the pump temporarily and eliminates the need for a tape hold down to protect against tear-out of the tubing gets snagged. More than 2 insertion sets fit in space that one Autosoft inserter set would occupy and pairs of them are a more convenient shape for transporting.

Finally, if I ever hit a bad site, with TruSteel I could change just the cannula, do a “Change cartridge” reinserting the same one, and do a minimum fill of 10 units. That’s not just easier than doing a full change of Autosoft, it wastes a lot less insulin.

Btw, my TDD is around 40 units, with boluses up to 5.5 units. “Virgin” sites seem to work very slightly better than ones in often-used zones, but my TDD varies enough from day to day that I have no objective evidence, just a feeling.

So I used to use humalog a few years ago before switching to FIASP and I haven’t had issues with either as far as clogs. I think I have had maybe 2 occlusions in the past few years. I don’t think the set or anything is clogged as insulin still flows out of it well.

I tried 6mm ones some before and they didn’t work for me. The site would fail much faster (though compared to what I’m dealing with now I would say it fails the same amount lol). I am a little chunky and have pretty thick skin so I think I need to be able to get in deeper.

I do think there is something to that, despite what one endo I used to see said (he seemed to believe that big boluses and stuff had no effect). I usually am in the 70s range of daily dose, sometimes even 90s or up to the 100s if it is a heavy carb day. I am considering asking about one of the GPL-1 meds that can lower insulin resistance.

In regards to TruSteel: I used to use those in the past but switched due to discomfort and because I disliked having that extra little tube that always seemed awkward to secure so it didn’t get caught on anything. They are also harder to disconnect/reconnect (unless they have redesigned that) requiring 2 hands for me usually. It was nice knowing that any issue definitely wasn’t the cannula getting kinked. I may consider trying them again but I am on the fence. I don’t recall them lasting any longer though, but I could be wrong as it has been quite a while since I used them last.

Also in regards to bent cannulas, I don’t usually have problems with that. They usually go in pretty smooth. I do have them on occasion but usually it is expected because something happened. Actually the last bent one I had lasted a full 3 days and I didn’t notice it until I pulled it out. That one was caused by the site shifting shortly after insertion (I have to use an added adhesive and if I don’t wait long enough for it to dry before insertion then it can sometimes get shifted).

Tru-Steel was the answer for me. No weird inserter springs to fail, just swab, insert, and secure with a latex-free bandaid. Getting my total insulin usage down, by restricting carbs helped too, plus I lost weight I didn’t need.

I am using the auto soft 30 by tandem and have had better absorption with the soft 30 because the canula goes in at an angle more into the upper layer of fat and I also use iv prep before inserting, holds really well. I have gone thru the gambit of things, been a diabetic type 1 for 54 years been on a pump for 20+ (Medtronic) just got the tandem in May 1 2022 and after some trial and error I got into the auto soft 30 much much better then the 90 insert. I am, was running out of good insertion sites. So don’t go straight go at an angle. Good luck Al

My experience with various insulins (t:slim c2) is:

  • Humalog (including the generic) and novolog, no difference, no problems up to 5 days use of a cartridge/site.
  • Lyumjev, works for about 160U delivered, then the site gets tender and it takes 2-3X as much insulin to get the job done. Also, it is really bad at bringing down a large high BG.
  • Fiasp, great response, works pretty well for large highs, but after exactly 3 days, I get an occlusion 100% of the time. Still my favorite juice.

Obviously everybody is different.

Now, a question for the audience. I have always used a 9mm cannula length and about 170U/day. But…over the past 6 months I have lost 76 pounds - due to two flavors of cancer and the resulting surgeries and chemo. I’m still not skinny (195#). Should I consider changing to shorter cannula length?

Congrats on the weight loss. When u lose a large about of weight u may still have excess skin and fatty areas in different places like the abdomen. You can always try the shorter length but if the 9mm is working for you…

Unfortunately, I can’t recommend the “diet” that gave me the weight loss: two different cancers requiring multiple surgeries, six months of chemo and radiation (the latter causing gut bleeding of three pints of blood). Exercise and eating less would have been a better choice if I had a choice. But on the bright side, I can eat just about anything and I still lose weight. And RBC’s, and WBC’s, and creatinine, etc.

Rob