Hi everyone. I have searched a bit on this topic but haven't turned up much yet. I am new to having a pump and have been on it about three months and so far am loving every bit of it!
That is, with one exception relating to changing the infusion site....
So, I understand the need to change your site every 3 days, but I'm finding that by the third day, my site is working awesome and my BG is responding to the insulin and basal/bolus rates exactly as I'd expect it to.. the problem comes on the morning that I change the infusion site.
I often change the site before breakfast, and find that two hours after breakfast, i'm always sky high. Same thing before lunch, and after lunch... I bolus and bolus throughout the day and most of the time, I'm more or less in check by the end of the first day.
I should add that I'm using the quick-set infusion set and have tried some others, but came back to this one. I've never had a bad set with the quick set but have had bad sets with other types.
Its almost as if it takes 1/2 to 3/4 of a day for my injection sites to "work" so to speak... Does anyone else ever have similar results after changing sites? Any feedback or advice would be much appreciated. Thanks everyone
I've heard of others saying this. I haven't seemed to experience this problem, but I can't say I'm doing anything different or special. I think like a lot of things, everybody is different. Hope you find a solution that works well for you.
I tend to run a little high 2 hours after breakfast and can bring it back down before lunch with a simple correction. Acidrock has said that he bumps up his basal (he calls it running hot) when he changes sites and finds that that keeps his blood sugars in range. You might just take an extra 1/2 unit or even a full unit with your meal and just watch carefully over the next few hours.
Maurie is correct. I had the suggestion from Ginger Vieira, who doesn't pump but knew someone with whom she'd discussed the idea. The theory is that the insertion is traumatic and impairs absorption of insulin for a while. While it's impaired, like if you have steroids, stress or other BG "boosters" a basal boost will counter the BG boost. I like basals b/c they are "softer" than taking an extra unit or two as Maurie suggested but, in the end, at .8U/ hour, that's a unit or two anyway. W/ a basal though if I do 1.6U/ hour instead of .8U, I can turn it off when I perceive the site to be working when my BG is sitting where I want it to. This is obviously easier with a CGM but a couple tests would cover it too.
I also will run high after a site change, doesn't matter what infusion set I use, the location of the new site, or the time of day I change sites. I just automatically correct with a bolus, for me around .8 to 1 unit moderates the spike. At times I need to do a additional correction at 2 hours if I feel I am still trending upwards. Usually within 4 hours, I have stabalized and will begin to trend downwards if my sugar is elevated, or will maintain in my target ranges. And I have seen others post similar problems on other forums, so this does not appear to be an abnormal occurance, with most people noting they either increase basal or add a bolus to cover the spike in sugars with the site change. Good luck!
There's actually no reason to take the old infusion set out right away, you can leave the old one in for 4 hours and bolus for breakfast on the old infusion set if it's still working and put the new one in at breakfast so it's warmed up for lunch.
I have the same issue and I agree with Jeff C below. I keep my old site in while the new one gets warm and switch about 3 to 4 hours later. Here is another trick a CDE told me once that works occasionally. Upon change push about 5 U and then set up normal basil for about 2 hours before you check. This implies that you dose for breakfast in the old site, before you remove it. You have to be very careful however, because this has driven me to an unexpected low. I gave it up because it was not working the best for me. If I was not low I was high, so I found the idea of placing a new site and not using it a better alternative.
Let me know how it turns out, this issue drives me nuts.
Thanks everyone for the feedback… I will definitely try some of these options (use the original site for 1/2 a day before swapping to the new one, or adding a temporary basal for a few hours while the new site sets up)
Most of all, I’m pleased to hear that this is more common for others and not just something happening to me.
My infusion sites are best when new, I do prim a little more than recamended but by day three I can usaly run a 110% temp. I usaly get 3 days but compleatly reject the steel sets (Sure-T) in about 24 -36 hrs.
If you are not adding a few units after inserting the infusion set there may not be enough insulin surface area to get affective absorption of the dosed insulin. I been on the pump for 16+ years and I add 2.5 units to the new infusion site even though the infusion line and needle have been filled before injecting the infusion set.
I came up with the 2.5 u # by tracking bg post infusion site injection and seeing no change in bg. This mean, like with basal testing, steady bg before, no meal or dose to adjust bg, and measuring for several hours. If I done add the extra post new set, my bg will rise and the I:C ratio will be way off.
Some CDE’s call this extra insulin a pool to set the site or prime the site.
Thanks S Woodward for the information - that is interesting and something I haven't heard of before... so just to be clear, you prime your infusion set before inserting it, then you instantly bolus 2.5 units after the insertion of the site to create a pool of insulin to help the site set up?
My Endo told me to do a temp basal on days that I change my site. For me a temp basal of 75% for 4 huurs seems to work. Before that I was always high (200+) 2-3 hours after changing.
OH, great to hear you're liking your pump. I restart mine tomorrow. I'm going to bring this up to my pump nurse about higher after changing sets. maybe I'll look into quick set, she wanted me to try the sure-t as it's metal and doesn't bend but she also said one has to change it out every 3 days. thanks for this post....very useful info!
When I called Medtronic helpline, they told me that the Sure-T infusion set should be changed every 2 days, not every 3. Good Luck on your pump re-start tomorrow :)
Right after the infusion set is connected I bolus 2.5 and add whatever needed for a meal. I stay away from temp basal to cover set change, it seems to take several hours to get back on track with the temp basal for me. It is best to ry it w/o eating a meal and starting with a BG in range and not changing.
It has worked for me, hot you can find a way to feel as you are under control again.
That is an interesting recommendation from a not professional.
My understanding from talking with research people is that the reason for changing the infusion set is due to a combination of tow thing, healing and the insulin preservative begins to crystalize in the tissue and the insulin is unable to easily pass through into the body fluids.
The symptoms for me include I:C ratio change, slow rise in BG w/o food, unexplained low BG and corrections that will not lower BG even with high boluses.
I have not seen a real difference in different infusion sets other than the tissue irritation being greater for me with metal sets.
I also do a small bolus after inserting a new set, +1u or more depending on location and my BG at the time of change. Sub Q insulin therapy works by saturation and it can take some time for a new location to achieve the level of saturation necessary.
