I have the T4 slim insulin pump. Ive been using it now for about 4 months and absolutely love it after giving myself injections for 30 years!
I use the t-90 infusion set. I was told by my pump educator to change these every three days. But I’m curious how long you have gone before, in between changing infusion sites? Every time I take one off after 3 days there is nothing wrong with this site, and the thing is still working perfectly. The adhesive is still attached perfectly. What is the reasoning behind changing it every 3 days and does everyone follow this protocol?
First of all, it’s great that you can handle three days of insulin infusion with little apparent site irritation. Insulin infusion into the subcutaneous area is naturally irritating to the surrounding tissue. As always it varies from person to person but some irritation is inevitable. The physical movement of insulin into the tissue plus any immune system counteractions make up this irritation.
You may very well be able to run an insulin site past three days with good performance. Studies have found, however, that the incidence of poor absorption and occlusions goes way up after three days. You are tolerating infusion sites well and that’s a positive. What you want is to be able to do that dependably for many more years. Over-irritation of infusion sites can lead to scar tissue build-up and loss of that site for future infusion.
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In addition to @Terry4’s points, another issue is longevity of insulin. The preservatives start to break down once it’s transferred from its glass container into the plastic reservoir. I first learned about this when I (temporarily, alas) switched from Medtronic to the (late lamented) Assante Snap pump. The Snap used the same glass cartridges that are in insulin pens, and for the same reason: the glass is inert, so as long as you don’t overheat it you can use the same pen until it’s exhausted. With the Snap you still had to change infusion sites every 3 days for the reasons @Terry4 cites, but you only had to swap in a new cartridge when the old one ran dry, about every 6-7 days. The infusion sets came in twos, one with a tube attached and one without so you could just swap it in, clip on and go.
This brings up another question I’ve been having about site rotation. I use the Omnipod, and I’ve been trying to rotate in a way I can more easily remember. Since my February diagnosis of “gestational” that turned LADA post delivery, no one had ever explained to me why I needed to rotate at all! Until this forum. Just another reason I’m grateful for tudiabetes!! Now I’m trying to rotate religiously but also in a way I can keep straight in my head.
Following Liam’s dad’s advice, I apply the Omnipod vertically now, so that I can flip it top to bottom on a return pass over the same territory. My question is this: how close is too close for site placement repitition? 2"? 3"? I’ve been going round the belly mostly and per Rose’s advice dedicating my arms to Dex. Occasionally I’ll use a thigh but haven’t been as comfortable with that.
ETA: I use the pods past the 72 hr window til the 80 hr death knell. Rose, didn’t you mention at one point changing your daughter’s site strictly at the 72 hr point?
I also have a t:slim and love the reminder feature to change infusion set every 3 days. That being said, as others have stated, there are reasons why you should and there are many who go past the recommended 3 days.
When I first started on a pump in 1990, I always did 3 days but I was using metal infusion sets. The Teflon were just coming out and when I switched to Teflon, I often went up to 5 days and as Terry stated I would have unexplained highs. Over the years, I learned , it was much better to change every 3 days vs fighting hose highs that start happening around day 4.
I have switched back to metal infusion sets. I have no problems any more with bent canulas or occuslion alarms. But I must change them every 3 days or I start getting some redness.
So I guess, like everyone else has said, there are reasons why, but you need to find what works for you and remember what works now might change in the future. Good luck and the freedom of a pump, Wow! I love the fact I don’t have to feed the insulin peaks any longer and I can sleep in and not worry.
One point about rotation. I useMedtoric and I have found good success with a four to six-site rotation. Side left, side right, back right, back left. If I go a six-day plan I use my upper legs. The advantage for me is that the back is a terrific place for my pump (so i do not overuse it, and hitting the same place twice is unlikely).
The rotation gives me 9 days between sites which is also helpful for some healing. I have used many different rotation methods over the 16 years I have been pumping and I truly love it.
I usually change my quick-set every 3-4 days, generally on Sat/Sun and Weds. I change the reservoir once/week. However, if I go closer to 4 days or beyond, I sometimes notice higher BGs, and change as soon as possible.
For the first month or so after switching to a pump, while I was still a “good” D-mom, I never let her go past 72 hours. As she is 14 now and “pubertizing” big time, she doesn’t get much past 72 hours (if that) without running the Pod completely dry.
The biggest consideration for me, in addition to the excellent comments already made by others, is that keeping a site in for over 3 days puts one at risk for developing lipoatrophy and/or lipodystrophy (sometimes synonymous with scarring if it is permanent). I have read one too many horror stories written by PWD who routinely used sites beyond 3 days and had to eventually stop pumping because they ran out of real estate that was not rendered unusable due to scarring. One unfortunate PWD was struggling to find even tiny areas in which to inject. As I do not expect a cure for Type 1 during my daughter’s lifetime (may I be proven wrong!) preservation of viable real estate is something high on my list.
I usually change sites once a day, sometimes once every two days, sometimes every 12 hours. But this is mostly because I have major problems with infusion set allergies. So, typically, it only takes one day before the site is feeling irritated, getting painful, itching like crazy, or my blood sugar goes high. I use Contact Detach sets (I react much less to the metal needle than I did to the plastic cannulas), so often I will just move the site a few centimetres away from the first site after 24 hours and use it for another 24 hours in the second location, so that each set still gets two days of use, but in slightly different spots. On rare occasions I will have a site that is not irritated at all and my blood sugar is perfect and I’ll leave it in for two or, on very rare occasions, even three days. But other times my body is so reactive that I need to change sites every 12 hours for a few days.
If I leave a set in for longer than 2 days my BGs start to rocket on day 3 due to reduced absorption at the site. I average about 4 days out of a reservoir but have gone longer without any problems.
Changing the infusion site every 3 days also cuts down on getting a possible infection.
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I go through a whole reservoir in 3-4 days, lines up perfectly for site change. Using 8 sites so 20-25 days between re-use helps a lot.
For me, 48 hours is the longest with an infusion set, even the new Minimed Pro set (which they suddenly took off the market until further feedback). I rotate my sites and switch between thighs and stay 3 - 4" inches away. I use the smaller cartridge, which lasts about 4 - 5 days.
Type 1 for just shy of 39 years. MDI most of the time, pump & Dexcom since 2008-09. I was advised to rotate MDI and pump sites for all the reasons mentioned here. Did so very religiously which has worked out very well.
My first pump was the Omnipod which made rotating sites a bit more difficult until I began using this method. I start with the front of the pod, the rounded part with the canulla, facing and 1" to 1.5" away from my belly button. The next pod was in line with the first, same orientation, but 1" further towards my side. Kept doing that until I ran out of reasonably flat spots to place the pod. Then I moved up or down or switched sides and started a new ‘row’.
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I’ve been pumping for almost 19 years now and I’ve had 3ml pumps all along. This meant that I could keep the same set for up to 4-5 days. This has led to plenty of scars (small dots) and hardness under the skin. The absorption also starts to decrease after 2 days, even though we don’t see the redness or any other irritation.
My last pump is a 1.8ml one, and I took it just for the purpose of being forced to change the set every 3 days. I have seen positive results in terms of insulin sensitivity and less irritation on the skin and under it.
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I’ll probably get shouted down for this, I certainly have on other forums, but I can go 7-10 days per infusion site with no issues. I’ve been using Softsets (no longer around AFAIK), and Quicksets since 1999. Longest was 14 days, when I was a poor student and supplies were not subsidised.
Obviously if something does go wrong, I change everything quickly, but I’d say 95% of the time my set works just as well day 7 as day one.
I know my way of doing things isn’t recommended blah blah blah, but my HbA1c is pretty fabulous, I have no lipodystrophy, so I shall keep on with my lazy pump lifestyle. It’s worked splendidly for me for 18 years…
Regarding infections, I’ve had a couple, back in the Softset days, but they were minor and I’ve never required antibiotics, just a swipe with an alcowipe.
Whole different story with the first Medtronic CGMS though! Couldn’t tolerate that for more than a day at a time without massive reactions and occasional infections requiring antibiotics. I use Freestyle Libre now, no reactions at all. Yay.
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I routinely go 5 or so days between changes, sometimes as much as a week with no problems. You are not alone! I do, however, fully understand the risks of this. I always have supplies with me to change at a moment’s notice. I just figured it’s better to leave a sight with great absorption alone rather than switching and possibly having poorer absorption in a different sight.
One of my tricks is to leave working site still inserted for a short time after new site to make sure it is up and running. Problems would sometimes arise if I had to change site before leaving for work. All would be well until first bolus and no delivery so I’ll just switch tubing to old site until I can get home and re-do everything.
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When I was working I would do the exact same thing as you. I have a bad time with site changes. I sometimes insert my cannula in a vein. My bloodsugars rise when no food has been eaten or corrections don’t lower it. I have been thinking of ttying every 4 days to see how it goes.
I purposely load my cartridge to what I need for 3 days plus a little extra