Infusion Site Change Spikes

#1

When I change infusion sites, I have trouble controlling my BG for several hours afterwards. My endo tells me that the trauma of the insertion causes the area around the site to be poor at absorbing insulin for a while.

I’ve tried a few strategies to deal with this.

For a while, I would give myself a big bolus into the new infusion site, but this didn’t help much. The insulin would kick in eventually, but there often seemed to be a long delay.

I’ve also tried making the change right before going to bed when my insulin needs are the lowest. This strategy is often but not always effective, but I don’t like going to bed with uncertainty about whether I have a well functioning infusion site or not, especially if I have to make a bedtime correction to my BG.

More recently, I’ve started giving myself an injection with a syringe at the same time I change sites and then increase my basal by 20% for the next six hours. This is a new strategy for me and it seems to work OK, but doesn’t quite eliminate the spikes I get on the first day of an infusion site.

The second day of my infusion sites is usually the best.

I’m curious if other people have similar issues and if anyone has a strategy to suggest. Does anyone use a totally different profile on the first day of an infusion site vs the second?
Thank you for your advice in advance!

#2

Which insulin infusion pump, infusion set, and infusion sites do you use? How long (how many years) have you been using your favored infusion sites?

I had this problem particularly with the Omnipod system but have experienced this phenomenom with tubed systems, too.

Have you tried using infusion sites you’ve never used before?

My experience is that I can dependably eliminate any post infusion site change highs.

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#3

I use the Tandem pump. I’ve been using infusion sites on my abdomen the whole time I’ve been pumping – maybe 15 years, I can’t remember exactly.
I use angled infusion sets which insert with a spring. Tandem calls them Autosoft 30s. (I think they were Comfort 30s when I was on Animas). Years ago I used manually inserted angled sets (no spring). I have to admit that they seemed to work better, but I really hated the process of inserting them.
My infusion sites look pretty good to me. I don’t notice any scarring or hardened areas.
I tried my upper butt a couple times years ago, but it’s uncomfortable because my pants tend to rub up against the site.
I guess I can’t quite imagine using a tubed pump on my arms or legs in terms of freedom of movement and clothes rubbing.

#4

My daughter has always had to take a small injection with site changes, with both the Animas & t:slim pumps. Changing brands of infusion sets never made a difference. It was worse with steel sets. We’ve been told the same, it’s from inflammation due to insertion. I’ve heard the same from many parents, so it’s seems to not be uncommon.

#5

I am sorry to say I have never had this problem but can maybe understand it if you are using one of the auto injection infusion sets. In my 29 years pumping, I have always used a manual insert.
And the problem could be the infusion set. Most problems with pumps are the infusion set not the pump. And I went back to the steel infusion sets about 5 years ago and love them. I never have any issues, ever!
My only suggestion would be to ask for different samples from your pump rep or doctor to see if there is something else that might work better for you. And so sorry to say, you really should try those out of the way spots. I use my arm outer and underside, my hips and buttocks, upper and lower abdomen and my thighs. I just tape things down and I just have learned to pull my pants down slowly no matter where I have the infusion set placed. I hope you can find the right infusion set and can find some new and interesting places to put them. It was drilled into my way back when that site rotation is everything!

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#6

What Sally said. You couldn’t pay me to use cannulas again. Highs after set changes, no-delivery problems, soreness, redness, swelling at the site. I have none of that occur with Sure-T’s.

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#7

i third this. steel sets and using my arms, legs, chest and butt area give me enough sites that i never you my abdomen. My abdomen gives me the poorest results of any area, and I actually prefer setting in large muscle groups for faster absorption.

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#8

This happens to me sometimes. I blame it on being chunkier in some places. It seems to take longer in certain of thsoe ahh fold areas.

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#9

I have noticed this too. My strategy for now to give it some time to settle in and use a syringe for the next meal. Sometimes it is not convenient so I just deal with the spike. A few times I have left the old connection set in ( I use sure-t infusion set) and go ahead and put the new set in. When it is time to hook up again, I use the old set (just the bottom part as sure-t comes with two sections) for a couple of hours before connecting to the new one. Again, convenience comes into play on whether I do either one of these. Sometimes life happens and I am joining in.

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#10

Might it depend on where you are placing your pump? I have experienced poor absorption when I put my Omnipod in areas that are not fatty, and too muscular. It seems that when the canula is feeding insulin into a muscle (or very rarely, a shallow vein) instead of fatty tissue, I run consistently high.

I’ve also found that when giving a huge bolus (like a super-bolus to combat a high-carb meal), my pod often leaks and doesn’t deliver the insulin as intended, anyway. This is a waste of insulin and results in poor management. Therefore I’ll need an extra short-acting shot, similar to what you’re already doing for yourself at night.

It sounds like you’re very on top of this issue and trying everything possible to keep your BG leveled. Is it possible to try overlapping your site change times, like maybe giving a shot BEFORE changing your site to avoid the BG rise during poor absorption time?

#11

Thank you all for your suggestions.
I definitely think that if I’m on top of giving myself a shot before the change, that should help with the big spike and then upping my basal for a period of several hours.
I’m intrigued by the many recommendations of steel infusion sets. I’ve never used one. The idea of having a needle remaining inside me put me off.
Those of you who use steel, do you ever have discomfort if you lie on or get pressure on the spot where the infusion set is?
Other than the initial absorption problems, I’ve found flexible cannulas to be fine. I don’t get inclusions or leakage unless I leave an infusion site in for too long.

#12

I have problems if the insertion is very painful. I’ve seen this so many times over the years. When it happens I just pull it out and put another in at a different location. .

#13

One other thing. I’ve read that steel sets need to be changed every two days while plastic cannulas can be left in for three. Any idea why that is? To me that indicates that the steel causes more inflammation or damage to the infusion site, but maybe that’s not the reason.

#14

What you read about 2-day changes was mostly due to when Sure-T’s were introduced they were designed primarily for youngsters. Because of their strong immune response, it was good policy for those sets to be changed every 2 days. It wasn’t long before adults found that those sets work well for them too. There is no need to change Sure-T or similar sets every 2 days. None at all.

#15

When I first started pumping, cannula-type infusion sets hadn’t been introduced for diabetes care. Only steel sets were available and the guidance was the same as today for cannula-type sets - change every 2-3 days. I don’t think there’s need to change steel sets more frequently. I was using sets for 5-6 days in the first few years I was pumping, unless the site became painful. In hindsight I wish I had changed more frequently. I think I have more scarring as a result.

#16

I had a ton of scarring from using about a decades worth or more of cannulas. Switching to Sure-t’s greatly reduced scarring to an imperceptible level after a number of years following the switch. Same schedule of set changes (around 3 days) and same locations. My body didn’t like cannulas. They would itch, get red and irritated and puff up nearly every time. I don’t feel the Sure-T’s and sometimes I even forget to remove the previous one and a couple days later I might finally realize I’m wearing 2. LOL! I’ve gotten a lot better about removing the old one prior to installing the new one. :slight_smile:

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#17

Based on this community’s multiple recommendations, I’ve tried Tandem’s version of Sure-Ts (TruSteel – why they chose the same name as my spinoff of 80s hit Remington Steele, I have no idea :slight_smile: )
I like it. I don’t feel it when it’s in at all and I’ve found the insertion more comfortable than the harpoon of the spring loaded angled sets.

I find it a little trickier to attach and detach (the clip is smaller), but not hugely so.

I’ve only used two sets, but, as far as I can tell, it doesn’t actually help with the infusion site change spikes. The insulin still seems to absorb poorly for at least several hours.

I was at a JDRF event on Saturday and a researcher mentioned that there’s some work being done on infusion sets where the patch that holds the set in place is also infused with medication that would calm site-insertion inflammation which sounds very clever.

One more random question. Does anyone use those little pieces that come with all infusion sets which you can clip onto the point where the tubing clips on when you have your pump detached? Do they serve any purpose?

#18

those are good for swimming in dirty water (assume anywhere you swim is “dirty”)

You may have built up scar tissue from the use of the previous types of sets. I sure did. it took a long time for the tissue to return to normal.

#19

“good for swimming in dirty water”

But water doesn’t get in, does it?

“You may have built up scar tissue”
I’m not aware of any scarring. Can’t you feel hard spots when there’s scarring?

#20

The port itself could collect bacteria if not covered. Then when you hook back up, that bacteria could enter the tubing. But you are correct that the elastomer “valve” will prevent ingress of fluids into the line during disconnection.