Infusion site failure

I have been pumping for 18 years, always on a minimed pump. I now use a 522, quick sets and Novolog. Recently my sites have not been lasting as long as they should. Upper abdomin 24 hours, lover and buttocks almost 48. When my site fails I feel it start to itch, I then take my BS which is 280 and over and spilling trace ketones. This is after a check 2 hours before of 140. Any hints and suggestions would be helpful…thanks.

Have you tried using the backs of your arms? I’ve got some significant scar tissue on my abdomen that really limits my ability to get good absorption. Lately, I’ve been using my arms, and I’ve found that my sites are lasting longer.

Another option is on your upper thighs. I’ve had pretty decent luck there, too.

No, I haven’t tried that. One of the theories of why this is happening is of beening on the pump so long and the tissues using the abiltiy to absorb. Thanks for the suggestion, I will try that.

I have been on pump therapy for 14 years. I went through a period where I got significant irritation from my sites, I had to switch to the bent needle infusion sets for a while and that helped. After that I changed to Insets, but I don’t think they have those for MM pumps, just the ones that use leur lock connecitons like the old MM pumps did. I do still have certain areas that are more sensitive and I just stay away from those, but they aren’t as wide-soread as yours sounds. Have you tried putting a piece of IV3000 or Tegaderm down (with a hole cut in the middle) before you insert the set as a barrier? Or do you use Skin Tac or I.V. Prep as a barrier between your skin and the set adhesive?

I have never tried the back of my arms. I just can’t envision that being comfortable. I know when my husband has accidentally given me glucagon too far from the top muscular part of my arm, it is painful for days. I have tried my thighs, but those sites always bleed like crazy when I take the site out. I mean, gushing, so I don’t use them very often. I figure with 23 years of injections into my thighs before I went on the pump, I have even more scar tissue there.

You might try changing from Novolog to Humalog. I had to do that in reverse. I used Humalog for a long time and then it started burning and turning the site red within a short period of time. I switched to Novolog and that went away.

The high BGs might not be an absorption issue. Whenever an irritation or infection happens in an infusion site, it can raise BGs. (You already know that, I’m sure.)

Experiment with changing different things or different combinations of things and maybe you fix the problem.

Good luck!


Are you using Quicksets with 9mm or 6mm cannula? The 9mm kinked often and itched / hurt. The 6mm works great for me.

I would echo Shannon’s suggestion for the arms. I tried the back of my arm for the first time last week. I don’t have much fat there so I thought that it might be painful, but it was great. It’s always good to have more options of where to move the set.

I also use my thighs a lot. I put it on the side of the thigh anywhere that I don’t sit on (I always sit down when I insert the infusion set so that I won’t put it somewhere where I would constantly sit on the site). Another site that I like is the ‘love handles’. More rotation will may for better absorption on the long run.

I used exclusively my buttocks for a couple years. Now there is so much scar tissue that I can’t use it. :frowning:

Same thing happened to me. I got some great ideas from members in this post, and I’m also keeping a log of my sites, so I don’t go within a square inch of a site within a 30 day period. I have not used my lower abdomen in over a year. I get my husband to help me put it in my back and other out-of-the-way areas. Still, rarely can I go more than 48 hours without a change. I also use the 6mm cannula in areas where I don’t have as much fat. Being on TuDiabetes has given me the support and encouragement to deal with this.

Thanks for all the advice. I use the 9mm canula, I am overwieght and have alot of fat. LOL That is part of the reason I have not used the front of my abdomin for sites, I first tried Humilog and my sites did not last a day, but that was when Velosolin was taken off the market. (which I never had site failure with). I had the same problem I was high with samll ketones, I was getting some insulin but not enough. I knew I would get some good advice from fellow pumpers…THANKS.

Almost lasted 48 on lower back. Had to change site 378 and samll ketones form 130 at 2 and bolusing for a meal. I am trying my my thigh.

Are you experiencing any swelling along with the itching? You may have developed an allergy or sensitivity to something in the insulin… I had been using Novolog pretty much since it came out and I am unable to use it anymore… it makes me itch and I get swollen lumps at my infusion sites fairly quickly… I was having site failures after 36 hours or so.

I switched to Apidra and things improved a LOT - I still occasionally have some itching, but nowhere near the amount of irritation I had before. I can easily get my sites to last a full 3 days now… usually when I change one it’s because it’s just not sticking very well, not because it’s not working.

I am overweight and I use my stomach. Give it a try.

Trying a Sure-T. that seems to be working beter than the quick set. I have used my stomach for over 24 hours so far.I think my butt, hip area has alot of scar tissue, so no set would work, I used my stomach and the Sure-T and it is lasting more than 24hours. I think the canula must have been kinking when used htere. Thanks for al the advise it certainally did help! : )

When I first started pumping, I tried the Quick Set. It was a disaster for me! I’m slender, so they gave me the Silhouette, which I insert manually. Works like a charm!

Thanks for starting this discussion Sue, I enjoyed reading all the responses.

I’m curious if anyone has had trouble with sites leaking with large boluses? I’m a type 1, or at least that’s what I was diagnosed 15 years ago but I’ve always been overweight, more so now than when i was diagnosed years ago. I just started on a pump but my CDE/pump-start trainer was taken back by how much insulin I might bolus on a high carb meal with a 1:5 I:C ratio at evenings. Anyway, I’ve found while a site might work the first 24 hours, after that, on large boluses, I inevidably have slight leakage from the site. I’ve read this is called tunneling. I was using the Inset infusion sets (Humalog insulin) and the trainer thought maybe I was having a reaction to the silicon sets so I’ve started using contact detach for two reasons (1) they are metal needle, and (2) they have the seperate disconnect that should prevent as much accidental tugging, etc., that might cause tunneling to happen. Well I noticed yesterday (Thanksgiving) that I was having leakage issues only a few hours after putting in the new contact detach site. I’ve heard of trying to stablize the sites but what little I’ve tried had no effect. I never had trouble with a syringe so I find it odd that with a pump site it leaks back out…guess that’s part of having something inside all the time?

Dave–thanks for your response and sorry for the delay. I’m on a computer 8-10 hours a day at work so when I get home I’m not on the computer much. The brand I use is an UnoMedical Contact Detach. I’m still new to the lingo so does “contact detach” describe the type of set vs the brand name?

As far as what I see/feel, it’s always very obvious–the white pad surrounding the needle (contact detach) or disconnect (inset) will be wet plus the smell of insulin. These are typically with large boluses where there is sufficient insulin to do so; which begs the question how often is it happening when it’s too small to notice. I typically use my stomach area and I’ve had this trouble off and on with various sites but the frustrating thing to me is I’ve yet to find the “don’t use this area” areas that consistently do it–if so I’d avoid those areas for new sites.

Sometimes I have trouble with the adhesive working loose but not very frequently. I use IV Prep and although the CDE gave me some other wipes to try I haven’t used them. I got a very brief education on using the IV3000 about cutting a hole in the middle and using the IV3000 to basically cover the connection with just enough cut out so that I could disconnnect. I found that this just meant the insulin leaked under the IV3000 plus when I would go to take off the IV3000 I’d have a huge red patch on my skin from removing it–not sure if the adhesive remover works on it? Honestly, I was so frustrated with it I gave up although I still have the box. I’d WELCOME more education as to how to use them. The instructions indicate you leave it solid and puncture through it but that wasn’t the education I got.

Thanks again for your time!

The one thing that I found when I started pumping insulin in 1993 was that ANY straight in infusion set gave me problems. Mind you this may be more because I’m a thin Type 1 that often bends my abdomen in all kinds of ways while working in a factory.
Anyway what I found was that the base pulled the needle or canula part way out, apparently when i happened to move in such a way that the base was in the middle of a fold. This made the tape “tent” away from the skin, with less of it below skin level. Then when I straightened up it would push back in naturally. With steel needles (which I stopped using as soon as I found Teflon canulas that were suddenly available in early '94) this led to a lot of damage and/or leakage.
Then I found the (then new) Tenders (aka Comforts or Silhouettes) and have used nothing else since. These avoided the whole problem I’d had before that time. Since the canula goes to the side of the plasti base disk it can flex outside of the body without affecting the working part of the tube nbelow skin level. Basically a strain relief.
Maybe you should consider Unimedical Tenders (aka Comforts or Silhouettes)?

Does different Kind of fast acting insulin really make difference ?

How are you doing with the infusion sites now ?

I have pumped almost 16 years, and always on Humalog.

Here is my story :slight_smile:
I have pumped insulin on Medtronic pump for 16 years now.
The first 10 years, delivery was accurate and I never had much of problems.
My control is within non-diabetics level.

About 6 year ago, I got no insulting delivery or partial delivery, so
often got unusually high. So I switched back and forth
between all the infusion sets in order for some kind of the infusion sets to work.
2 months ago I switched off Silhouette since it stopped working, back on
Sure T. But it worked a couple of weeks. I had to change the set
every 1 1/2 days.
And it’s getting shorter and shorter time for a Sure-T to work.
Right now, it’d be good luck if it works overnight that long.
I am seriously thinking about going back to injections.
Any better long term insulin to use these days. I actually attempted a couple
of years ago after all the existing Medtronic infusion sets failed on me.

Any other pump manufacturers carried REALLY different infusion sets
that may change the dynamics of working or not working. I remember
that I studied a few years ago, they do not seem to any difference in
terms of infusion sets. i.e. either canola or metal inside your body.

I have used upper arm, thighs, waist, butt. No luck of success.

Anyone any comment ? I am really frustrated. During the day time,
I resort to needle injection currently.