Infusion Site Lifetime

I have been troubled by short infusion site lifetime lately. It seems that 48 hours is about the time when my sugars will start to rise, even with normal activity and carb intake. I use the Comfort Short infusion sets with an Animas IR1250 pump. If I’m doomed to short site life, I’d like to be able to change the site without having to waste insulin and cartridges. The cartridge for the 1250 could keep me supplied with insulin for at least 4 days. Does anyone know of a manufacturer who sells the infusion set separate from the Luer-lock tubing which attaches to the pump cartridge? If I could change sites every 48 hours, but only reload the pump every 96 hours, it would be a savings in insulin, tubing, and solid waste too!

Hi Tom,

Unfortunately I do not have any personal experience with this set, but MidnightButterflyIris made a reply in the group called Infusion Sets here on tudiabetes, back in October, talking about an infusion set that would work with any pump: www.fifty50medical.com

With my Minimed Paradigm pump reservior cartridge, I can draw up whatever amount of insulin I might be using in the next few days… I don’t have to fill the reservoir. I’m not sure how the reservoir on your Animas IR1250 works, but maybe you could do something like that.

I hope some of this can help you.

-Bill

Hi Tom! I use Comfort (regular length-- which means 17mm instead of 13mm needle length). I usually can keep it in for 5 days with no problems. But I know that the length of time between site changes depends on so many different factors…

I wonder if the length of the cannula could matter? Have you tried out other infusion sets yet?

Tom,
have you thought about scar tissue buildup as being part of your absorption problem? Do you move your site around frequently, or tend to use the same area?

Toni-
I move the sites around the abdomen and sides. I’m a little bit limited on sites with enough thickness of fatty stuff right now. I guess that could be a happy problem, except when you hit muscle tissue, things really don’t work very well in terms of absorption. I generally rotate around the available sites, and don’t revisit a used site for at least 4 set changes, about 12 days. Does that seem like a reasonable rotation rate to you ?

Hi Kristin-
Thanks for that info. 5 days would be really cool. Is your cannula made of teflon or stainless? Mine are teflon, which is nice cause it is soft, but I wonder if it could be causing some kind of allergic response that is blocking things up in short order. Up to now, I’ve not experimented with any different sets or materials. At first I thought my 3rd-day highs were the result of tiny bubbles in the tubing. I usually noted a few bubbles in the cartridge being discarded, so I thought they were more numerous and dense by the time the insulin level in the cartridge was low. But to my surprise, simply changing the site earlier than 3 days has eliminated those late-cycle highs. Thanks again for the suggestion.

I know that’s more frequent than they say to revisit a site, but it’s tough for me too. I wear a cgm also, so I’m really limited in my sites. I wear the pump on my hips and my cgm on my tummy. Have you tried a different infusion set? When I switched from mimined to animas, I kept using the minimed sets, as my insurance will pay a higher % for them (they have an in-state address and Animas does not), and I figured why change if they work.

Hi Toni-
Yeah, I saw your Blog. How are Thelma and Louise today by the way :O)
Next time I see my Endo, I’ll have to ask him about the teflon vs. stainless steel options on the cannula. I have been using only the Unomedical comfort short sets since going on the Animas pump. They go in at a shallow angle, and have a 13mm length. I ought to check out those minimed sets you mentioned. Do you have any details on those set you could give me, or a link to their website? Thanks!

Thelma and Louise are doing just fine. They keep me on my toes!

As for the minimed sets, I use the Quick-set in my belly, and it seems to work well in the leaner tissue. I use the Sof-Set Ultimate Quick Release (QR) on my hips. You can order them from Animas or Minimed. You could call Mini-Med at 1-866-948-6633 and ask to sample one. I know they have done that for me before. They are both teflon. Check out http://www.minimed.com/products/infusionsets/index.html. Is the Unomedical set one of Animas’ brand?

Hi Toni-
This is the link to Animas’s order entry for the infusion set I use currently. Thanks for your link.
-Tom
https://estore.animascorp.com/ProductDetail.aspx?groupid=77&topcategoryid=2&subcategoryid=5

Tom,
I use the inset - by Animas—also on the 1250 pump—it goes straight in, but is only 6mm—each one comes with it’s own inserter. I frequently change my site without changing the cartridge…i waste the new tubing. So if i have a site issue, i just insert a new set, unprimed…remove the tubing at the site, and plug in the old tubing(still attached to my pump) and prime .3 units. (6mm means very little priming is necessary).
I am very insulin sensitive, taking about 17 units total per day…most of the time i get 7 days out of the tubing.(i only fill the cartridge with 130-150 units)…and 4-5 out of the site…sometimes they match in days when i get real lucky with the site.
I almost never change the entire thing out at the same time…maybe once out of 10 times.

That is amazing lifetime. Just out of curiosity, how long have you been on a pump? Are you really active or just really sensitive to insulin by nature? I saw your blog about your brother too. I was diagnosed at age 37 with BS of 780, muscle spasms, fatigue, dehydration, the whole deal. My doc didn’t get the idea that it could be Type-1. He snap-diagnosed me as Type-2, and put me on the pancreas-stimulator meds until they stopped working after a year ( apparently when the last of the Beta cells finally gave it up ). Looking back, I’m still amazed at that diagnosis. I MUST have had Ketones boiling over!

Tom,

If you have a good idea about how much insulin you use between changes, try filling the cartridge with no more than you’ll need. At least you stop wasting insulin, if not infusion sets.

I use the Medtronic and my sites will last forever, but my diabetes trainer says the insulin starts to lose its ‘buffering’ after three day, so I should change that often, as the manufacturer suggests. The fact is that Medtronic sends me more sets than I need every three months. I’ve cancelled a few orders. I’m fortunate to have insurance to pay for it, though.

Terry

If your infusion sets/resevoirs are similar to mine you can put the remaining insulin in the resevoir back into the insulin vial by reversing the steps used to fill the resevoir. I have done that several times. I can certainly understand your not wanting to waste insulin.

Richard

Hi Mollie-
After a week or so of consistently using the little plugs that come with the tubing to plug the set when I disconnect to take a shower, it seems that things are working much better. I wonder if the water from the shower ( or soap ) was intruding into the set since prior to this I’d not been bothering to plug while showering. So far so good. If you were the one that suggested this, many thanks to you!
-Tom

i actually did not suggest that one…but i did learn through the years that having the plug facing down—towards the floor has helped in site life…but my infusions sets go straight in.

Regarding insulin sensitvity—i think it biological—i excercise, but not like crazy…and not super consistent…most of my excercise revolves around playing with 2 young sons 6 and 8 years old. when i was younger i felt great that i was so sensitive…but a 1/2 unit incorrect bolus can send me to 50 mg in a snap— and a whole unit too much is really scary.

My brother got lucky—he was quickly hooked up with the Endo i had when living in St. Louis. i always kept in touch with her and she agreed to see him even though she has very limited office hours. She does aot of research and is the best endo i ever had. Dr. Janet McGill, Washinton University, Barnes Hospital St.Louis.

Has anyone had experience with Novolog insulin in a pump? If so, please comment on infusion site lifetime using Novolog compared to Humalog ( or any other Lispro insulin ). I’ve seen some studies that lead me to believe that Novolog may be worth a try for longer site longevity.

Water cannot enter the set when you shower. I can only speak for the Medtronic sets, but they self-seal when not connected to the tubing. Inserting the tubing connector opens that seal.

Water won’t even get in when you go swimming. I’ve gone out in the ocean for about an hour, come back, re-attached, and never had a problem.

I use Novolog in my pump, and I get about 4-5 days out of my site. I am also very insulin sensitive and so I don;t take a whole lot. I’m not sure if that has anything to do with it. I use both the Insets and inset 30 sets from Animas, and am very pleased so far. I hardly ever change my cartridge and set at the same time. I usually waste my tubing with the set and plug in and prime.

Be carefu Mandy and Danny!!! Using the same infusion site for that long can create scar tissue beneath the skin surface. The scar tissue causes slow and uneven absorption of the insulin. I used injections for 61 years , mostly in my upper abdomen. There is permanent scar tissue there and I will never be able to use that site again. When I do I get a “No Delivery” alarm, If I do not get the alarm I see high numbers because the absorption is so slow. I now use my lower abdomen, below the level of my navel, and my upper legs. I rotate sites to give old sites a chance to completely heal. I prevent new scar tissue from forming that way. I have read many times that leaving an infusion set in place for more than 3 days can cause some scar tissue. I am OK with 3.5 days but not 4. If you use 5 days you are asking for trouble in the long run. I advise you to change every 3-3.5 days to avoid scar tissue and delivery problems. Don’t forget to rotate sites as well. Good luck!

Richard