New pump user with questions...please help!

I have a question. We have only been using the pump for a few weeks with our son.
He was getting insulin through his arm by syringe. He is extremely skinny ( 3% for his age). They said the only place he can put the insets is his buttocks ( top part). Well, the problem is… we had great control on the syringes. He was always within target. He could eat 15 minutes after the shot in the arm. Now, his BG are fine if he doesn’t eat ( so background insulin level is fine), but every time he eats…he spikes. I know it’s not a ratio issue because he does come down to where he should be after 4 hours. I think it’s a timing issue. I have had him wait 30 minutes and it still spikes. Anyone else have a skinny frame and needs to put it in this site? Any idea how long we need to wait to eat? The convenience of the pump is being lost by how long we have to wait. He is using the angled inset as well…which is supposed to be better for skinny people. Thanks in advance for any tips/ help you can give. I’m getting frustrated and want to bail and go back to needles! Help!

I’m also rather thin, which makes it tough to find proper infusion sites. I have used both my abdomen and the top area of my butt, but overall the abdomen works best and most consistently (I use the Medtronic Silouhette infusion sets). The problem is using the butt/hip area is that even though you don’t sit down on the site, when you do sit, the the tissue/fat in the area is compressed (much like if you pinched yourself at that location). This means that the “empty space” in which the insulin normally flows to make its way to the bloodstream becomes more “crowded”, so it takes longer for the insulin to get absorbed.

If I’ll be swimming, I’l use my butt area, though, because then I can take off my shirt without a visible infusion site. (I do disconnect to swim, by the way).

You need to be a bit visual to understand my example, I hope it makes sense to you. The other thing which might be an issue is that the bolus is too low and the basal is too high (so the basal is covering the tail end of the meal), but I’d try finding another site, if you can.

My son is 11 and started the pump when he was 9. He is also very thin and we have to use the top of his buttocks. We use the straight inset as it goes a little deeper. My experience is that the expectation of his doctor is that overall his A1C is below 7.5 and not that he is in range at all times. I find that because he is able to eat what he wants when he wants it may be a little harder to control than when he was on a prescribed number of carbs with the shotsAs he is growing I have a lot more need to adjust his basal and bolus rates. Have you spoken to his provider?

Barry

I haven’t talked to his provider. They aren’t all that helpful. Our private diabetes educator has been and she said that she ran into the same problem with her daughter being so thin. They actually ended up stopping the pump :frowning:
I tried the straight insets with my son and because they went deeper, they always hit muscle and he couldn’t walk. He had to have the angled in order to make it less painful. The problem is, I wonder if sometimes it is still hitting muscle and maybe the absorption isn’t as good or as quick.

Can the abdomen be used if there’s no fat on it? I think you are right about the absorption issue in the butt. That’s what I’ve been thinking it is. Just didn’t make sense that the numbers were fine with syringes and the numbers are fine with the basal on the pump. The only time the numbers go batty is the bolusing for food. It’s so frustrating. My son hates being high. It really makes him feel horrible. He is asking to stop the pump because of the highs with eating. He is also not wanting to eat because of it. It’s a serious issue.
I’d love to know how much “fat” needs to be on the abdomen to try it. Thanks

I don’t know how to measure how much fat you need, but it’s often a bit of trial and error for finding a good spot. With the short-cannula Silhouette, I do fine.

Take a look at this video about NHL player Toby Petersen: http://www.youtube.com/watch?v=nxlIf3pusKM&feature=player_embedded . As a professional athlete, he’s not a little guy, but he doesn’t really have fat on his body either. At the 1:53 mark you can see where he puts his infusion set. Not quite at the butt, but not on the abdomen either. Maybe that spot would work? (it looks like a Silhouette, by the way).

When you say you use the angled ones, do you still mean an angled cannula (like the Silhouette that I’ve described before), or the Sure-T, which is a needle that remains in the body?

I’m pretty thin too. I am 5’6" and only weigh 115lbs. I had problems with the slanted insets. I prefer the shortest straight insets. I also put the inset in my upper buttocks. I haven’t seen any problems but there is a learning curve on timing. This all depends on what he’s eating. I usually does right before I sit down to eat and a little after then use the ezCarb which allows the release of insulin for a specified amount of time, ex. 1 hour or 2 hours. The amounts I tell the pump to give me depends on what I eat. I will give you a couple of examples. If I eat chicken, vegetables and salad. And then have a bowl of berries. I will calculate the carbs I am eating, in this case about 35 to 40 carbs. So my ratio is 15 to 1 unit. I would need 2.5 units to cover this. I would does .50 at the beginning of my meal and .25 at the end than the rest I will tell the pump to give it to me in the next hour. Now if I was to have chinese food, which I calculate to be about 60 carbs. I would do .50 at the beginning and 1 about 15-20 minutes after and the rest I will tell my pump to give me in the following 2 to 3 hours. It all depends on what I’m eating and how much fat it contains. Remember the fattier the meal the longer it takes for your sugars to spike, ex. pizza. This is all an art. Hang in there, you will soon get it all figures out. Good Luck.

I am giving the insulin to him 30 minutes BEFORE he even eats and it is still spiking! It’s crazy. Maybe it is the inset. If I didn’t give the insulin until after he started, he would be so high…

It’s the animas 30 degree one. It stays in the body - but not a needle, just a cannula

Ok. Thanks. Is the Silhouette compatible with other pumps?

There’s really only one company that makes infusion sets: Unomedical. Medtronic has a different type of connector (between tubing and reservoir) than the other pumps, so the Silhouette isn’t entirely compatible. The Unomedical Comfort Short (http://infusion-set.com/index.asp?pageid=h2286) is the same as far as the infusion set piece. You might be able to get it from Animas under the Comfort Short name; if not, look through the Unomedical (www.infusion-set.com) site.

You may need to put it in at a slightly greater angle than you’re doing. Do you see a little bit of a bump on the skin after insulin is delivered? If so, it’s delivering into the skin, and not below it.