Running out of good sites for pump insertion

Ok friends. 50 years T1, thin body, lots of scar tissue , and having trouble with site selection that is good absorption and not resistant .

I am using triceps and quads but they are painful b/c not enough fat. Abdomen is full of scar tissue and butt is most muscle too. CGM seems to do OK in abdomen and arms but not pump insertion. Using steel canula and they has made big difference for the better. Have gone a day or 2 on MDI and not good results.

Please advise. thanks.


That’s why I went off the pump and back into injections - Scar tissue and bad adsorption. So many more options for injection sites on mdi - I use arms and legs which I rarely did on the pump. It takes a while to get doses sorted on injections I’m finding though. Is it worth trying injections for a bit longer ? Sorry I don’t have any other helpful advice. I feel your frustration though having been through it myself.

thanks Amelia. i had frustration with Mdi but may talk to CDE and try again for a time? Do you use pens or syringes and bottles as we didi back in the day?

It still meals 6 shots/day so I am not sure that is even better?

One day at a time! We are good at that.

I worry about this all the time. I got off the pump once to eliminate this as a variable that might be causing trouble. I used syringes because they were cheaper. However, when I went back on a pump, I had better luck with a different brand, so I could never be sure if it was scar tissue that was the problem. How are we supposed to know for sure? Always wondered about that. Is there anyway to be 100% certain?

P.s. I had better luck with MI absorption using smaller bolus dosages (sometimes splitting a single shot into 2 shots into different areas, but that may make more scar tissue) and a split shot of basal (one in morning and one at night).

Would metformin or some other oral drug help in this case?

Hi lisa My name is Nadine and I am new to this site. 48 years T1, thin body and lots of scar tissue also. I am currently beginning transition process to pump and have concerns about site selections. Is the pain in your triceps and quads at insertion or does the site remain painful until or even after the site is changed? Any advice is much appreciated. Thanks

I think there are so many variables on any given day. This moring BG rose to 330 after breakfast. CGM was on 2 hour warm up so did not realize for awhile.
I did not sleep so think it was insulin resistance from that. Also water is major for me. Have to be over hydrated to absorb well. Then there is food timing with Bolus. I did change site after only 2 days inserted. It goes on and on. With scar tissue, I believe its mostly abdomen and hips that is bad. I would often get bent cannulas in those areas. I use a steel one now and it seems better.
I don’t think we can ever know for sure Richard? Still wish MDI once a month for a week to let body settle would be good. But I am not good on that plan since cannot take small increments.

Look forward to tour thoughts!

Of course I have a ton to share but not much of a typer. For 1, I love being able to chase BGs with small increments and eat lots of snacks with small bolus. MDI not good for one who likes to eat I.
I use steel cannula which cannot bend. The sites where we are skinny hurt until I take them out, which is usually the same day. No pain on insertion. If I lie on the site, I believe it hits things other than adipose tissue which causes the pain.
I am seeing my CDE this week and will focus purely on this issue. Which pump are you leaning toward?

Hi lisa My Dr gave me an OmniPod demonstration to wear just to see how wearing it is. Gave me the number to call a Dexcom rep. I know very little about the pumps and am just starting the research phase. Insurance coverage (Harvard Pilgrim Healthcare HMO)
and out of pocket costs as well as reliability and ease of use will be the determining factors.

hi lisa, i’m daisy mae. i am very very lean, too, and have had many problems such as yours. i am T1D for 30+ years and have been using the MM Paradigm 523 . when i started pumping, there werent many choices as there are now, but this is my favorite of all the pumps i have tried since starting. i also use the steel insertion needles. i use the silhouette 13mm canula ( which i love for its quick release feature). i put it in manually at about a 25 degree angle. this helps me to not hit nerves, muscles or capillaries. also, i found that if i change my set out every 2 days instead of every 3rd day, i get less scar tissue issues, and am able to have a much more comfortable and successful insertion. also, b/c there is less opportunity for scar tissue to occur (due to the 2 day change out) , i have much better absorbtion and greater insulin sensitivity. another thing that may help you with insertion comfort (not that it is EVER comfortable) is icing the area before insertion. the ice numbs the area and there is less discomfort.

hope this helps, and good luck to you. :blush:

thanks Daisy mae!

i do not mind the physical pain. The pain of 300 BGs is what I mind.
I need to change out every 2 days instead of 3 and that will definitely help. I also love the pump you have. I wore it forever and now trying tandem b/c of CGM.

be well! and thanks for feedback

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its funny, b/c for me the shots dont hurt at all. i much prefer them over finger sticks (which i do about 20+ times a day/but i just started my dexcom, so hopefully that will change :wink:)

I use pens - Novo pen echo. It has a memory function which tells you when and how much your last dose was and comes in half unit increments. I have up to 8 injections some days but find it so so much less stress than the pump for me at the moment.

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i am glad to hear that you have something that works for you and is less stressful. when i was on MDI, i was doing about 10+ shots a day. it was a lot of work. for me, i have the “wizard” feature on my pump, and once its programed, i dont have to think much about how much in sulin i should give msyelf at any time of the day, no matter what my BG is at the time. i just program in my current BG and my carbs, and the pump takes care of the rest.

for me, this is less stressful. different strokes for different folks. its nice, though, that we have so many choices. :sunny:

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You might also want to inquire about using Afrezza, since that removes the need for most of the shots with MDI. If not in general, perhaps as a temporary rest. There are some of us, however, who use it solely for bolus.

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And Afrezza is actually great for grazers because you don’t have to be accurate about counting carbs and dosing just take your dose and eat.

I gave up on CGM as it was wiping out all of my pump sites, maybe you could take a break from that?

Lisa C and Daisy,

I have many of the same issues—40 years t1, 20 yrs. pumper. I too am thin, except for a belly roll—which suffers from overuse. Infusion sets do not work for me on my legs and it is difficult to get a good one on my hip/butt.

The past two weeks I have used the sure-T infusion on my upper abdomen area (above my waist) to give my belly a break and I have had to adjust my pump’s basal rates down because of so many lows, which I attribute to better absorption.

I am still using a 7 year old Paradigm 523, but am looking to replace it before it fails on me or breaks (it has a ton of cracks in the case). I am thinking of getting a tandem and finally going to cgm, but not sure I will be able to tolerate the cgm sites.

I have tried going back to shots (insurance would not cover pens) but also missed the bolus wizard too much!

Just commiserating with you both.
The other Lisa C.

Lisa C 2,
I went from Paradigm to tandem and it was a serious learning curve and much challenges. I now love it. The CGM insertion sites are more forgiving. I can use areas of scar tissue and many areas that the infusion sets are unhappy. The CGM is just a couple hairlike strands that get inserted.
I dont know how I lived w/o CGM . I look at my BG every few minutes and know exactly which direction it going. Think its worth a try for all.

Best! Lisa c

Hi, lsa_c1.

OmniPod pump is the best pump to use for other bodyparts than abdomen. I use it myself and has yet not used my abdomen. I use my arms,my thighs and my calves. I never wear the pod more than two days.

If you want to go back to MDI, there are apps that works the same way as “bolus wizard” and the likes works in a pump. Personally I find “Rapid Calc” to be the best.

There is also a new “smart pen” on the market. It’s called InPen and helps calculate your doses and keeps track of injection data.

When paired via Bluetooth with the smartphone app, the InPen delivery system keeps tabs on how many units you received at your last injection, when you took them, IOB and other information.

Hope you find something that can keep you going without too much stress. Good luck!

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I’m at 48 years (wow this August…) and thin. Years of sites falling out, scar tissue issues etc and tried MDI but no luck. Went to Omnipod, and have not had anymore problems. Having to change every three days (plus eight hours), having an auto insert that makes it easy to apply anywhere, well for the first time in 18 years I am doing good with boluses and infusion sites.

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