Guess I’ve been pumping for about 10-12 years now and though I rotate locations religiously I am finally starting to run into a lot of site problems. Swelling at the site, bad absorption, painful insertions, bent cannulas.
But there are only so many places you can stick an inset–aren’t there??? For me using a tethered pump has restricted me to belly, love-handles and upper thighs. I try to spread them around, use one region long enough to give others time to recover as much as possible. But I’m having increasing difficulty finding spots that don’t end up with subcutaneous swelling, inflammation/loss of absorption, bent canulas etc. A recent string of bad sites (changed 4 times in as many days) finally had me on the phone to Tandem clinical support. They’re telling me I have to switch to steel insets and are sending samples, but I’ve tried them before and am not a huge fan. Some have to be changed even more often than standard ones and Medicare won’t pay for that, among other issues.
So meanwhile, I’m reconsidering the options for new “real estate” entirely. Tandem sent me that venerable injection-site map that I’ve had memorized since I was dx’d in 1983 (thanks guys). But a lot of those spots just aren’t practical for tethered pumping, no??? I do see references here and there to tubers using those places but how do you manage the practicalities? How to route the tubing through your clothes, how do you avoid rip-outs from clothing snagging, pain from pressure against seat-backs, etc., not to mention contorting yourself to attach/detach your tubing when showering and whatnot. How do you do it? Overtaping? Spousal assistance??? Would appreciate hearing from anyone who’s using these (to me) unorthodox locations successfully. I need details!
yeah…same issue here. I’ve been pumping for 22 years and also have lots of skin/site sensitivities. Around 50% of my infusion sites “go bad” in some way. I really just keep trying my best to rotate and hope for the best, and I also check the site frequently to make sure they’re not leaking. You might want to use tea tree oil on the sites after removal, epsom salt baths, etc to try to heal some of the resulting swelling and irritation more quickly
I’m sorry for your current troubles with infusion site absorption. So many things can interfere with good consistent absorption that I can only offer my limited experience.
I’ve worn a pump since the late 1980s so I’ve seen most of the usual things that interfere with absorption. When I changed to an old Medtronic pump, a 722, in 2016, I also switched to a new infusion set for me. This is a 30 degree angled Silhouette infusion set. For me, this set has been excellent. I’ve had extremely consistent absorption for almost all of the time in the last seven years.
This may not be the answer for you but I had to mention it. I’ve tried the steel sets, too, and found they got painful within 48 hours. I’ve used almost every other style infusion set over the years and the Silhouette stands head and shoulders above the crowd. I wore the 90 degree insets for many years and had to give them up due to repeated absorption failures. This, after many years of success.
I know my experience is not universal and your experience may differ, a lot. I’d hate to give up pump delivery since I think algorithms offer amazing performance.
If I could not adopt an infusion system that delivered consistent absorption, I would switch to MDI with Tresiba as the basal insulin. In order to make that work, I would need to use a system with some sort of digital memory. Mine is not dependable!
Good luck with finding a new system that will work for you!
I have consistent problems with my pods. Luckily more places are available for placement, however, different areas don’t absorb as well. And on top of that I have back issues that I use a heating pad for my back and a leg at night so it cancels out certain areas. And unfortunately we don’t have the ability to switch out infusion depth, angles etc. I finally did read an article of someone else that was having the same issues as me. Different lot numbers or boxes of pods having consistent issues while other lots or boxes not at all.
Things that have helped are larger boluses through a shot and not through my pod and if it’s painful knowing I need to switch it out earlier. But another thing is using a scar oil or argan oil on the side of my stomach I just removed my pod from.
I didn’t mention pods specifically in my extended comment above. I tried pods for about five months many years ago. I had some success with them but then hit a bad stretch with them. I often faced “third day fade” as my blood glucose would steadily rise on the third day.
In addition I noticed my glucose rising when I started a new site. This led me to adding insulin, like 3-5 units to cover for this expected control gap. With increasing doses, I never found a compensating dose to consistently bridge me between pods.
I really tried to make the pods work since so many reported good experience with them. I stuck with them for five months as I tried figure out a way to make them work for me.
I think the angle that the cannula was deployed and the specific depth it reached was just a bad absorption patch for me. It taught me that sub-q insulin adsorption was an individual thing and there were no universal truths about any one system. A person needs to try various sets and pumps and see what, if anything, may ultimately work.
What particular sites are you having problems reaching? I have to do a little yoga to get them on the back on my arms, but that’s just because the auto inserters are rotated stupidly. (why does nobody else complain that the spots you squeeze on the inserter are rotated 90 degrees from the spots you squeeze on the infusion set???)
Totally not me, but this is the back of the arm move:
Everywhere else is easy enough to apply. A mirror is very helpful for connecting tubing to sites on my back half. Have never needed help.
I think the females might have it easier with tubing management since we tend to wear at least one snuggly fitting layer at any time that the pump can affix to. I like to wear a tank top as a base layer all the time, akin to a men’s undershirt I guess. The tubing just runs under that nice and secure and I clip the pump to the neckline. 23-inch tubing will reach about mid-thigh on me from there. I can’t do the back of thighs or calves with that, though. I’d have to size up. Thankfully, I haven’t had need to try them yet. The tubing never interferes with clothing because it’s under them all.
Here are a few things that I have done myself(T1D ~45 years) and done to help some of my patients.
Changing to steel canuals helped many. What I often had patients do is bend the canual back about 25 degrees to avoid painful pressure pokes. It also seemed to help putting Hypafix dressing over the canula to mitigate excessive movement.
Another thing that seemed to help long term pumpers(myself included) is to cycle between 6 and 8mm canula lengths. The human dermis is only about 2mm thick so varying angle and depth exposes fresh tissue.
I recently posted about my own issues with pump site real estate and trialing different angles of insertion with the typical 90 degree sets. I used to pump, but bleeding, bruising, and otherwise invisible tiny beads of scar tissue eventually had me back on MDI. I need to switch back, but I have no idea how. I used to be a Joslin patient, and even they couldn’t find a site for me in the end. It turns out, I’m vitamin k deficient, and that deficiency means that I bleed and bruise at the drop of a hat. Have you had any blood work done with your doctors to rule anything out? When we were really struggling to find sites, here’s what they taught me: I mainly used Sils, but they left behind hidden bits of scar tissue. I bent the straight-in metal one on muscle or something supposedly, but I remember that they lasted the longest even though they never stopped twinging. Tegaderm underneath was my friend, and sandwiched on top is even better. If you have site inflammation, your doctor might okay you to use something for that, too, which is something I did way too late. I think some doctors have people using inhalers still, or creams. Icing the areas beforehand was a decent technique because I lost fewer sites to “bleeders” that way, and using a disinfectant spray alongside alcohol seemed to reduce scarring a bit for me sometimes. I wish I had put hydrocolloid bandages on my sites right after removing them because they often oozed and then made insulin crystals, but I don’t know if that’s actually for the best? It’s just that I get insulin crystals with every site, and just pulling them up and out with the bandages seems less scarring since mine didn’t just dissolve quickly. Do you get “pump bumps” or “insulin crystals”? Anyway, excuse my rambling. Currently in hospital with a roommate that won’t let me sleep. Hopefully something helps!
“Pump bumps” is a good description. Used to be they reliably went away within 24hrs or so but recently I was on the lower-belly segment of my site rotation and every single one left a painful subcutaneous swelling that lasted for days, like 4-5 insets in a row. I tried to be even more assiduous about alcohol-swabbing the area before inserting, treated 'em with topical antibiotic and they went away eventually but it left me wondering what the heck was going on. That kinda triggered this whole query.
Ugh, the idea of having to bend steel canulas to avoid “twinging”—not making me eager to try! THat’s already one of the problems I’m having with the teflon ones.
Another issue, I think, is the old-style giant-bare-needle-and-THWACK! inserters. I still have a dwindling supply of Mio Advance insets from when I was using Medtronic, which seem to be far less traumatic for the dermis. They’re kinda half-compatible with the tubing on Tandem XC sets (the clip on the Tandem tubing matches the receiver on the Advance). So I use those when I have to swap out a really bad insertion with the Mios but I’m almost out. But maybe the manually inserted sets will work as well.
For 10 years I have used my back just above the belt line (so it doesn’t snag.) I march L, R, L, R about one inch from the previous site on that side until I get close to my love handles. I get about 5 per side until starting over. No troubles and I just visualize what I am doing back there. Standard cannula with 23” tube. I don’t know if this makes a difference or not but I leave my old reservoir attached for several hours after the change and then leave the cannula in till the next day. Merry Christmas or Seasons’ Greetings and good luck.
I have similar problems with real estate. When I started pumping every new site would inflame and leave a swollen sore bump. (My mom cooked with Teflon my whole childhood, so I figured it was allergy to the cannula.) I tried the steel sets and have used them ever since. One thing I’ve learned about placement, lightly tap the needle tip in the area you’re putting it till it doesn’t feel sharp. Nerves and vessels run close together, so a non painful area will be less likely to bleed or hurt. I do have to change it every other day, though sometimes I get 3 good days. Interesting that bending the needle can help!
Anyway, areas I’ve only recently (past several years) started using are the chest area, just above my actual breasts, my actual breasts- around the perimeter, backs of my arms, butt - requires spousal assistance - .
For routing tubing, I can sew, and so I make a buttonhole on my pants or shirt pockets for tubing, or I safety pin a baby sock wherever, waist band, under shirt etc.
Leaving a thickened area alone for several months does seem to resensitize it, I’d say. Good luck!
I have pumped for over 25 years, back then I followed advice and changed sites every 3 days but after a several years changed to every 2 days and I still had the "pump bump"I stuck with this for many years until about 3 years ago I encountered more bad sites than good, i think too much scar tissue. I then switched to changing sites every day, the only good sites i have left are on my rear. Changing the sites daily is not an Inconvenience, just a new daily habit that I consistently get predictable good results from.
Several people mention changing sites more frequently. Required with steel sets, and Tandem clinical support mentioned it as a way of dealing with 3rd day fade with conventional ones.
Any of you guys on Medicare? Cuz they’re pretty rigid about this stuff. Coverage is for a 90 day supply based on changing every 3 days, you have to certify you have less than ten days’ supply on hand when you reorder, etc. Don’t you need some special dispensation to change every second day (or every day, like @Que is doing)?
How did you do the bend? Fingers, pliers? Alcohol swab it after? Any diagrams I could look at? Also, how did your patients remove them without tearing the skin (since they couldn’t pull them straight out)? Thank you so much! Possibly switching to steel myself soon and I have been wondering if I could do angled cannulas. I use a 30 degree teflon set right now, probably too shallow but it’s helped me avoid bent cannulas since my tissue seems really dense.
I have been on Medicare for a number of years, been a T1 for 58, and have never encountered any issues with the amount of supplies I order. My endo just writes the script per my request, I order directly from Tandem every 3 months. I have to call and have them push my order through because I don’t order like amounts of cartridges and sets, this causes a snag in their system? I change cartridges every 3 days. My past research on the “pump bump” indicates a immune response from either the insulin or the sets (a foreign body) or a combination of both. There was extensive research done insulin infusion sets where the scientists used pigs and they excised the tissue for examination and even after 1 day they found an inflamatory response taking place. But this goes back to individual tolerance. Myself I only pump about 35 units per day, not much in the scheme of things and I do use the steel sets
I use the Medtronic silhouette sets. After 3 days, I keep the tubing, but replace the cannula with their “cannula only” product.
Here’s my insertion map: From midline and up to 3 inches back, I go from my left upper back, as far as I can reach, gradually down to my butt. I’ll go in a box shape here because its easy to reach and there are lots of good spots. From there I move to my upper thigh and down as far as I can. Then I move across my lower belly to my right lower upper thigh. Then up my right side, back from midline, up as far as I can reach. From there, I go across my upper belly. Repeat. When I go across by belly, I’ll first go low and next pass, I’ll go high. I’m a side sleeper and there are some spots that I have learned to avoid because of pain, but they are few. I’m a slow healer, so it’s often easy for me to follow the last line I took. I just offset my line a bit to avoid using the exact same spot.
This system seems to give the tissues a long time to recover until I use the area again.
I have been told that I can use breast tissue too, but haven’t yet tried that.
I use the 18" tubing, but when I’m at the lower part of my upper thigh I use the 23" so that I can put my pump in the side pocket of my leggings. Otherwise, I clip the pump to my pants/belt. I also usually put hypafix tape over the insertion point on my upper thigh as it sometimes gets yanked accidentally, especially on those really urgent trips to to bathroom.
