Running out of sites for infusion set

T1 50 years. Pumping 20 years. My issue is I am running out of sites to put the steel infusion. Scar tissue and very thin body often has me needing to change out my set every other day or every day. The CGM seems to do OK with the scar tissue and thin areas but not the pump. Considering taking a few days/week for MDI but dread the thought of it.

Any advise welcome !

thanks!

The insulin’s available now are much better than they used to be. Consider Tresiba as a long acting, it’s once a day and for a lot of diabetics controls BG’s really well. If your hesitance is about taking extra shots then inhaled Afrezza is a fantastic mealtime insulin but it’s so different from anything else on the market that you’ll have to get advice from those of us who has had success with it if you don’t want to give up on it out of sheer frustration. Good luck!

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My husband has been on pump 36 years using steel needles whole time. He does have issues of scar tissue especially from beef/pork insulin use. I help him put sites more towards the back and love handles. Try using arms or thighs.

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Hi @lisa_c1! I stopped using a pump for similar reasons a couple years back. I had trouble with sites working consistently, and it was interfering with my ability to control my blood sugar levels. I didn’t use steel infusion sets though. I found that if I avoided giving large insulin doses in sites then the sites would last longer. Large doses at one time tended to comprise how well the site absorbed insulin later.

The MDI insulins are much, much better than they used to be. I found a lot of freedom when I switched from the pump to injections again. I started with Humalog/Lantus because that’s what my insurance covered. I’m now using Humalog/Tresiba, and recently started using Afrezza. Afrezza is amazing!

Tresiba is a very convenient long-acting insulin because it lasts several days. You still take one shot/day, but it layers several days of insulin. I think this helps stabilize blood sugar levels. If you have varying basal rates on the pump, Tresiba may not be the best fit though. I found that my basal rates weren’t working consistently when I was using the pump because I had trouble with my sites, so Tresiba was a much better match for me- even though I had varying basal rates when I was on the pump! Everyone is different though.

Levemir is another long-acting insulin that I’ve heard works pretty well. This might be a better fit if you have varying basal needs because it doesn’t last as long.

When I went on MDI to take a pump break, I expected I would take a few months off then switch back. MDI has been so much better for me though! I love not having the tubing attached to me all the time.

For most people, a good A1c is very possible on MDI. Are your basal rates on your pump very different throughout the day?

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I wore a pump for 31 years and totally ran out of infusion sites. I had no absorption, and infections after the first day. I switched to Tresiba for my basal insulin because it works very well for me. I had to add Metformin at bedtime to counteract the dawn phenomenon. Since I want to reduce injection sites as much as possible, I went to Afrezza 2 years ago and it works great for me. I only inject once daily (the Tresiba).

Using 4mm/32g Novofine or BD Nano pen needles, and u200 Tresiba for a lower volume for my TDD, causes no damage to my skin, compared to an infusion set.

I tried the Omnipod for a few months last year but had the same absorption and infection issues. I wouldn’t go back. Even if I couldn’t get Afrezza, I would go to something like Apidra.

I do eat low carb and only whole foods, just as an additional data point.

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thank you everyone for the feedback. I just went on T slim 1 month ago from MM and hoped the steel infusion would be better than teflon. Endo prescribed pens of Basaglar for back up emergency use. If I go to MDI for a trial, is this a good long acting insulin?
Aslo, do the novolog pens come in 1/2 units? The homolog does not and that would make a big difference for me.

I eat a lot of carbs, as i am low fat plant based eater.

love everyones thoughts!

thanks. I will get my husband to assist for some more site options of enow.

Basaglar is a biosimilar to Lantus. If you’ve used Lantus, then it’s supposed to be very similar to that drug. For most people it lasts around 18-20 hours, so it’s usually best if you take it at 2 different times of the day. You can plan the doses so that they overlap when you need more basal and plan the non-overlapping time for when you tend to have lower basal needs.

I would recommend using Tresiba if your insurance is willing to cover it. If not, then give Basaglar a try and see how it works! That is, if you decide to do a trial run of course.

Looks like there is a Novolog pen with 1/2 unit measurements: https://www.novologpro.com/prescribing/insulin-pens/novopen-echo.html

katers 87,
this is great info. i will take a few day break from pump with the basaglar and injected insulin for now. If i decide to continue, will get Novo pen instead of shots and vials and see how the basaglar goes. I take small dose as endo said to do 5 units every 12 hours for basal. Wonder how they decide which ones to write for? ( drug reps I imagine)
thanks again!

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That’s one argument for Afrezza, since it responds very much like our natural insulin does to a fast rise from carbs.

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is it that much more reliable than basaglar? endo wrote for 4 pens so i need to use them first.

It sounds like @lisa_c1 may be pretty insulin sensitive though if 1/2 units are needed. Afrezza’s minimum dose is 2 units (though they list it as 4). I know the dosing is pretty different with Afrezza, but I can’t give the low 2 unit dose if I only need 1 unit. I’ll end up dropping low. Perhaps some combination of both Novolog and Afrezza could work?

@lisa_c1, Afrezza is a very fast-acting insulin. It’s intended to be taken at meals and in conjunction with a long-acting insulin (like Basaglar). It only lasts about 1 hour, and you usually take it after you eat because it kicks in so quickly- this makes it ideal for high carb/ low protein & fat meals. It’s pretty awesome! I’m hoping they’ll refine their doses a bit though so they offer a smaller one. It’s an inhalable insulin too! Which might work well for you if you have a lot of scar tissue.

@kmichel posted a link and helpful post about Afrezza above.

Let us know how it goes @lisa_c1! Wishing you the best :smile:

More carbs means larger insulin doses. Larger doses may mean that infusion sites sustain more tissue damage with a longer time needed to fully heal.

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Hey friends,

I went off pump for 2 days and was crazy not knowing how much insulin on board and having to take 3 units if I only needed 2.4, etc. I loved not being hooked up to tubing but back on pump. Will change out infusion set every other day and see if that helps. I don’t thin they ever expected us to live this long with T1 so all new sets of issues.
Love any thoughts .
thanks

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Yeah, I know how knowing the IOB number is helpful in many ways. You don’t realize its value until you don’t have it anymore. If you ever want to try MDI again, you may think about getting an app that would keep track of your IOB and other things. You also might want to look into an insulin pen that can track in 0.5 unit increments.

Good luck with your return to your pump. I have happily returned to my pump more than once.

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I had the same problem…I have no body fat. I quit the Tslim and went on the Omnipod because my new CDE suggested it. He said I’m surprised anyone suggested you get a Tslim to begin with. With the pod I have been putting it on my arms and my numbers dropped like crazy. I highly recommend it for someone with low body fat.

Are you staying with Omnipod? I have decided to change infusion every 1.5 days as long as insurance covers it. It seems to work OK. However, the steel cannula hurts b/c it keeps hitting things in body its not supposed to hit. Guess I have 4 years until I can do a change up.

I agree with Willne1 that if you have not considered the OmniPod, you might want to give it a try. While having no body fat is NOT my problem, I have been diabetic for over 50 years, so I do battle with scar tissue and some sites that no longer absorb well. However, I have not had any problems since I went on the OmniPod. It gives me tubeless freedom and many, many more sites from which to choose. I have great luck with my upper arms, and I also use both lower and upper parts of my abdomen. With the OmniPod, though, you can use upper buttocks, lower back, thighs, and some people have even tried the Pods on the shoulder areas or the calves of their legs! I change my Pod, as directed, every three days, and I have had no problems with insertion or absorbtion. I highly recommend the OmniPod if you are able to give it a try.

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SherrylAnn,

Great thought but think I am stuck with Tandem four years. That said,
I am managing OK on changing site every 1.5 days. I am thin and using arms and low back this past week. The dexcom seems fine in scary tissue areas? you too? I too am 50 years T1 and the challenges keep us diligent. I did not like going back to MDI as have gotten spoiled. Very grateful for the friends on Tu diabetes for knowledge and comrade.