I wanted to run this past everyone. My daughter has been on the insulin pump since June 2011 so 6 months. We always rotate the infusion set site between arms and belly. Recently we have noticed she is requiring A LOT more insulin. Will scar tissue cause the insulin to absorb slower or will it cause you to require more insulin?
Yes, scar tissue can slow down (and seemingly stop) the absorption of insulin. But before we conclude that this is the issue, how old is your daughter? If she is in her teens (or younger), there may be other growth or (non-insulin) hormonal issues causing the increased need for insulin.
If it is, indeed scar tissue, you may want to consider a different type of infusion set that is more in line with her body type.
I agree w/ Scott. It could be scar tissue...but there also could be other factors at play (such as age/hormones/growth spurt).
she is 8 years old. What do you mean by an infusion set type more inline with her body type? Unfortunately she is allergic to stainless steel so the steel infusion sets are out for us. Are there different types of teflons that the cannula's are made of?
I agree with everything Scott has said. I would like to add that it when I hit scar tissue my insulin absorption basically stops, I go high very fast and need to change my infusion set. I think I am a pretty typical response to scar tissue?
In any event stay on top of it and keep adding insulin or changing sets as needed. The important part is keeping (near) normal BG levels. In the Fall my insulin requirements went up almost 10% in about a week for reasons I can only guess. I just added insulin to my TDD as needed until I was back to normal. Good luck I know situations like this are very frustrating.
When we tried the metal infusion sets she broke out in hives so we knew she was allergic. I would guess if she was allergic to the Teflon cannula she would break out? Has anyone experienced this or is allergic to Teflon?
I think he's referring to 90* insertion vs. 30-45* insertion, and then different depths (6 mm vs 9 mm, etc). And also what you already alluded to: using something like sure Ts over the teflon canulas. To my knowledge the teflons are all similar, but that would definitely be a question to ask the various manufacturers.
Exactly. Whether she is thinner or heavier may affect which type (size, angle) cannula is best. Also, it depends on how much "usable real-estate" (potential site locations) she has.
The angled Silhouettes are generally advised for thinner body types, but since they go at an angle, they cover more real-estate than the 90° Quick-sets. The Mio is a newer type of infusion set that lots of people seem to like (and some doctors don't even know about yet), but I have no first-hand knowledge of it. It might be worth looking into. (see herefor some good photos of the Mio)
I called my pump provider, Minimed, when I was having trouble with infusion sets and they sent me 2 each of their 4 or 5 other types free of charge. I believe another member received free samples from their local CDE. This may help you and your daughter figure out if a different infusion set will help her.
The need for a lot more insulin at your daughter's age could be a lot of things. Hormones begin to surge (not just the sex hormones, but growth hormones) and these cause MAD insulin resistance.
Definitely try different infusion sets if you can.
Also, if the weather has gotten significant colder all of a sudden, this can cause a pretty dramatic increase in insulin requirements for some (cold means that the insulin absorbs less quickly).
What kind of increased needs are you seeing? How much has her TDD gone up?
Typically, the arms and the legs absorb slower than the stomach. Also I've realized from my experience, the weather can some times play a part in it. I use slightly more insulin during the cold winter than in warmer climates. In terms of scar tissue, sometimes I use natural coco butter stick to help my skin heal better (however, ask your doctor about this, I don't know if your daughter maybe to young to use it, or other meds that interact).
-Yogi
I am fortunate to have been able to have three babies with T1. However, my babies were big and my abdomen is wall-to-wall scar tissue from old stretch marks. I have a lot of problem with the Quick Sets as I get "no delivery" messages. When I remove the cannula, I often find it is bent as the scar tissue would not allow it to poke through. I am able to use the Sure T's but those are made of metal. I recently started using the Sillhouettes and they are working fine too. I find them more scary as the cannula needle is so long but they almost always feel comfortable. Sometimes they are bent too but because they are long the cannula seems to stay open and the insulin can get through. I haven't had any "no delivery" messages with the Sillouettes. Good luck!
We left her site in at the same location to see what would happen one more night and she has had one of her best days. Her numbers were excellent. I guess I'll chalk this up to hormones. Its frustrating that she can go from one of her worst nights having a high of 355 and dosing over twice the amount of insulin to being better than normal the next 2 days.
Glad to hear you had a good day! Lets hope for another, and another, and another....