Scar Tissue strikes terror into my heart

Type 1 and LADA
1

The last two weeks have produced two days that could be called "extreme excursions" for me. Why, you ask? Because of scar tissue! See if you agree with my reasoning and chime in with your rotation routine and any comments are welcome.

I have a routine for avoiding scar tissue and I thought I was doing pretty well, since I have been following it for about 15 years. Basically, I change my infusion site every 3 days. I start on the left side of my stomach, then move to the right, back to another left stomach site at least 2 inches away, then the same thing on the right. From there, I go to the love handles on my back, left and right, followed by the upper buttocks area, left and right. About 21 days later, I get back to the same basic area where I started.

On Halloween, I started a new site on my left love handle, exercised in the morning; went low, low, low, before my numbers started climbing. Of course, I choose this day to overcompensate for the low, since it just wasn't coming up after 10 glucose tablets. When I was over 400 for over four hours, and got a reading over 500, I finally said something to my wife. She calmly suggested changing my set and since my cartridge was low, how about new insulin? Bingo(!) - perfect solution!

By bedtime, I was @ 114 and I woke up the next morning @ 100.

Fast forward to this past Thursday and I had a new set in my upper left buttock. A post-meal reading of 148 seemed innocuous enough, but then it went up and up and up. After two corrections, seeing the constant up arrow on my CGM and a fingerstick reading of over 320, I changed the set and placed a new one in my stomach. Of course, I got a little overzealous on the correction dose and ended up low, but I evened out and went to bed @ 87, waking @ 78.

In looking at my love handle and buttocks, I can see that I am unable to get as much location variation as I do on my stomach. Today, I am trying my upper thigh - seems to be working pretty well so far.

I am a little worried though, because I don't have a lot of real estate to work with - actually more than a little worried.

2

I've done thighs, biceps and chest too. It seems like if I go a couple of weeks ago from my stomach, my stomach usually recovers and works again.

3

When I was having this problem a few years ago, I changed from the inset 30 infusion set to the inset 6mm (90 degrees). I also started to use a loofa sponge to rough up my sites a bit and cause some extra blood circulation. Those two things helped a lot. But I still can feel some scar tissue below my skin. Before I insert a new site, I gently rub the site and avoid spots where I can feel some knotty tissue or I feel any pain.

This makes me wonder if physical therapists have ever considered using their craft to restore infusion sites. Seems like it would work.

4

Back when I was doing MDI, I used my thighs a lot. On the pump, it seems a little weird snaking the tubing down my leg, but I will get used to it (I hope!).

Terry, I loofah all over and have for years. I am wondering about buying some sort of device to help massage those areas. Like this: Wooden Massage Tool

5

When was treated for plantar fasciitis (bottom of my feet), the therapists used hot and cold, aggressive massaging with their knuckles and rounded wooden tools shaped like an egg. It was painful at times. They also used ultra-sonic stimulation and a “tens” unit. They told me that the object of all their therapy was to release the adhesions between the fascia and the muscles. It seems similar to rehabilitating scar tissue to me.



That rolling massage tool looks like it would help but I wonder if fully resolving scar tissue might take more aggressive and focused action.



I can still feel that I have scar tissue on my abdomen; I’ve just gotten better at avoiding it. I need to address this issue, too.



I’ve hesitated to use sites like my thighs or quads since I feel very little fat there. Maybe I should just go ahead and see what happens. It would be great to open up more real estate and give my abdomen a rest. I would be interested in whatever measures you end up using.

6

There are so many variables with scar tissue. I have had Type 1 for over 31 years and my belly looks like a war zone!! I can't use the backs of my arms for my cgm due to scar tissue from allergy injections. So, being creative, I use any spot I can get to within reason and rotate as you do. It is my understanding that how we develop the scar tissue may have a genetic disposition to it as well. In the past when I could not resolve excursions, I changed the type of infusion set I was wearing and this made a huge difference. Don't give up.........you'll figure I out.

7

I've been treated with ultrasound for various injuries as well as my carpal tunnel. I've wondered whether the same treatment would work with scaring from insulin since ultrasound is a routine standard of practice for breaking up scar tissue. There are many ultrasound units sold on amazon. The only difference between professional units and consumer units seems to be power and over the last couple years the units on amazon seem to have increased in power.

8

Regardless of method our skin requires a site to get the insulin into our bodies. We are pin cushions. No matter how many times you zealously rotate, after a point there are going to be spots which its obvious and sometimes visible we have been there before, many times.

Based purely on your description, I'd use your arms, your legs, your butt a lot more than you have in the past. I had to shave on a daily basis (apparently I'm part Wookie). The sole place I could make my set ever stay was my hip pointer... it was not fun.

You can use lots of real estate, but keep it a hands length away from the boney bits. Too far down the leg, not going to work easily. Too high on the chest, the same... not a great idea. Anyplace you can reach (not your belly) add to your new list of additional sites to use. Use them!!!

9

Thanks for your comments.

I just finished with placing sets in my thighs. The first one was ,,, okay, but left a pretty big scar. The second was so painful that I took it out after 1 day.

My stomach remains the best place. I just can't imagine placing a set in my arms. There is no fat on them whatsoever. There might be another spot on my buttocks to try, but I might have to get some help reaching it.

10

Hey Tu friends!

I just wanted to give you an update on what's going on scar tissue-wise.

I gave my love handle and buttocks a 30-day vacay, then when I went back to those areas, I only left my sites in place for a MAX of 48 hours. I am now back to generally being able to go for 72 hours, but I watch unexplained highs like a hawk when I am using those areas. I am also stretching a bit so I can reach more of the area behind me.

As part of giving those areas a vacation, I tried the tops of my thighs. My absorption worked pretty well, but they were painful the entire time, so I only used each thigh once. I could only get 48 hours out of those sets and it took 30 days for the scars to heal.

It's kind of strange, because when I was on MDI, I used my thighs quite a bit.

11

Hi Mike,
I have a lot of scar tissue in my belly from not changing my infusions sites often enough when I was a teenager. I’ve noticed a significant difference in insulin absorption rates in my belly versus my arms or love handles. One thing that helps me is massaging the areas with scar tissue. I massage them before I take an injection and also when I’m applying lotion after my showers. The massage helps to break up the scar tissue and get the blood flowing. It’s not a fool proof method, but it helps. I also notice a difference in where I put my CGM. Certain spots on my belly just don’t take well to the sensor and sometimes it will stop transmitting, even if I haven’t moved or done anything out of the ordinary. I hope you can figure out a solution to your scar tissue problem!

Alex

12

In my understanding of scar tissue, a massage won't help out in the short term. It might help in the longer term because of the increased blood flow that results, but I don't think that's a long term solution.

Our bodies really don't like foreign things poking through the skin, especially when the hole allows a liquid to enter the body!

13

I recently went through seven sessions of physical therapy to possible restore tissue sensitivity in my abdomen. The therapists used ultra-sound, a "tens" units, massage, and stretching. At the same time, I've given my abdomen a infusion pump and CGM sensor vacation.

I've recently restarted using the CGM on the love handle area but want to give my abdomen a longer break from infusing insulin. I've been mostly using my back to infuse insulin. This is an area that I've not used before. I'm getting good consistent absorption there. I need to consider other areas as options, too.

I don't think I'll be able to measure well the success of the physical therapy since I'm doing it in conjunction with not using the abdomen sites for a while. I'm hoping to return to using the abdomen in the next few months. I'll see.

14

I am still thinking about getting one of those TENS units.

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I've been on lantus for about a year now, and find I'm running out of real estate too. I want to move away from my stomach and the CDE suggested the back of my upper arm....nice if my arms were long enough to reach around.....so thigh is next. But some place I got the idea that muscle tissue is not a good place to inject. Did I dream this or should I do the sides of my thighs not tops. Now I am confused. Helped

17

I would use the sides of my thighs rather than the tops. That's one of the few places on my legs that have a bit of fat. I would have put my infusion set there, but it's just not practical with the tubing and the rubbing of the legs.

18

Hi Sdkate,
I have this weird pose for injecting into my arms that I wanted to share with you. If I’m sitting, I prop one knee up and then rest the back of my arm on my knee. I use the heel of the hand I’m injecting myself with to push my skin up, sort of like my knee and my hand are pushing the skin up and out into a mound. Then I inject myself. It took some figuring out to get it right, but that’s what works for me. If I’m standing, I do the same thing, except I put my foot on the opposite knee and stand on one foot. I have good balance, so this might not work out so well if you dont.

I try not to inject in my thighs. I just have too much muscle and not enough fat (except the part of my inner thigh that touches my labia, but don’t inject there cause it hurts like nothing else! I tried it once… only once) to properly absorb the insulin. i also bruise really easily on my legs, so I try to avoid that area. My love handles, upper butt, stomach and arms are where I take my injections and use my CGM.

I hope that helps and you don’t look too funny trying to pretzel yourself to take a shot!

Love,
Alex

19

different but similar issue/question/concern with the Omnipod for me (thought I'd share the experience). While no tubing snaking down there, I was a bit concerned about the pod getting in the way on my thigh, especially with pants pockets.

My concern was wrong -- I can go all day without even remembering my pod is there. Also, there's a TON of real-estate!

Biggest issue I've found with my thighs is care to make sure there's enough subQ fat where I'm putting it, and for some reason the skin there is more sensitive to the teflon cannula in the Omnipod so I get a larger itchy lump when I'm done with the site that take 24 hours or so to go away completely.

My biggest indicator of scar tissue is a painful insertion.

20

Well, an injection is a completely different animal. In and out in a handful of seconds; thin thin thin 33 gauge needle; no object sitting there for days irritating the body and getting the local immune response all riled up.

The two just aren't comparable.