Set insertion causing pain and possible failure

I'd welcome your opinion on my 14yo daughter (4y dx'd) and problems we're having with control.
One particular issue is the insertion of the Mio infusion sets and the pain often experienced at insertion. She does (despite reassurances) count to 3 and hold her breathe while it is inserted (variously by me or herself) and mostly to the abdomen, while standing.
On removal, we sometimes see a few drops of blood at the site - perhaps 1 in 5 removals.
As mentioned our control is poor despite tremendous efforts - carb counting, pouring over Carelink charts, considered, careful tested changes to basal/bolus/ICF/ISF etc.)
She is approaching menarche so perhaps hormones are a factor though we've struggled with control since dx.
Any help appreciated,

What's your daughter's opinion about what may be wrong and/or possible ways to fix it?


Hi, a quick reply just about the pain bit - I used to use Inset IIs with my Vibe (I believe pretty much the same as Mios) and amongst the various things I didn’t like about them was the speed of insertion, I found the action to be quite vicious (for me)! So I tried various other sets including manually inserted teflon, angled teflon and steel sets, and settled on the steel sets. I find them much easier to insert and I have total control over it (& no worries about kinked cannulas any more). And when I have occasionally hit a blood vessel or nerve, I withdraw and reinsert immediately a little to the side with the same cannula.

I know not everyone is suited to use steel or do manual insertion, but I def prefer the gentler, more controlled insertion, and minimal risk of failure of them.

I'm not familiar with the Mio sets - are they inserted at a 90-degree angle or 30-degree? I had problems with the 90-degree ones, but my problems disappeared once I changed to 30-degree. You should not be getting blood that often. The set should only be hitting the subcutaneous fat, and if she is on the leaner side, the 90-degree might be hitting her at a bad angle. Hope this helps.

I'm sorry to hear you are both struggling. I have had issues with insertions over the years too but I am also not familiar with the Mio. As others have mentioned, I much prefer a slower insertion (I detested the auto-injector!!!) and also a 30 degree angle works better for me.

I would actually avoid holding her breath during insertion as that seems to tense everything up (which for me increases the pain). If there's a way to breathe out as the insertion is happening, in order to decrease muscle tension, that could help.

It may or may not apply for you, but something else that helped me was to tell myself "pain is just another sensation" and to try to hold onto that notion. It's a sensation that we avoid (obviously!) because it usually signals something needs attention. I realize YMMV, but for me that helped me to at least stop some of the resistance and fear about the whole experience. Just my two cents on that one. :)

Good luck.

thanks for your help, makes good sense. Agree with the exhale on insertion approach - have advocated it but negotiations with teenagers can be fraught. We'll have another go as well as see if there are 30degree options on her provision.

Anybody still struggles with the failure of infusion set failures on Medtronic pump ?

Here is my story:

I have pumped insulin on Medtronic pump for 16 years now.
The first 10 years, delivery was accurate and I never had much of problems.
My control is within non-diabetics level.

About 6 year ago, I got no insulting delivery or partial delivery, so
often got unusually high. So I switched back and forth
between all the infusion sets in order for some kind of the infusion sets to work.
2 months ago I switched off Silhouette since it stopped working, back on
Sure T. But it worked a couple of weeks. I had to change the set
every 1 1/2 days.
And it’s getting shorter and shorter time for a Sure-T to work.
Right now, it’d be good luck if it works overnight that long.
I am seriously thinking about going back to injections.
Any better long term insulin to use these days. I actually attempted a couple
of years ago after all the existing Medtronic infusion sets failed on me.

Any other pump manufacturers carried REALLY different infusion sets
that may change the dynamics of working or not working. I remember
that I studied a few years ago, they do not seem to any difference in
terms of infusion sets. i.e. either canola or metal inside your body.

I have used upper arm, thighs, waist, butt. No luck of success.

Anyone any comment ? I am really frustrated. During the day time,
I resort to needle injection currently.

I find Mio’s almost painfree compared to Quicksets. I had huge issues with kinking of Quicksets during the last few years, after more than 10 years of constant use and since I’ve switched to Mio I have not had such issues.

You are probably hitting the blood vessels. What is the length of the needle, 6 or 9mm?
PS. Mio now exists in a 45 degree version as well, but the needle is a bit longer than the usual 6mm that I’m using. That may be a good solution for you.

I can see that you are an experienced pumper, sixteen years is a long time with the possibility of a lot of scar tissue. After 16 years I’m sure it is hard to find new ground.

I don’t think you will find a difference in sets between manufacturers, the same company makes most sets out there. I now use Comfort Shorts with my Tandem pump, this is the exact same as the Silhouettes I used with my Medtronic.

I’m sorry I do not have any suggestion other that one you are already trying, that is to take a pump vacation. If you love your pump as much as I love mine I know how hard that option is.