What is the thinking behind the recommendation to change a pump site 2 hours before a meal? What difference does it make when you change the site? We try not to change my son’s site close to bedtime, because we like to have a test or two to make sure the site is okay before sending him to bed, but I don’t get the need to have time between a site change and a meal. During the school year, My son isn’t home 2 hours before dinner and it doesn’t make sense to do a site change 2 hours before breakfast, and he’s at school 2 hours before lunch. What am I missing? Is the 2 hours really important?
i usually go right after a meal and bolus for the planned missed basal. It has always worked for me. I’m guessing the 2 hours before hand is to see if there is a rise without a food bolus on board. If you are fasting and you get a rise then you can attribute it to the site change and not a miscalculated meal.
Thanks - that makes sense to me.
I have never heard that recommendation. I often change sites just before a meal (sometimes I forget I need to refill a cartridge until I try to bolus and it won’t let me).
If I change a site before bed, though (bad habit, I know) I will often have a snack so that I can “test” the new site and make sure it’s working before going to sleep.
Yeah if you change right before a meal you have the chance of a bad site and missing an entire bolus. Been there, done that and it’s not a fun night! lol!
Our CDE made the recommendation when we did pump training, and, if I’m not mistaken, it’s also in the direction booklet that comes with the infusion sets.
It sounds like it would be nice to do to prevent a possible missed bolus because of a bad site, but it doesn’t sound like it’s so vitally important that I need to delay dinner by an hour or two to make it happen.
Thanks for chiming in!
It never occurred to me to bolus for missed basal. Do you mean the basal you miss while you’re disconnected for a few minutes for the site change? With the amount of my son’s basal, he only gets a little smidge every 5 minutes or so, so he would miss one little squirt at most. I guess he doesn’t have a large enough dose or isn’t sensitive enough for that to have a noticeable effect on him. It’s something to keep in mind, though, as his basal needs change/increase.
I haven’t run into very many problems I’ve noticed “bad sites” having been involved so I usually change it when it runs out and don’t worry about the time. I’m not organized enough to say “there’s 25U left in the AM so I’d better throw them out”. I also don’t bother w/ the 2 hours before eating as that’s not realistic.
The CGM sensors are a bit dicier as it seems as if they work better if they are put in when your BG is fairly stable? I try to get up early on those days or just bring some kind of breakfast bar to eat later if I don’t get going.
I would do it in the evening right after his dinner bolus. That way at bedtime you will know if things are out of whack or not.
I never heard that rule, either, though I’m sure SuFu is right about the reason. I’m not particularly rigid about when I change my sites (nice to have something to not be rigid about!). I pretty much do them when the insulin is low or when I think there’s a problem. I definitely wouldn’t worry about extra basal for the short time it takes to change the set. I disconnect for a nice leisurely bath and don’t see any difference or feel the need to add basal. I guess it would be more of a concern at higher doses.
I think “rules” all have reasons, but we each pick and choose what we feel is important and find our own comfort zones between being relaxed and cautious.
I always change my site right before breakfast but then I like to shower right before my site change so the skin is nice and clean.
Maurie
Me too, I usually change out the set before breakfast, but also, Like acidrock, I do it when the insulin is close to running and it has been 3 days… I prefer to change sets it before breakfast, but if I am running late, as when I was working in a school district ( That is breakfast on the run, in the car(lol) and i Know it would l be cottage cheese and fruit at the stop light, I would bolus and I then change the site out at work after the meal… I had not heard of the two hour rule…
I think there atre 14 units in 43 inch tubing and 7 units in 23 inch…so it is not empty as it says on the pump… Yeah I know this is pushing it, but I always had supplies with me, syringes, infusion sets, a boittle of insulin with me or at work. in the fridge in outrlounge…Thus , I only have 'run out" once and it happened last week, two months since I retired; No ketones,dka or really high sugars, just was irritated d that I had to .drive back home and change out the set due to my own negligence…But all is about learning not to test the minits TOO much… I do not think that not following the rules is testing the limits in your case,AustinMom; just do not try what I did with your little one… But of course you would not, most loving Mom!!!
God Bless,
Brunetta
How are you enjoying retirement, Brunetta? At the 4 year point, I’m spoiled rotten and rarely leave the house before 10, can’t imagine working fulltime+teaching like I did before and consider myself very blessed to have insurance and enough money to live. I do sometimes miss doing things I’m good at and interacting with colleagues. All my friends who are my age or older (I’m 62) seem so exhausted all the time!
I was always told to change site and wait an hour. I usually change my site in the morning before breakfast. I check bs before changing and an hour after I also bolus a little extra insulin to cover missed basal insulin.
I was told to always change a set just before eating. When I bolus for the meal, it pumps enough insulin into the site to make sure the infusion cannula did not become clogged during insertion and that the site will accept insulin. My Minimed pump generates a no delivery alarm if it gets more than 3 units behind. In other words, if I bolus 3.5 units for a small meal, my pump will generate an immediate alarm if it cannot deliver insulin. This is much better than waiting for an alarm triggered by my basal rate: somewhere (depending on time of day) between 0.3 and 0.9 units. At 0.3 units per hour, it would take 10 hours before I knew there was a site problem!
Gerry
We were instructed to change my son’s site before a meal bolus so that we would know if the site was working. Although we do try to do it per the doctor’s instructions, we have also forgotten and had to do the site change after the meal bolus. The only thing we try not to do is to change his site before bed.
Thanks everyone. It seems as though everyone does this a little differently but that the different timings work well for each of you. It’s easier to decide which rules/guidelines to follow and which I can tweak when I understand the reason for the “rule”. With busy teeneagers at home, being flexible is key to domestic harmony, so we’ll change when we can, avoid changing at bedtime (the one time I had to do this because a site fell out in the pool during a late party, I was up all night checking - that does not make for a happy mom or a happy teen, so we try to avoid that as much as possible).
Thanks again. I always learn so much from all of you.