I am using the 780 and I will change my site and my basal bloodsugars will seem okay according to my cgm but as soon as I eat my bloodsugars will spike. My carb factor is good. My question is, how would I determine if my site is working properly when eating?
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1: I have to give my bolus 20-30 minutes before I eat. That can be challenging, especially when eating out.
(Also, good luck estimating carbs from a fancy restaurant meal!!)
2: physical activity seems to influence both insulin absorption and insulin effectiveness. So if I’m sitting around, the recently bolused insulin seems to take its time as opposed to when I’m moving.
3: I have experienced times where the basal insulin keeps me level but the bolus seems not to “work” but I don’t know if that is a site issue for sure, there isn’t any reliable reproducibility of the phenomenon. Except perhaps #2, above.
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I just want to add to what @MBW wrote, I am convinced that for some of us there are no hard and fast rules when it comes to glucose regulation, there are just so many variables.
I think that in those using a pump, because the basal drip is so small it may be absorbed quicker than bolus which is usually much larger.
This may be better with the T:Slim because the infusion is fairly slow, a few tenths of units at a time. Not knowing if that is true with other pumps.
Just spitballing here.
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I’ve experienced the same thing: a site change seems to go fine but then the first meal bolus is really ineffective. This isn’t the case 100% of the time, but it’s frequent. I don’t consider these bad sites because they work fine later but they are sites that for some reason need to be “broken in”
I use a t-slim and steel infusion sets.
I’m sorry to say, I’ve never found a way to predict whether this will happen with a new site
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The only time that this has happened is when my site is in blood. I will remove the site and there is a tinge of red in the cannula. Could my 780 be reducing my bolus too much because that is what it does for breakfast. I haf my carb ratio as low as 2.8 and I still ran above 10mmol.
Post can’t be empty.
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When changing a site there are a few things that may help it keep you BG from dropping and to have the insulin start working as soon as possible. Some of these are not, for unknown reasons, not taught to new pump users.
1 - Leave the old site in for several hours to be sure the insulin infused at the site is fully absorbed, and does not leak out after removing the old site.
2 - After inserting the new site fill the cannula. The amount of insulin may vary with different infusion sets. With the T:Slim pump you can use the Load/Fill Cannula feature to ensure the the fill is not seen by CIQ as IOB.
3 - Use the Fill Cannula feature again to prime or soak the site to create a puddle of insulin at the end of the cannula. I’ve used 1u for 28 yrs with success. This creates an opportunity for the insulin to begin absorbing ASAP because as it comes out of the vial is is not effectively absorbed until the insulin molecules are separated to be absorbed.
The amount of insulin needed to fill you cannula and to prime or soak the site will vary so experimenting would be productive.
Note: If this a new site that is replacing a bad site you may need to bolus to make up for missing basal insulin because it was not absorbed in the bad site.
This should be taught to everyone who uses a pump, as I was 31 yrs ago.
Hope this can help make pumping easier.
I often use a syringe for the next meal if the site change happened less than an hour earlier. Also be sure and fill the canula even if you are using a metal infusion set like Sure-T. I do .3 for it and use Sure-T. I hope this helps.
Before I put in a new set, I fill it until drops appear. I’m filling the short piece of tubing plus the cannula. Perhaps it’s a medtronic/tandem difference but I don’t get where .3 comes from. It could be the length of the actual steel cannula part, but how would you know the tubing was full up to the cannula without seeing drops coming out in which case the cannula is full as well as the tubing?
I get what you are saying, but for me this works. Since I started doing this I no longer go high after a site change unless I make poor choices (food). It probably does because what others say about getting a pool of insulin.