Use sight and touch to select infusion site

Diabetes Technology Insulin Pumps
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I’ve been using an insulin pump for almost all of the last 32 years. One of the key elements of success is consistent insulin absorption across the 122-183 infusion sites we utilize, on average, every year.

I’ve been through times when poor insulin absorption due, in part, to scar tissue resisting taking up the cannula-delivered insulin. Confusing this issue, and very much related, is the body’s ebb and flow of overall insulin resistance.

This topic, however, focuses on an infusion site selection tactic that has been particularly successful for me.

Doctors will often employ palpation as a way to learn about a patient’s health. Wikipedia defines palpation.

Palpation is a method of feeling with the fingers or hands during a physical examination. The health care provider touches and feels your body to examine the size, consistency, texture, location, and tenderness of an organ or body part.

Now I know that people use a formal site rotation routine and that sounds like a great practice to me. Unfortunately, I have never been able to make that practice stick and I now primarily base my infusion site selection using my eyes and sense of touch.

I generally use my abdomen from my sides above my hip to the area around the umbilical or belly-button. I move sites every three days and usually alternate between left and right, a crude rotation scheme, I know.

I stand in front of my bathroom mirror and visually examine prospective sites in the mirror as well as looking directly. Good lighting is needed for this. I’m looking for skin without any darker discoloration or redness. Formerly used sites often show a small dot of redness and I avoid using that exact site.

Using my fingertips I press and prod the potential site and also gently squeeze the flesh between my fingers and thumb looking for sites free of fibrous or scar tissue. I also press in with my index finger and focus on whether I feel any pain, even a minor pain sensation. If I feel scar tissue or any pain, I move on to another area.

The ideal sites are flesh colored, free from any red marks, and return zero pain when pressed.

Using this method has rewarded me with consistent insulin absorption for many years. Anyone else perform a visual exam and prospective site palpation when selecting on infusion site?

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2

I do this every time as well taking a good look at the available “real estate”. I have a CGM which is most successfully worn on the right side of my abdomen so that is also a consideration.

Recently I switched from a 6mm to 9mm cannula which I’ve had much better results with in terms absorption and less irritation just below the skin surface.

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I’m not surprised that others are also using a visual and touch screening to select sites. I’m writing about it since I don’t think it is often explicitly encouraged. Perhaps it is just one of those obvious considerations that people don’t think about much.

Your successful cannula depth change reminds us that we need to respond to the dynamic changes that good diabetes management requires. Sticking with what we’ve always done is often a recipe for mindless failure.

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Does anyone use a marker / pen to mark the new infusion site after palpitating?

Missing a virgin spot by even an inch can have disastrous results.

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No, but that is a great idea!

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6

I like this idea. It could improve my aim. I have noticed that I don’t always hit exactly where I’m aiming.

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7

Terry and @Tapestry - My aim is terrible. I’ve tried scratching and leaving a fingernail indent at intended ground zero but by the time I have the adhesive off I usually can’t see it :stuck_out_tongue:

I’ll try it this afternoon - have to do a site change in 3 hours

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I have a site change tomorrow and I’m going to mark it with a pen first!

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9

I do this when I’m the one changing my site. However, about half the time I use my husband to change sites because he can reach places I can’t on my arms and butt. He does a pretty good job, but the one thing that I can’t seem to teach him is to look carefully before he pokes. He’s getting better; the first several times he kept trying to put it in the same place because he didn’t want to put it somewhere wrong lol. It’s been a learning curve for both of us since the last time someone injected me was when I was 12 years old.

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Yes, I look for a site that shows little or no signs of recent use and feels normal. I’ve never tried a site rotation scheme, because I think I wouldn’t stick to it.

No, I usually don’t aim for a very specific spot

11

It’s been nearly 20 years since I used a tubed infusion set, but can’t you take the adhesive off first and hold it while you look for a target spot? With my pods, I remove the adhesive and hold the pod in one hand, and with the other hand I poke around for a good spot – looking down or looking in a mirror, whichever. When I find it, I don’t even have to take my eyes off it – the pod is right there, ready to touch down.

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Mdi-er chiming in, yes I do visually and manually check before injecting. In addition when I am beginning to insert the needle if it hurts at all I remove the needle and inject somewhere else otherwise I will end up with either a bruise or a large painful lump under my skin. If I were to go on a pump I would probably opt for infusion sets that you have to manually insert for that reason although I rarely have any issue with CGM sites so I figure it must be the insulin itself that is at fault.

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I always feel around for a spot that does not have any scar tissue. I also try to use a fairly flat area. Some areas just seem to have a better absorption rate. Might try the pen idea.

14

I can’t use sight to select sites, but I do use touch to avoid any sites that feel sore, dry, or any other signs of irritation or feel lumpy underneath (which I assume is scar tissue). I use steel sets, so if it starts hurting when I put the needle against the skin or start to insert, I move to a new spot. Sometimes I have no choice, though, because at certain times all sites hurt regardless of their location, so in that case I just insert and hope for the best. I’ve also had sites that don’t hurt at all and yet didn’t have the best absorption (probably scar tissue).

I wish I were better at site rotation. I’ve pretty much killed my absomen as far as use for pump sites goes and now only use it for CGM. I don’t know if or when it will ever recover to use for pump sites. I’m worried the same will happen with my arms and other areas. I use a set that requires manual insertion, and because of this combined with my visual impairment (and having to do one-handed insertions when using my arms) I’m never very accurate at aiming. Sometimes I feel like I’ve put the set in at an angle (it’s not an angled set) and sometimes I feel like I miss the area that I’ve covered in alcohol.

If my next pump turns out to be the Ypsopump (debating between this and t:slim) the sets that they come with (Orbit 90) are metal but have an insertion device that can be used with them. That seems like a huge advantage to me, as it would allow me to aim better and access sites I can’t access manually.

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15

Yes, this was my experience while on a pump. My upper thighs showed no visible signs of scar tissue and most areas weren’t painful when pressed (unless I recently used that spot as a site). However, I had significant hidden scar tissue. My preferred placement site was my thighs; I should have used other locations more. I tried to rotate as much as I could on each thigh, but apparently it was not enough.

Despite being on multiple daily injections for several years now, I still cannot use my thighs for shots. The insulin does not absorb well.

Currently, I do inspect my abdomen before giving short-acting injections, but I don’t follow a rotation schedule. I use Afrezza for most meals and corrections, so overusing areas for these injections is not likely to occur.

My 2x/day long-acting injections are done on my butt. I do the morning injection on the left cheek and the evening injection on the right check (by remembering Right = Night). I try to move these injections around as much as possible because I don’t want to end up with the issue I had with my thighs. Injections seem to cause less scar tissue than pump sites anyway.

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The inset infusion sets need some SkinTac, and I don’t have enough hands to palpitate, then hold and Skin Tac, and then insert canula.

Hence the 2-3 step process

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I have lost the ability to use pump sites in my upper abdomen completely, but the CGM still works perfectly fine there. To be fair, I haven’t tried using the upper abdomen for pump sites for at least 2 years, but the last time I tried, every site resulted in a bent cannula pretty much immediately, which is odd because there’s plenty of fat there, but I think I was worse about site rotation while on MDI and that’s why it’s so bad now. Since my upper abdomen became completely useless, I’m a lot more vigilant about site rotation. I don’t really have a schedule, but just look at the area and if I can still see a spot from the last time I put a site there, I move to a different general location. It still feels like I’m constantly running out of good real estate though, despite there being more than enough surface area.