I'm curious when people on here change infusion sets? Is it at the first unexpected high?
Yesterday afternoon I changed infusion sets around 4:30, was 15.8 (284) at about 5:30 before dinner which was a bit weird, and was 22.1 (398) after dinner. I did a shot but I am always reluctant to change newly-inserted infusion sets, so I left it. My correction with the shot was minus the IOB since I didn't know if that insulin would kick in. By 11:30 I had come down to 11.2 (202) and did a 1/2 correction with the pump (thinking the correction from the shot might still be working), and went to bed.
In the middle of the night I woke up feeling weird but I did not get up and test, just went back to sleep. It very likely could have been a low ... In the morning at 8:30 I was 5.2 (92) and ate my usual breakfast.
Three hours after breakfast I was 20.2 (364). So I did a correction with a shot (this time also bolused with the pump disconnected to capture the IOB). It's two hours later and I've come down to 10.5 (189), so I'm now thinking I'm going to give lunch a try as soon as I come down, and if I'm high after that I'll change my site.
So I don't know if this is due to a bad site (maybe working for basal but not boluses?) or a rebound from an overnight low or my I:C ratio changing drastically for some reason. I changed my last site after only a day due to itchiness/irritation, and this one is itchy, too, so I'm thinking my old infusion-set-irritation-issue might be playing a part. I hate "wasting" infusion sets, though! I might try just moving this one to a new location, but that means I have to stick it down with Band-Aids which get ridiculously itchy.
I use the Medtronic Paradigm 722 and only change every 3-4 days. The company recommends no more than 3 days to prevent infection, but I try to get more bang for my buck. The few times I vary are when I accidentally pull it out (!) or it gets really red and itchy. There was a time when I KNEW I had an occlusion and then I changed.
I guess I'm kind of a fly-by=the-seat-of-my-pants gal. You seem soooo educated and up-to-date with the whole pump issue. Makes me ashamed of myself. I guess I just leave it up to my endo when she loads the info from the pump and glucometer. I guess this is OK because my last A1c was 6.4.
Pretty much all my infusion sites are red and itchy. :( I may be up-to-date and educated but I am stubborn! I think lots of people would have given up on the pump by now if they were me ...
No need to be ashamed of yourself, though; your A1c is great!
I feel kinda sick now but my BG is down to 8.0 (144) so I think it's just from so much yo-yoing over the past 24 hours.
My "policy" re changing sites has actually changed since I started using the metal sets. With the plastic sets I had kinking and other problems so if I got a high of 300 or over I usually changed my set. Now, with the metal, I only occasionally get cartridge problems or other unknown set issues. Generally I make it the full 4 days I allow for them. Also, with the metal sets, if it starts hurting or something I can just pull it out and tape it back into another spot (I am lucky not to have allergy problems). So now, even with a 300+ I will often do a shot correction (disconnecting and doing an air shot to get the IOB). But if it goes back up for a second time, then I will change the set.
I don't know what I'm allergic to, but there's definitely something in infusion sets and/or adhesives that my body does not like. When I was using cannula sets I used to get itching, hives, redness that would last for days. I figured my problem was the cannula, because there was often a big welt directly where the cannula entered my skin, and a few times I tried sticking the set on without inserting and got almost no irritation. So I tried other cannula sets, got the same result, and switched to needle sets. They seemed to work great for the first few months, but for the last month or two they have also been getting irritated. Itchy and with a lump and redness that often lasts for days.
The weird thing is that often sites that are a week or two old will all of a sudden get an itchy rash again. So I definitely think it's some sort of allergy. It's just figuring out if I'm allergic to the cannula, needle (or both, since I do have issues with jewellery), adhesive, or insulin.
So far I have tried putting Skin Tac under sites as a barrier which just made the irritation 100 times worse, so I stopped using that. Tegaderm under the site also causes irritation. So does medical tape and Band-Aids used to hold the sets down if I move them. I haven't yet tried IV3000 or Opti-Flex or I just heard of a new one called MyFlex or something like that.
I feel like I am a broken record on here sometimes! Really what I would like is an if I could determine exactly what material I'm reacting to so I could just avoid it ... I'm going to an allergist in April (for unrelated issues) so will ask them about it.
Wow, four days! I read in the pamphlet that comes with the sets that the manufacturer recommends keeping them in for 1-2 days. I just had a friend suggest that I remove the set after a day and move it somewhere else, then change sets at 2 days. That might prevent them from getting so itchy. But it also means I have to use tape or Band-Aids to stick it down which cause unbearable itching after a few hours (especially Band-Aids).
If I'm high in an hour or two (I boluses for lunch with my pump) I will definitely be moving the site to a different location, though. At this rate I'm changing sites about every day, again. *sigh*
I normally leave my sets in for 4 days. If I have an unexpected high,over 200 say. I do a correction with the pump. Then test again in an hour or so, if it's started to come down then it's just one of those diabetes inexplicable things, if it's about the same I wait a bit longer, if it's still climbing then I change the set & usually tubing & cartridge too. If it's the middle of the night I correct with a syringe & change in the morning, I'm usually not awake enough to change.
Wow. I learned something new. I didn't know you could reinsert sets. You see, the QuickSets I use has a needle that is withdrawn after insertion and the cannula is soft plastic. I don't know what a "metal set" is. I use "I.V. Prep" supplied by Medtronic and have no complaints at all. I also use the IV3000 and have only positive things to say. If I get red and/or irritated there for no known reason .... just sensitive skin, I guess.
Actually, the Medtronic rule is no more than 3 days. I got "yelled at" by a company rep for not changing before 4 days. The risk of infection increases after 3 days. And, personally, I can't afford to change every 2 days. Not only does Medicare not allow for more often, my other insurance company won't allow it either. The only thing that would benefit us is if Medtronic would change their recommendation. Then (I think) they would send us more than 3 stinky boxes of 10 every 3 months.
I try to change every three days (One of the things I loved about my Cozmore pumps was that it had an alert telling me it has been 3 days) If I get an unexplained high bg, I'll check my history on the pump and there it is: 6-7 days. When The Endo asks about the rogue readings, I tell him - forgot to change set. He suggested just putting 3 days worth of insulin in the reservoir. NO! I hate wasting all that insulin in the tubing when the reservoir is empty and it can take - what seems a lot to me - to prime everything.
As a ps. Does anyone else "fat finger" and accidently get all caps and then have to retype so no one thinks you are shouting?
Back on the allergy topic, Jen, I was thinking of you today. I was in the drugstore and looking at various types of medical tape. I remembered "adhesive tape" which was used to tape down gauze. I was interested to see cloth tape and paper tape and one or both of those said "for sensitive skin". I didn't look too closely as I already ordered the fancy stuff from Animas but I thought I'd suggest you look at some of those things. They are kept in the first aid area near bandaids and gauze. Maybe something will not make you all itchy when you tape down the metal sets!
A metal set just has a needle that stays under the skin, rather than being withdrawn. Some people are allergic to the plastic cannula, and I was having huge welts form around the cannula when I used those sets, so I gave metal ones a try. I'm allergic to some metal, though (probably nickel) so the metal sets are causing issues, too, and so are a lot of the tapes which make me itchy.
You are right, though: the usual cannual sets cannot be removed and re-inserted, since you have to remove the needle after insertion.
I change them when the tank is down to around 5U of insulin, usually I get 4-5 days out of them. I don't get unexpected highs as much as maybe perceive the insulin to be slightly less responsive at that point. I will admit that the sites seem to be getting quite itchy this winter.
I always shoot for four days, and the time of day for the change depends on my schedule.
I DO change them if I am having a problem. Here is my usual practice: Over 200 and under 250, correct with the pump. If after 4 hours the BG readings remain high, I take that as an indication that my location is not good. Sometimes I just change the site; often I change the insulin also.
I also will not eat in that four hour period if possible.
I use the Medtronic Paradigm 722 and use the Mio infusion sets. I really do not change my set until it falls out. I do have an allergy to the infusion tape, so I use the Opsite barrier, which I trim when it starts to roll up, ect.
I will have to try this tape out. I am continually amazed at how many people have sets last for 4-5 days! I sometimes start thinking my set problems are normal, but then I do a post like this and realize that nope, they're not.
I'm trying a Comfort set to see if after a break it works out better, but after one day it was getting itchy/sore (it's been 1.5 days now).
I need to get my hands on some of these barriers people have recommended. I have time today so will try to give Animas a call (I'm hoping to get samples—I'm reluctant to order a whole box after trying that with Skin Tac and finding it made irritation 10x worse).
Thanks, I will see if my pharmacy has anything like this. I am determined to find some combination of barriers/tapes that will work for me! (Right now my main problem is lack of time for contacting companies and shopping around ...)
