Am I just a rookie or am I doing something wrong? Help with infusion sets!

I just started using the MM Paradigm and have the Quick Set infusion sets. I switched from Omnipod because of insurance reasons and LOVED the new MM when I got it. I've had trouble putting it on but I figured it was just nerves every time. The last few have been on just fine. But now instead of me causing occlusions, I have had high BG's and a no delivery alarm. I've gone through 3 infusion sets since 10PM last night and now I'm not sure what insulin I have been getting.

I changed the set last night because of a 300 reading, which was strange since I had good numbers with that set. So I changed everything out, reservoir and all and corrected. Then I woke up at midnight and was still 294 so I changed out the site only, I hate that I lose about 11 units in tubing alone so the less I can change, the better. Woke up in the 180's and figured I would try it and see if giving insulin would fix it. THEN a no delivery. Could it have been because I only changed the site and not the whole reservoir setup?

I'm a little frustrated because I don't want to go through all these infusion sets! Does anyone have any suggestions?

Tags: infusion, quick-sets, sets

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You will get a lot of suggestions here, so I will start.
-Are you sure you do not have air or bubbles in the cartridge? Always fill cartridges with room temperature insulin and be really careful to tap the cartridge before adding it to the pump, which will allow any air to be dispelled when you prime.
-Did you have a pump coach when you changed pumps? You pay for usually 20 hours of his or her time, so call them up.
-No delivery usually happens for me when I prime a new set and has to do with the way the infusion set has been inserted into the cartridge. I set the cartridge on a table, tap it, then insert the infusion set striaght down onto the cartridge, then I graps the cartdge and turn it a little until it clicks into the infusion set--you can hear it.
-You are not getting sick or have an infection? Could the high blood glucose levels be because of that?

That is all I can think of at the moment. I have been on the mm pump for about 6 years now and have had very few problems. Remember, too, that the more you get stressed out about this, the more erratic your blood glucose levels may be.

It could be that the cannula size doesn't suit you. You could try using a different depth. It can have a big influence over the effectiveness of the infusion set.

One other way to resolve this problem is to switch to the Sure-T Infusion Sets which use metal instead of teflon. Phone Medtronic and explain your situation. They will probably send you some free samples.

I had the same problem with the quick sets. I switched to the sure t and have not had a problem in 4 years. I change the set every 3 days without any site problems, and I reuse tubing once or twice which saves insulin. The sure ts are easy to insert without an inserter. I just tap it in painlessly. Minimed might let you try a few. Good luck.

I had a problem inserting the Quick sets, because I found that they would get caught on the inserter in the process (likely my own nerves causing one side to click before the other). So I contacted Metronic and they sent a rep out to meet me and show me how to use it properly. She actually recommended using the Silhouette instead. She said that because they are inserted on an angle, you would have less troubles with kinked cannulas, and therefore issues with insulin delivery. I enjoyed it for years, but recently, while visiting the dietician, she asked about my sites. When she saw them, she said that I was likely having an allergic reaction to the cannula, which was causing random highs that I couldn't explain. So I recently switched to the Sure-T, which has been great! I am left with virtually no marks afterwards, no itching, and stable bloodsugars. I agree that it might be the length of the cannula as well. If you are slim, you might need a shorter set. Regardless, you should be able to return any unopened boxes of infusion sets to purchase a different kind. Good luck!

I have used the quick sets for years and no trouble until recently but I think that is due to scar tissue.

My first thought was your cannula size.

I use the 9mm.

Get samples of all sets. I've used QuickSets, Sils, and SureT's, mainly with no problems. I'm currently using only SureT's, because they're the cheapest and my insurance won't cover DME - which is what they consider infusion sets. Seems kind of stupid, cause they're certainly not durable.

Since the SureT's have a metal cannula, they will not kink. I strongly recommend trying them.

Tom

Thank you everyone for the advice! I'm seeing my nurse on Thursday so I will ask her as well. I was afraid to try the Sure T's because of the metal but I heard that it doesn't feel any different. I'll see about getting the samples to try some out. Hopefully they'll do that!

I do have the 6mm cannula because I am smaller and I was wondering about getting a longer one. I don't like the idea of using one at an angle because I think that's why I had so many problems with the Omnipod.

@Nicole, how did you determine you were allergic? I would be interested if that was my problem. I always have little red marks and it ITCHES all the time after I take off an insertion site.

Thank you everyone for all your help!

Sometimes the itchiness is a reaction to the glue on the back of the insertion set. I had a terrible time with the quickset until I started using a barrier between it and my skin...something like tegaderm patches or IV3000 tape works for me.

Ruth

My dietician looked at my stomach, which was covered in scars from past infusion sites. I had changed my site the day before, so she looked at the spot from the last site, and it was red, very tender to touch, and a little crusty (ew!). She asked if I ever noticed it feeling itchy, which is always did. I would try to scratch, but it would be sore! I always thought it was normal, but she assured me it was not, and advised me to try the Sure-T's instead. That might be your problem! An allergic reaction will cause a quicker build-up of scar tissue, and therefore, poorer absorption. Good luck, and keep us posted!

Here are a couple of idea I have had. First the infusion set might take 2-4 hours to seat correctly, or at least mine do. I usually push 5 units once i get the set inserted just to check it out and get things going. Even doing that I will sometimes run up around 250 to 300 before I get the thing under control. Sometimes I will push 10 to 15 units in a regular syringe if things seem to be getting out of control.

Second, Be sure you push insulin through and out the new set before you insert it. That usually cuts way down on the no delivery msgs. I do this by using the remaining insulin in the reservoir I am discarding and an older saved, plunger (I save the plunger form the reservoir I am changing out and I connect it to the new tubing and new set then I push the remaining insulin in the old reservoir, until I see it has run out of the reservoir and has sprayed out the set. That way I know I have a good set and occasionally you will see a bad one but not very often. I then hook up the new reservoir, push a couple of units and make sure it comes out the end of the set. A DE showed me how to do this and it works most every time.

If tubing or flow goes bad, I usually change both the tubing and the set. If anything I am more likely to change the set and reattach the recent tubing, but if its a day or so, I just go all new.

Finally look at you canula when you pull it out. IF the nylon shaft that is inserted into the skin is bent, or the wound is bloody, you likely had a set issue. If it is straight and there is no welt or not a lot of blood, then it is likely the tubing or reservoir.

Like someone else points out, if air bubbles get in the tubing, it can reek havoc, one way to clear air is to leave everything the way it is and remove the attached connection to the set, the reservoir and then use a plunger to hand push 5 to 1o units out of the connection. but not into your body. Sometimes that will clear the air out of the system.

Rick Phillips

You are a GENIUS! I knew there had to be a way to get around that priming because it's such a waste in the tube. I'm okay with losing insulin in the tube but I hate that it's not just lost in the tube, it's lost in old reservoirs and especially if I need to make an infusion set change early. Thank you for the tips!

I've had the Paradigm for a few years, and I use the Silhouette, simply because that's what I started on. They are a little bit awkward to put in, but since they go in at an angle, somehow it works better. I've heard about a lot of problems with the quick-set, so simply switching infusion sets could help!

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