okay, so our son has been pumping since early october so we are still kind of new at this, but...

we have had 3 sites that went in wrong and were not working, a couple of sites that went bad because we had trouble reconnecting after a bath (quicksets) and 3 sites that got ripped out and changed before they would have needed changing otherwise.

but my question is can a site just go bad for no apparant reason? he was low actually at bedtime and had some snacks, which we bolused for. I went to check him before i went to bed and he was 13.4 (canadian, so a little higher than he is usually at that time). I thought this was a little odd given he was low earlier and so i waited another hour and checked again. This time 19! I did correct, but I was wondering what the possibility is that the site is bad given that there is nothing (to my knowlege) that could have made it go bad? (It was changed yesterday afternoon).

Also, In less than 2 months of pumping we have gone through almost an entire extra box of infusion sets, which is costly, so i was wondering how often you have 'bad' sites that need changing long before 3 days is up. Thanks.

Tags: bad, infusion, sets, sites

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since deciding to use the emla cream for site changes we get more site rotation then we ever did with shots. we had another bad site last night, but he had trouble reconnecting to the pump before bed and when i pulled the cannula out it was indeed kinked. it is the ones that appear to have no reason that frustrate me the most. We pay 80%, but we do have to pay first and wait for reimbursement. We are also going to try the minimed soft set and pray that the mios come to canada soon-lol. 3 or 4 of the bad sites we had were due to not being able to reconnect properly, so at least if we can eliminate those....
I recommend going to the bent needle and using Tegaderm tape With IV prep. You need to allow the IV prep to partially dry before you apply the Tapes. Do this by fanning the spot with your hand and then right before it dries, apply the tape evenly. Push down on the site with your whole hand over it and make sure that the tape bonds to all of the nooks and crannies around the tube and the needle. I can do just about anything with this setup, including surfing. The softserter and all of those plasticky sets have never worked for me.
what do you mean by the bent needle? are you talking about the angled infusion sets?
The bent needle is an infusion set that has been around for at least 10 years, and I see that Medtronic don't even list it as a product on their website anymore, but you can order it through the Medtronic online store.

They do still make this product though! In fact I just received my 3 month supply order of these. The bent needle is kind of a slang term for it. The official name is "Paradigm Polyfin QR With Wings" As the name suggests, its inserted at a 45 degree angle, and it has a very easy to use quick disconnect. I would ask Medtronic to send you a trial of the Polyfin and the SureT. My experience is that if one of the plastic infusion sets don't work for you, the rest probably won't either.

this looks a lot like the soft set, which we did get samples of though we haven't used them yet as we do not have the inserter, which apparently makes them really scary to my 6 year old:) It appears to be the same kind of connector which is good. I figure if we can at least eliminate the bad sites that have been caused by not being able to reconnect properly that would help a lot. I think this has been the case about 4 times since we started pumping oct 5. the soft set is still a 90 degree teflon cannula same as quick set but it looks like this pic.
We tried the orbit micro, but his body seemed to reject the steel sets, so we didn't try the sure T though i do have a sample of one. we also tried the cleos, but it fell off (came completely unstuck) after a couple of hours.
I just wanted to add a response about your "sets going wrong for no reason" question. Anything thats inserted into the skin is viewed as an irritant by the body. Sometimes due to a number of factors including perspiration, water getting in, and excessive twisting or physical contact with the site area, the site will become inflamed.

Its often not noticeable, but its the body's way of trying to work foreign objects out of the skin. Much as with a bad splinter, the area swells and starts to scab and callace internally to keep contaminants away from the blood and the tissue. If the site feels overly sensitive or if it looks red this is probably the case. Only your son will really be able to know.

Even the steel bent needle will get "no delivery" a few times a year. Sometimes a kink isn't a kink, but a blockage of dense tissue. I've had the restriction be so significant that the insulin leaks out onto the surface of the skin. Sometimes things go bad, but it should not be very often. I've seen just about every possibility after 10 years and 3 pumps. I think the bent needle should solve most of your problems. It works on me, and I am 6' 148lbs with almost no fat tissue. Just keep an eye on your sun and make sure he isn't writing and squirming around all the time. That will often kink or cause the site to become irritated.
The canula is probably kinked. I have experienced this a numerous amount of times without a notification from the pump. I would give him a shot of insulin to bring down his levels and then change the site asap. The pump probably isn't alarming because there is probably a little amount that is going through the line, but obviously not enough. Hope this helps!! Poor little guy probably feels like crap having his BG level so high :(
I also find that sometimes a site just doesn't absorb well. When I see higher numbers and I take the site out, I try to watch how much insulin flows out (I know -- not very scientific), but I tend to notice that when I have these highs more insulin is coming out compared to routine site changes.

Have you considered the Sure-T infusion set? I use this now and it has a metal cannula, but it is even thinner than the plastic ones. It is supposed to be good for kids, but you would need to check if it is comfortable for your son. One part that I like is I find insertion to be much less painful (about the same as an insulin injection) AND if I think that the site is not good, then I can relocate the site without changing the infusion set. I just pull it out clean off my skin (with IV Prep to increase stickiness), reinsert it and tape it down. The Sure-T needs to be changed every 2 days because of the teflon cannula, but I get 4-6 days out of each infusion set (and I think that they are even cheaper than other infusion sets). If I even have doubts that the site might be bad, I just move it.
what do you do with BG that neither comes down with correcting nor goes up? I had a 19 reading (confirmed on the other meter), an hour later a 15 on the usually more reliable meter, half hour after that 16 on the same meter as the 15, 14 on the other, half hour after intial reading 15 on the one that had read 16 and 14 again on the other. If the site is bad wouldn't his BG be rising? and yet it isn't coming down either. He had been low before bed and since last night I couldn't keep him UP at a good number, thought it best to not count all the carbs in his bedtime snack bolus. mayb this backfired. this site was changeed this afternoon and was working great.
There have been times that my glucose levels have stayed the same no matter what I did. Sometimes this just happens. If my glucose levels are above a 9 and I have done a second correction bolus. I do a correction injection. I do this because this is what the doctor told me to do when I first started on the pump. I am not a nice person when my numbers are not in control.

My dog does not like it either and she can be a royal pain. I am allowed to be between 5 to 8 or the dog starts letting the family know something is wrong. If I am at an 9 the dog starts standing on my chest or lap and gets very annoying. She will do what ever it takes to get my attention.
maybe we need to get a dog:) I guess I was just thinking that if the numbers aren't going up, it must not be the site? (which it turned out it was not the site in this case and they did eventually come down with a second correction)
Tracy sorry to hear about these stubborn numbers -- this situation can also be a sign that he is not getting enough basal insulin at that time of the day. I correct every two hours in this situation (and would do the second correction by injection).

Check and see if his blood sugar tends to rise at that time of day. One of the benefits of the pump is that if he needs more insulin as basal insulin at that time of the day, it is possible to adjust his settings for just those hours.

Given that he is new on the pump, his settings may still need adjusting, which can be very frustrating! When I started on the pump, my doctor made me promise to stick with it for 1 year because often you don't experience the advantages of a pump until all your settings are right.

Does you doctor have you doing basal tests?




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