When people are very muscular, i.e. have minimal body fat: where do you put your pump insertions and what insertion sets do you use? I hear people often say they would get a pump and/or CGM but they don't have enough fat to insert it into. What are your thoughts?
I'm not very muscular, but am very lean. I think, over the years, taking insulin in a very targeted area of my stomach has left a fatty layer there, since that is where the glucose and insulin will first interact. Considering how darn skinny and active I am, I find no other explanation for the belly bulge. ;-)
I use both a CGM and pump these days, and if you have elastic skin, you may be able to pull it away from the muscle to inject the insertion set into. The CGM isn't supposed to work as well if it isn't deep enough, but I haven't had any issues yet.
Having more muscle and less fat definitely makes me think about where I can put the Dex or Omnipod. The pod seems particularly subject to occlusions if there isn't enough tissue between muscle and the catheter. Areas with thicker skin make decent sites and I've found plenty through trial and error. The Dex doesn't seem quite as sensitive but the better the spot, the longer a sensor will last.
Around the trunk from the abdomen to the handles has plenty of good spots for either the pod or the Dex, but since the pod is more sensitive, I reserve those choice spots for the pod. I can get a couple more pod sites on both upper arms in the areas with thicker skin between my tricepts and posterior delts. I have plenty of good Dex sites on the upper, outer part of my thighs.
That's about it.
I'm getting less and less lean, so I don't have any issues with this any more. I have used Silhouette and Comfort infusion sets, both designed to go in at an angle. These days almost all infusion sets are available with shorter cannulas.
Muscular is one thing, but you would almost have to be anorexic to be unable to find a place where you could use one of the many infusion set options which are available.
The abdomen works for me, but others might have to use something around the backside and hips.
My CGM sensor is in the back of my left arm right now. There isn't a lot of fat there.
I'm definitely not lean, but I ran out of ideal stomach fat while pregnant. I ended up putting my pump sites into my uppoer butt and hip. On women at least, there's almost always a little cushion there even when you're thin.
I also happen to use the Inset 30 (angled) infusion sets for my Animas Ping, which I love partly because I can put them in less fatty areas. It means I have more "real estate" for rotating my infusion sites and CGM sensors, and I actually have some control over the depth of the canula.
Also - as a sub-question: being lean and muscular - do you find your insertion sites for both pumps and/or CGM to be comfortable - or do you find it painful if you insert into muscle or too close to muscle?
With limited site selection - do you find your sites heal up all the way (i.e. no 'lumpy bumpies under the surface, no lingering red dots from the pump sites, no reddened skin in the frequently used areas)? I work with people that use the same spots for years and their skin usually looks terrible in the 'used too often' areas.
When I first got a pump, I was much more muscular at my same, current weight. I used to have the Quick Set 6mm catheters litterally bend/kink over when my muscles would flex against it in my abdomen. So I used to use Silhouettes. I use the Animas Ping and Inset 30s now. I note that sometimes the insertions are quite painful, and other times, quite comfortable.
This is really stupid - but it has been on my mind for a long time. I'm afraid to exercise like I used to (though I miss it and my fabulous muscles!!!) because I'm worried I'll run out of spots for my pump. Tell me I'm just being a worry-wort and go out and exercise again!!!! Tell me I can always try it and if it doesn't work, I can always eat even more and gain 3 lbs. to have pump insertion sites!!!! I get frustrated when my pump sites hurt because I wonder where in the world else I could put them since I'm lean and sites are limited...
I jokingly tell some of my diabetic friends that I have to eat enough donuts to maintain subcutaneous fat for infusion sites. It's just a sacrifice I have to make.
But I'm sure you can make it work for you to exercise and use your pump. It won't always be easy. There will sometimes be kinks or pain. But there would be problems anyway.
As I said, I'm no longer lean, and I use a large area of my abdomen. There are little red dots all over, in various stages of healing. It's not pretty, but I'm OK with it. I'm not going to make a living as a swimsuit model.
I'm about as lean as I could imagine. I'm 5'10, and was about 140lbs until a few years ago when I started biking. I since lost a few inches on my waist (never thought that was possible), but put on pounds of muscle. I almost hit 160 last year, but I've since been more active and eating better and hover right around 150 now.
For the first ~5 years of pumping, I only used abdomen. I had 2 heights on each side that got used often, though towards the end of that time I was hovering around a little more looking for a fresh patch of skin. When I got the CGM ~2 years ago, I used the abdomen (though a little higher) for that only, and pump sites on my upper butt. I'm starting to run out of good real estate there now and may try the abdomen again, but the few times I tried this year, it was much harder to get into, and not very comfortable. Sites don't last as long on my abdomen either.
I tried legs only a few times, and had to rip out the sites after a day. It was so irritating that I couldn't stand it. My arms have even less to work with, and so I've never tried one.
I considered going back to shots temporarily, in hopes of letting some spots heal up better, but considering areas unused for 2 years still cause problems, I'm not sure that a few months of shots is something worth pursuing.
If only I could eat more junk food or stop biking so much...