Replies to This Discussion

Permalink Reply by Sophie on March 15, 2012 at 6:59am

This is VERY common. It has to do with slow insulin absorption with the new site. I actually get incredibly high post site change without lots of planning. My endo says some people have different rates of absorption with a site change and I must be one of the people that has very resistant tissue at first!

So this is what I have to do:
Temp basal rate of 140% for 1 hour before changing site.
Change site, .5 fixed prime. Immediately set a 2 hour temp basal for 200%. That usually does it. I'll check 1-1.5 hours in and reduce or cancel the temp basal if I notice numbers in range that early.

I also never bolus immediately after changing the site--for me that's a recipe for a disastrous high. I try to wait 2 hours. So I'll bolus on the old site, eat breakfast, then change the site, so by lunch I'll be able bolus on the new site.

For me it's really quite a production!

Permalink Reply by Cheryl on March 15, 2012 at 7:42am

David has always used a prime that is slightly higher than the recommended prime. He uses an MM pump and after reading about post site change highs on tudiabetes and how a number of users have dealt with that by increasing the set change fixed prime, he increased his fixed prime, and has kept it increased the past couple years.

Permalink Reply by Tracy on March 15, 2012 at 7:58am

I have inconsistent post change highs, so I have not been able to give a set formula. I try never to change at night so I can test frequently. I use a .5 prime not a .3. I try to do it prior to a meal, but also to be sure that the site is "good" before eating and bolusing. After having diabetes over 30 years, some sites just don't work well, and I have been known to struggle with multiple site changes,manual injections, and high sugars. I just do my best each time. I test within 30 minutes of inserting, to see which way I am trending. if high, I treat, then check again in 30 minutes. I know that is not much time, but I can see if I am at least going up or down. If I am still high or going higher, I will usually wait about one more house, then start again. It wastes a lot of time, and I am grateful on the changes that do take, are not uncomfortable, and last a few days.
iddm-1979 pumping 10 years, all systems go with a few small exceptions :-)

Permalink Reply by Darren on March 15, 2012 at 8:51am

Yep, I fought this for the first few months I was on the pump. After consulting with my CDE (who has been pumping for years) and finding out she uses a much larger prime to combat this, I have ended up with a prime of 2.2. I had pretty consistent highs, so my adjustment was fairly easy - I knew the standard .3 prime was leaving me at about 160 mg/dl 4 hours later, so I increased it to 2.0 for a couple changes, then fined tuned it to 2.2. I'm still a bit high sometimes (120 - 130) but not consistently enough to change at this point.

Permalink Reply by KiwiRox on March 15, 2012 at 9:35am

Which set do you use? With the silohuette sites the prime is 0.7 and never really noticed an unusual high. I'll need to pay more attention.

Permalink Reply by diabud on March 15, 2012 at 2:21pm

Wow! What a revelation...I thought that I was having problems because the old site was causing me to run high (not work as well). I wouldn't have even thought to ask my D-team about it. I should look back because I do not always have problems but it might depend on timing with meal and/or needing a correction...hmm

Permalink Reply by Elizabeth on March 15, 2012 at 2:47pm

What sort of infusion set do you use? the .3 prime is fine for Mios, but Silhouettes need a .7 prime.

Permalink Reply by MinnesotaAnn on March 16, 2012 at 11:21am

I usually need a higher basal rate for 24 hours. When this first began to happen I would sometimes pull out my new set thinking it was bad!! Now, I set the basal higher and supplement with shots.

Permalink Reply by sultansfam on March 20, 2012 at 11:08am

I do get highs after a site change but never took a prime. I might be dumb asking this but how do you calucalate prime. Is it a fixed amount or should be calculated. My DE never discussed about this.

Permalink Reply by Jason 80 on March 31, 2012 at 8:04pm

Call me crazy but I use a 3.0 prime. Usually fixes it. Plus it helps to have a good BS to start with before you change sites.