I have a question. We have only been using the pump for a few weeks with our son.
He was getting insulin through his arm by syringe. He is extremely skinny ( 3% for his age). They said the only place he can put the insets is his buttocks ( top part). Well, the problem is... we had great control on the syringes. He was always within target. He could eat 15 minutes after the shot in the arm. Now, his BG are fine if he doesn't eat ( so background insulin level is fine), but every time he eats...he spikes. I know it's not a ratio issue because he does come down to where he should be after 4 hours. I think it's a timing issue. I have had him wait 30 minutes and it still spikes. Anyone else have a skinny frame and needs to put it in this site? Any idea how long we need to wait to eat? The convenience of the pump is being lost by how long we have to wait. He is using the angled inset as well...which is supposed to be better for skinny people. Thanks in advance for any tips/ help you can give. I'm getting frustrated and want to bail and go back to needles! Help!

Tags: kids, new, question, site, skinny, user

Views: 128

Replies to This Discussion

Check with the nurse who taught you how to use the pump. Some pumps (not sure if all) have ways of holding off on part of the insulin depending on the typs of foods he is eating (called square wave bolus and dual wave bolus). More information on how it works is here http://www.minimed.com/products/otherpumps/features/bolusoptions.html but you may have a different type of pump.
Hope this helps!
We have an animas ping. It seems that it needs to come sooner, not be held off. The food is getting ahead of the insulin..
Hi,
Wow, how frustrating. My 7 year old daughter is moderately thin, but we had no problems with her pump sites for almost three years. Several months ago we started to have problems with bent canulas. She would have high blood sugars and when we would take out the site we would see that the canula was bent. She has become maybe a little leaner recently, so this may have had something to do with the problems. So, we switched to the Sure-T site with Minimed. These use steel canula's and we have not had problems since switching. We were told that the Sure T can work better on thinner children. If you can see bent sites when you remove it, maybe it is worth asking about a steel canula?

If you are using the same type of insulin in the pump as you were in the syringe, I would think that he should react the same to both if he is getting all of the insulin. This makes me think that it is an absorbtion problem instead of a timing issue. You may want to consider talking to someone with the pump company to see if they can send you site samples that may work better. If you are still having issues after trying different sites, I would wonder if he just does not have enough fatty tissue to support a site? If shots were working for you, you may decide that it is best to switch back to shots. You can always try the pump again in the future if his body changes.
Can you bolus 30 min. ahead of the meal? that's often recommended. I had this problem with myself (absorption from the butt was too slow), but not with my son (he's had it in his butt for 4 years). It may be that my son wouldn't spike as much with syringes... but I really don't want to do that. (he only had them for a month). I do find that an earlier bolus helps. Also, running around right after eating will speed up the insulin action (using whatever limb it was injected into does that, whatever the limb). You could try those?
You could also try the leg/thigh...
Thanks. I do wait 30 minutes already :( It just doesn't always seem long enough. That's why i wonder if it's an absorption issue because sometimes it works ok, but most of the time it doesn't. If i give him a different insulin to carb ratio to increase the insulin he gets, he goes low a few hours after the meal. The spike is up until 2 hours after the meal and then it comes down - meaning it takes a while to kick in that insulin. Once in a while I've waited the 30 minutes and he hits a low :( before he eats. Don't know why those few times it seems to absorb quicker. Ugh.
When he runs around after eating, he always had a low with the syringes - insulin kept working and food stopped digesting. Guess I could try it with the pump since he is going high. Not always optimal to exercise right after though...especially when school starts .
I'd guess you are probably right. I don't know the solution though. You could try other areas, like arms or legs, and at least see if it makes a difference. This is also just a problem with manufactured insulin in general, it doesn't work as fast as normal insulin and lasts longer. We've sometimes tried increasing the basal before the meal and then decreasing it after, but that doesn't seem to work well, and you need regular mealtimes to do it automatically.
Do you get higher spikes at breakfast? we do, probably because there is less insulin on board then. it can just last a long time.
Problem is...he has no other place that he CAN put the inset. Apparently he is too skinny... That's at least what the doctors say.
My son always had really bad spikes immediately following breakfast- above 400 nearly daily. I have started working one on one with a CDE who suggested breaking the meal into two parts, and spacing them out and hour. Example: he is having 32 carbs total, I bolus for 32, give 16 carbs, then give the remaining 16 an hour to and hour and 1/2 later. Seems to work well for him and he hasn't been going over 250.
Also, I switched from Hemalog to Apidra which has also made a difference in the rate of rise and fall. I dont have to wait as long to feed after bolusing either. He is rather skinny as well, but I have found his fattiest area (legs/buttocks) do not seem to even work in comparison to his belly and back. His trainer told me if you are able to pinch up, then it should work. Its just trial and error... but dont be scared to try new places. It worked for us!
My son is quite thin (he is 10) and on the OmniPod. We use his tush, backs of his arms and the front of his thighs with good success. The thighs seem counerintuitive since they are so muscular, but they work very well for us.

It sounds to me like perhaps you I/C ratio needs to be a bit more aggressive and maybe lower the basal slightly. This will give you then net same insulin, but might help with the duration of his spike.
My daughter wears Animas Ping and you can't find a spot of fat on her whole body! She alternates left buttock, right buttock, then does switch over to her tummy periodically. I would call your Animas rep or the hotline to see what they say. Also double check your settings. Machines can get buggy sometimes. I recently upped my daughter's basal in the afternoon before dinnertime. You could do combo bolus and give half 30 minutes before and the other half during the meal. The other thing I learned at an ADA retreat this year was this formula: If your BG is between under 100, bolus and eat right away. If it's over 100, bolus and wait 10-15 minutes, over 200 wait 20 minutes, over 300 wait 30 minutes. Anyone else heard that? We've been trying to implement that.
Try using a "super bolus". Basically, you add insulin to a given bolus, but use the pumps function (temp basal) to subtract the same amount of added insulin from the basal over the next hour or so. In the short term, it helps counter spikes while over a four hour period it doesn't change the amount of total insulin given. I suggest you use the search function on Tu for "super bolus" - lots of great info and even a demo. Start slow and see what works. You'll find the pump offers an amount of versatility you could never obtain with MDI.
That sounds like a good idea. I'm going to try this. Thanks for the help.

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