I Hate Set Change Days...
I am very regular about changing my infusion sets. Every three days, usually in the morning - unless some emergency dictates otherwise.
I believe that it is important for me to not leave my infusion set in too long. I feel that it creates more scar tissue when it's left in too long. While I've never had a set in for so long that it created control problems (that I noticed anyway), I have gone longer than recommended in times past. If I remember correctly, my longest infusion set was left in for 5 days. Could be a lot worse.
Now I have been pumping for what I consider to be a long time. I don't know exactly when I started, but I'm thinking that it was somewhere around 8-10 years ago. After all those years, I do know that I have areas of my abdomen that have more scar tissue than others. Those tend to be former "favorite" site spots. Places that I used perhaps more often than I should have, and didn't give enough time to heal between re-use.
I was on shots for a long time before pumping, and I would bet that many shot users can attest to funny pockets or lumps that form when a spot is used too often. For me, I had overuse lumps on my thighs and the back of my left arm (because I'm right handed, so I used it to inject into the left arm). Nothing majorly huge and gross, but they were there. After 8-10 years pumping, they have healed and are back to normal. No, it didn't take all 8-10 years, but I'm just saying that at some point they healed up to where I didn't notice those shot lumps anymore.
So, experiencing the healing of those spots (the body is magnificent isn't it?), I trust that given appropriate rest, any scar tissue in my abdomen will probably heal up pretty good too. Not sure if it's possible to heal it 100% and make it go away, but I think you can get pretty close.
Back on topic - I'm very regular about changing my sets.
What I hate about the days I change my sets, is that I always seem to have trouble with the morning of the set change, and especially the very first meal on that set. I've talked about it a couple times, once back in January of 2005 , and most recently on this post. Kevin made an interesting suggestion, and that was to leave the old site in until the end of the day. Not connected to it, but leaving it in to avoid the little bit of "leakage" that happens when it's removed. Basically allowing time for any insulin infused there to be absorbed. I have heard that before, but haven't experimented with it in many years - so Kevin, thank you for reminding me, and I'm playing around with it again.
This morning is an example of why I get frustrated with this. I woke up and tested at 71. On the upper fringe of being low. I didn't have any symptoms of being low (which I made note of - always on the lookout for hypoglycemic unawareness!). I did my set change (and leaving the old site in) and then had breakfast. I had what I consider to be a very responsible breakfast. I had one slice of white bread (15g), with peanut butter (7g), 2 cups of skim milk (26g) and two servings of Nestle Quick Chocolate Milk (powder, no sugar added) (14g). I bolused for 60g and did not correct for the 71 blood sugar. This was all right around 7:00am.
At 8:45am I checked my blood sugar, and it was on a lunar rocket ship to the moon. 334. WTF?!? Arg. Now I'm lethargically sleepy, moody, pissed off and concerned about a problem with the new infusion set (which, by the way, has never happened in all my years pumping). As hours move on, I keep checking and correcting, and sure enough my BG is coming down (which wouldn't happen if there was a problem with my set).
Now, I can understand if I go and have a huge breakfast (like my Burger King special), throwing on a couple hundred grams of fast acting simple carbs into the fire. But don't beat me up when I'm being good!
Is it possible that I somehow rebound from almost being low this morning? Is it possible that some jerk cut me off on my way to work and pissed me off (though I don't remember)? Is it possible that I thought too hard about some sweet treat, and the mere idea of it spiked my BG? Who knows. Anything is possible.
I would like to try to understand if there is some pattern to this. Are there set changes that go fine, or are they all like this? Is there any other thing that happens consistently? Is it something I'm doing (yes, I do remember to fill the cannula)?
It's a real job to eliminate the variables, and it takes a lot of time and patience. Hopefully in three whole days, when it's time to change again, I'll remember that I'm supposed to pay attention.
I believe that it is important for me to not leave my infusion set in too long. I feel that it creates more scar tissue when it's left in too long. While I've never had a set in for so long that it created control problems (that I noticed anyway), I have gone longer than recommended in times past. If I remember correctly, my longest infusion set was left in for 5 days. Could be a lot worse.
Now I have been pumping for what I consider to be a long time. I don't know exactly when I started, but I'm thinking that it was somewhere around 8-10 years ago. After all those years, I do know that I have areas of my abdomen that have more scar tissue than others. Those tend to be former "favorite" site spots. Places that I used perhaps more often than I should have, and didn't give enough time to heal between re-use.
I was on shots for a long time before pumping, and I would bet that many shot users can attest to funny pockets or lumps that form when a spot is used too often. For me, I had overuse lumps on my thighs and the back of my left arm (because I'm right handed, so I used it to inject into the left arm). Nothing majorly huge and gross, but they were there. After 8-10 years pumping, they have healed and are back to normal. No, it didn't take all 8-10 years, but I'm just saying that at some point they healed up to where I didn't notice those shot lumps anymore.
So, experiencing the healing of those spots (the body is magnificent isn't it?), I trust that given appropriate rest, any scar tissue in my abdomen will probably heal up pretty good too. Not sure if it's possible to heal it 100% and make it go away, but I think you can get pretty close.
Back on topic - I'm very regular about changing my sets.
What I hate about the days I change my sets, is that I always seem to have trouble with the morning of the set change, and especially the very first meal on that set. I've talked about it a couple times, once back in January of 2005 , and most recently on this post. Kevin made an interesting suggestion, and that was to leave the old site in until the end of the day. Not connected to it, but leaving it in to avoid the little bit of "leakage" that happens when it's removed. Basically allowing time for any insulin infused there to be absorbed. I have heard that before, but haven't experimented with it in many years - so Kevin, thank you for reminding me, and I'm playing around with it again.
This morning is an example of why I get frustrated with this. I woke up and tested at 71. On the upper fringe of being low. I didn't have any symptoms of being low (which I made note of - always on the lookout for hypoglycemic unawareness!). I did my set change (and leaving the old site in) and then had breakfast. I had what I consider to be a very responsible breakfast. I had one slice of white bread (15g), with peanut butter (7g), 2 cups of skim milk (26g) and two servings of Nestle Quick Chocolate Milk (powder, no sugar added) (14g). I bolused for 60g and did not correct for the 71 blood sugar. This was all right around 7:00am.
At 8:45am I checked my blood sugar, and it was on a lunar rocket ship to the moon. 334. WTF?!? Arg. Now I'm lethargically sleepy, moody, pissed off and concerned about a problem with the new infusion set (which, by the way, has never happened in all my years pumping). As hours move on, I keep checking and correcting, and sure enough my BG is coming down (which wouldn't happen if there was a problem with my set).
Now, I can understand if I go and have a huge breakfast (like my Burger King special), throwing on a couple hundred grams of fast acting simple carbs into the fire. But don't beat me up when I'm being good!
Is it possible that I somehow rebound from almost being low this morning? Is it possible that some jerk cut me off on my way to work and pissed me off (though I don't remember)? Is it possible that I thought too hard about some sweet treat, and the mere idea of it spiked my BG? Who knows. Anything is possible.
I would like to try to understand if there is some pattern to this. Are there set changes that go fine, or are they all like this? Is there any other thing that happens consistently? Is it something I'm doing (yes, I do remember to fill the cannula)?
It's a real job to eliminate the variables, and it takes a lot of time and patience. Hopefully in three whole days, when it's time to change again, I'll remember that I'm supposed to pay attention.
posted by Scott K. Johnson | 10:14 AM
8 Comments:
Olivia used to spike when I changed her set, too. I leave her set in for a while (usually until the next morning - we do set changes at night) but I also bolus her an extra unit when I do the change. So she gets her fixed prime plus 1 unit. It's worked wonders for her. She used to regularly spike up into the 300s after a set change. Now she's maybe at 170.
WaitAFrickenMiniute--since when was white bread and chocolate milk a 'responsible' breakfast?????
Don't forget the peanut butter. We got some carbs, a little bit of protein, some dairy...
I guess when saying 'responsible' it's all relative to what I might elsewise choose to eat.
:-)
Hey Scott,
Sorry to hear the "leaving the old site in place" trick didn't work for you. Two things come to mind: 1) I agree with Wil - those items are pretty high on the glycemic index scale and 2) So this happens only on site-change days? Other days you don't see the spike? Have you done a basal rate test lately? (I guess that's more than 2 things, huh?).
I'm in basal test hell right now since I just got on a new pump (MM515) and need to fine-tune my basal rates (truth-be-told I never really did basal rate tests on the 508 when I started on it 5 years ago, and I haven't really made many changes since then). I've been skipping a meal almost every day and having 1-4 lows per day now for 2 weeks in a seemingly futile attempt to get my basal rates right. Quite frustrating.
Sorry I don't have more to offer. Try a lower glycemic breakfast on site change days, perhaps.
Keep trying and keep us posted...
Compared to what you've been eating, I'd say you had a pretty good breakfast.
When something like that happens with Brendon, we wait and see if it happens again with lunch or dinner. If it does, we change the set. If it doesn't, then we consider it a freak thing and move on.
You may have also been rebounding when you were 71. You may have been heading up before your breakfast. I also leave my old set in for 1/2 day to prevent leakage. As for running out of site space, have you tried the "W" technique?
Kevin -- I don't think I see the spike on non site-change days. And I think my basal rates are Ok - but you raise some good points that are well worth some testing and verification!
Rich -- I can't say that I'm familiar with the "W" technique. Though I imagine that it's sight rotation using the shape of a "W"? With insertion points being the points of the "W" - which would give a good 5 sites.
Imagine the W on either side of your abdomen. Start on one side and change sites at the points of the W. Try to stay 1 or 2 inches away from the previous site. After completing 1 W move to the other side and do the same thing. After completing it, you will have allowed the first site 30+ days of healing time. I am a 6 year pumper and now am wearing a Guardian RT. I have no site issues whatsoever. Good Luck!
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