How do you do yours?

MushyPeaBrain

Well-Known Member
Messages
647
Type of diabetes
Type 1
Treatment type
Pump
I've been on the pump a year now and am still learning how to get the best out of it. I'm quite interested in how people manage the set changes within their daily life and thought it might be useful if we shared our typical set change routine. Here's mine:

I always do my set at lunch as soon as I've put my son down for his nap. Firstly I put 70% of my hourly basal rate through the pump using my old set and then I disconnect but leave the old set in. I have a hot shower, which I find makes the change less painful, helps avoid infection and helps me relax a bit.

After the shower I chill out pump free for about 15 mins, which also helps prepare me for the change. Although it's more uncomfortable than painful I am still needle phobic and even after a year I get nervous about firing the new set in.

I grab my set from the fridge and get it ready. I pick my site and then it takes me about 10 mins to actually fire the set in. What a wimp! :lol: Once in I prime my pump and fill the cannula. I then fire 0.5u through to "clear gunk" as my DSN told me. I know others don't do this but it seems to work well for me.

I then bolus through for my lunch, wait 10 mins and eat. Two hours later I do my first BG check. I can't always tell from this that the set is working (it can be 8 or 9 sometimes due to food peak or if my new set is quite far away from the old one). Even if the BG is good I don't trust the set until another hour has passed. Then I'm looking for a good drop in BG to feel it's safe. I have had good readings and then the set fails later that day so I now leave my old set in until betime when I am fully happy that the new set is working.

This mistrust in the sets means I tend not to plan anything for the afternoons of set change days and I wouldn't feel happy changing my set in the evening. However I'm too tired first thing in the morning to do a set change!!

I'm interested in learning how other people do theirs, especially times etc. Although I wouldn't be without the pump I do feel that for half a day every 3 days I can't relax.
 

meela83

Well-Known Member
Messages
84
My set changes are far more haphazard!They tend to happen after a bath but I remove the old one before the bath so I can have a proper scrub set free!!!! They are also usually after dinner and before bed,not ideal granted but I haven't had any major problems. I have to say though I almost resent set changes now as much as I resented doing injections!!!
 

cally

Well-Known Member
Messages
232
Type of diabetes
Type 1
Treatment type
Pump
Hi..
Have you tried putting sets in by hand. I know you said you are needle phobic but personally I find using any kind of device which fires set into me much more traumatic and more likely to fail.

At least when putting them in gently by hand you can stop if it is painful.

I use Sure T's which are metal 90 degree sets, they are very thin and go in amazingly easily. I don't feel a thing.
I use a 150% temp basal for 2 hours after putting new set in.
 

MushyPeaBrain

Well-Known Member
Messages
647
Type of diabetes
Type 1
Treatment type
Pump
My post yesterday tempted fate and had a set fail this morning :( I had unexpected visitors yesterday lunch so took a chance and did my change before an early dinner. Two hours post set BG 6.4. An hour later BG 5.2. All looked good. Woke up with 4.8 and went to bolus for breakfast. Occlusion alarms and pump would not let me fire any insulin in. So annoying. We were planning to go out today but had to cancel and put new set in. Waiting to see if it's working but won't really know until after 2 meals :roll:

Cally I use Inset II sets which I don't believe can be put in by hand. I wanted to use the Contact Detach metal sets, which I found very easy to insert and no worry of kinking etc. However every change my sugars went sky high (over 20!!) and nobody could figure out why. I personally believe that, as the needle is finer than teflon, the amounts of insulin I bolus where too much pressure and it leaked out. I did find insulin at the site at one point. Even with teflon sets I find I have stinging boluses as the Animas fires insulin through at a very fast rate. I tried the metal sets for two weeks and became so ill I had to abandon them.

Since storing my sets in the fridge I have had a lot less failures. It's bad enough when one does fail but I wish it didn't take so long to know that they are ok. I was always led to believe I'd know in 2 hours by my DSN.
 

LittleSue

Well-Known Member
Messages
647
Type of diabetes
Type 1
Treatment type
Pump
I start by removing clothes, so I don't need extra hands to keep clothing out of the way. First I put the new set in, while still connected to the old one. That way if a site bleeds or I'm indecisive about where to put it, the delay doesn't affect the time I'm disconnected. (This was expecially useful the first few times.) Next I prepare the new reservoir (if not done in advance), change battery etc if necessary. I only disconnect from the old site when I'm ready to load the pump and prime, so I'm only disconnected for a few minutes. Then spray the old site with Lift Plus and leave it to work while I note the time & new site in my log book and test BG as baseline. Double-check I'm connected to the new site (not the old one through habit) and remove the old set. I don't bolus any extra or bolus to compensate for disconnected time. Test BG 2 hours later to make sure its working.

Initially was told to do changes in the morning, but on work days that meant getting up extra early and/or doing the change under time pressure, not good. BG seemed to go awry after 2 days, so I started changing after 2.5 days, thus alternate changes were around 6pm when I got in from work, with dinner bolus after. That works well for me, BG doesn't rise much after dinner so plenty of time to make sure everything's OK before bedtime. BG now more settled so I'm going to try changing after 3 days, early evening.

I have a little melamine tray, the size that comes in 'tea for one' mug & coaster sets. Cleaned it with alcohol rub before use. On there I put the next reservoir, set, inserter etc and put the whole thing inside a clean freezer bag. When I come in to do a set change all I need except the insulin & meter is in one place ready. Between changes it lives in the supplies drawer.

Recently started following iHs' suggestion of filling the reservoir 12-24 hours in advance then wearing it or carrying in my pocket. The insulin reaches body temp before it goes in the pump and any bubbles seem to form/expand during that time. I purge them before the insulin goes into the pump which reduces bubbles during use.

I use angled teflon sets with an inserter. It looks like a blunderbus but I don't mind it. Not sure I'd get such a long needle in by hand without bending or snapping it. Have learnt if it doesn't go right in, there's no point pushing it as there's probably a small blood vessel in the way which will hurt & bleed.
 

Dragonflye

Well-Known Member
Messages
235
Type of diabetes
Type 1
Treatment type
Pump
I was initially told to change my set before breakfast and when I first started pumping I had issue with non deliver 2 or 3 times before I got it right so a change later in the day wouldnt have been good for me as sometimes it would be 6-9hours before I got it right so I've stuck to doing that...

When I'm using a new vial of insulin I will get it out the night before, otherwise it stays out until it's empty...

I dont mark dates or anything in a diary because every now and again I somehow manage to unceremoniously manage to pull it out (2 days ago I had just plugged myself back in after a bath... was walking past the radiator and the tubing got caught so had to change early :) ) so I just keep checking last change and changing after 3 days :)

I now use Silhouette infusion sets, used the quickset to begin with and even though I'm not as skinny as I once was :cry: i had issues with them and I use the inserter... i have no phobia of needles but the thought of manually putting it in makes me feel a bit off lol its sooooooo long!!!!!!

So my morning consists of waking up, having shower, changing set, getting the babies up and ready for nursery... it only usually takes me 5mins, 10 tops to change it so it doesnt mean getting up earlier than i normally would :)
 

annettekp

Well-Known Member
Messages
153
Hi

My son also has a Animas 2020 and uses Inset 11. We change his set before dinner at 6pm. We leave in the old set and take it off when he has his bath later on.

If the set isn't working at all your blood sugar would soar after your meal (high teens and 20s) as no insulin would be getting through which is why you were told you would know after told 2 hours.

Just a thought but does keeping your sets in the fridge not make them cold and more uncomfortable to put in? Is it possible the cold is doing something to the tubing that means you have a lot of set failures?

Worth mentioning to your DSN.

Annette
 

MushyPeaBrain

Well-Known Member
Messages
647
Type of diabetes
Type 1
Treatment type
Pump
Hello Annette

It was my DSN who suggested keeping the sets in the fridge as many people benefit from this. I was having so many kinked cannulas until doing this and now only have a few. I only keep 2 sets in the fridge and rotate them as I use one. It actually makes insertion a lot less painful! However I never change my set and resevoir at the same time as they never time right so I'm not sure how it would effect the tubing if I used it.

When my cannulas kink I never get sugars over 12. The first time I know about it is normally when my pump has an occlusion alarm. Take Saturday. My BG 2 hours after change and meal 6.4 and an hour later 5.2. Looked good right?!? Went to bed and woke up 4.8. Still looking good yes? Went to bolus for breakfast and alarm goes off. Prime and retry 2 times more and every time refuses to deliver bolus. Pull set and cannula is kinked :roll:

So you see my sugars have never helped identify a working set. I have to wait for 2 meals to see if I get the occlusion alarm. This is extra worrying now I have a baby.
 

annettekp

Well-Known Member
Messages
153
I find it so funny/strange/unsettling that no-one is told the same thing. Surely we should all have the same information and training should be the same for everyone?

We were told to always change the reservoir at the same time as the set because the insulin starts to react to the bottle after that time - something about it sticking to the plastic and then becoming less effective?

So we're changing everything every 3 days and so far (I feel I may be tempting fate here!) have had no failures in our 4 weeks. I have to say it feels like much longer than 4 weeks!
 

Cheryl

Well-Known Member
Messages
180
Sometimes these threads, though always useful & interesting, can also add confusion. :? I too wish that there was a standard set of instructions! After reading various threads here I checked with my consultant re cannula/reservoir changes, she confirmed that I should change my cannula every 2-3 days, but only to change the tubing & reservoir when it is empty, which for me is 7-9 days.

I'm also about to change pumps & have been bombarding the various company reps with questions. The Medtronic Veo rep also confrimed that it was not necessary to change both cannula & reservoir at the same time.

The only thing my consultant said was (stating the obvious really) that we're all different & there could be all sorts of reasons why we're given all sorts of different advice.

I'm of the "quick change" group. I do it all in a few minutes, no TBRs afterwards; I get the new vial of insulin out of the fridge when I empty the previous one, so it's kept at room temperature for up to 4 weeks. I don't bother with a BG 2 hours afterwards as I have some absorption problems & always have double figures after a meal. I wait until 5 hours after my meal (for the insulin to stop working in my case) & then check my BG.

I change a cannula usually before dinner, purely as this is a convenient time for me; I'm just home from work, changing out of my work clothes, so a good time. I've never had a set failure/problem to my knowledge. I insert by hand & must say that the idea of firing it in with a gadget scares me! :shock: if it hurts when I break the skin, I move it to another spot. I use angled teflon cannulae.
 

MushyPeaBrain

Well-Known Member
Messages
647
Type of diabetes
Type 1
Treatment type
Pump
Annette I was told that the Animas reservoir and tubing only last 6 days before the insulin starts to have issues in it. Therefore I can change both of them whenever suits as long as they don't go over 6 days of use. For me it's just easier to not do with the set.

I am really envious of all of you that can do a set change before dinner. Although MOST of my sets work I don't have a hgh enough success rate to chance it that late in the day. That was why I wanted metal sets as they don't kink but they just didn't work for me.

How exactly do people manage to insert a teflon set manually? I am very curious, although I don't believe Animas offer a set like this anyway.
 

meela83

Well-Known Member
Messages
84
Have to say I feel like I am very slapdash in my approach compared to many of you! It takes me a couple of minutes and is done when convenient. Yesterday I was changing a set while getting dressed, putting makeup on and eating breakfast in a mad rush to get out the door to work!
 

Cheryl

Well-Known Member
Messages
180
I'm with you Meela83, I'm about to get a new pump & a major factor in choosing it is that I have to faff around changing reservoirs as little as possible & that it's quick & easy.

Re manual changes, the cannula has a needle down the middle if it of course, so I just stretch the skin slightly & push gently until it pierces the skin & assuming that isn't very painful, which it isn't 9 times out of 10, I just keep pushing until it's fully inserted then withdraw the needle. Simples! :D I'm sure you know how disproportionately painful it is when you nick a capillary, with manual insertion, I can avoid that excruciating pain.
 

LittleSue

Well-Known Member
Messages
647
Type of diabetes
Type 1
Treatment type
Pump
When comparing different things we've been told, remember that pumps and infusion sets vary. What works with one may not help, or even be possible, with another. For example, I googled for insulin pump/bubbles and what one Youtube video recommended would be impossible for me to do with my Veo.

Until now I've always changed set and reservoir together and wasted a lot of insulin as a result. I'd never even removed a reservoir and put it back in. Hadn't been told I must change all at the same time, just an assumption by the DSN that I would. This week I'm mostly at home, so time to experiment and change the res only when nearly empty. Seems a much better plan. Will reduce wastage but still won't have insulin in the plastic for more than 6 days, so I'll continue this.

In 2 months I've had 3 insertions that bled immediately, the last one quite profusely, but no occlusions or kinks.

The main cause of bubbles seems to be when the insulin warms from room temp to body temp, but with Omnipod you wouldn't see the insulin, so what do Omnipod users do about bubbles?
 

cally

Well-Known Member
Messages
232
Type of diabetes
Type 1
Treatment type
Pump
I never have a problem with bubbles. I only take my insulin out of the fridge just before I fill reservoir and put it straight back in fridge afterwards because that is the easiest place to keep it.
Medtronic pumps don't seem to have the problems with bubbles that other pumps seem to have but
I do wonder whether people worry needlessly about bubbles.

I am also of the quick change group, it takes me about 5 minutes. I don't make any special preparations or clean the skin with anything. I always change the set when I change the reservoir but also change set alone once in between. I do get a raise in blood sugar after change but a temp basal for a couple of hours prevents that happening.
 

Dragonflye

Well-Known Member
Messages
235
Type of diabetes
Type 1
Treatment type
Pump
On the back of what I said previously I was told to change resevoir at the same time as the infusion set, I was told just to draw up enough insulin to last me 3 days, as I usually use 40units a day i normally draw up 150 units, yes i do waste some insulin sometimes but i did experiment and I was always wasting some insulin regardless of if I changed it all at the same time or not so this is what works best for me :)
 

jospr

Newbie
Messages
2
I've been diabetic for 25 years and have always had a fear and phobia of needles and although I did my own injections this could at times take minutes to do and were often painful.
So when my DSN finally convinced me to go on the pump and I saw the different cannulas available I went for insertion device based on the fact of "how hard can it be to press a button?!"
However, I've had various different degrees of success with my cannula changes. When I first went on the pump it was done and dusted in 5-10 minutes, but after a succession of really painfull insertions each cannual change turned into an extremely traumatic experience, often leading to not changing the cannula for days (obvioulsy not a good thing to do as the insulin absorbtion decreases).
In the end I came off the pump because I had such a mental barrier with the cannula change it was counta productive. However, after much support and help from my family, I have gone back on the pump, had my parents changing the cannula for me to start with but have now just started doing it again for myself :) It can still take up to half and hour to change but it's a start.

I tend to do my changes early evening, just because it's more convenient, but I was told not to do it just before bed incase you're sugars spike. Sometimes I'll be good and keep the old cannula in for the evening/next morning just to make sure the new one is in properly. I have had a few occasions where after changing a cannula my sugars have run in the high teens all day so I know it's not working.
My cannula is changed every 2-3 days and the whole infusion set every 5-6 days. The insulin cartridge is changed when it's empty, the insulin is kept in the fridge until I get my warning alarm telling my cartridge is running low, and then I draw up the new cartridge and leave it out until needed. It was suggested by my rep that keeping a full/fill cartridge in the fridge is fine, so it's already set for when you need to change it.

I'm on the Accu-Chek Spirt Combo, from Roche
 

Unicornz

Well-Known Member
Messages
107
I have set an alarm for set changes on my phone because else I will never remember! I always do them on the same time of the day (10 am) not chosen for any specific reason it's just a convenient time. I used to change sets and reservoir at the same time, but for convenience's sake I have started to fill my reservoirs up full and only change them whenever they are empty.

So, I will do a set change every 3 days and a reservoir change every 5-6 days. It's what works for me!
 

janeyxxxxx

Newbie
Messages
2
Type of diabetes
Type 1
giving sets for roche combo

Hi

I am very new to this as just got my pump monday and still only pumping saline. I have a roche combo pump. Really getting het up though about thegiving sets. Like the idea of the soft canula as its only needing to be changed every 3 days but find insertion and connecting up really fiddlely. Has anyone else found this and does it get easier? At the moment I am thining the solid 90 degree metal needle seems so much easier for me but dont like the button connection showing under clothes and the fact I have to change every 2 days. Am I missing something ? Are there any other choices as spoke to someone on careline and she said ther ewere other choices but they were not being encouraged because stocks were low !!!!! If anyone can help advise me I would be grateful as I need to make a decision tuesday as to what giving sets to use and I dont want to feel I have not taken everthing into consideration that I need to .

I am 47 have had diabetes since I was 10 and was so excited at chance of new treatment and now feel scared I have made a mistake
 

MushyPeaBrain

Well-Known Member
Messages
647
Type of diabetes
Type 1
Treatment type
Pump
Hi Janey

Don't worry I felt like the pump was the worst thing ever at the start!! Now I wouldn't be without it. In the early days I felt like I was starting all over again as a new diabetic and filling my resevoir took 45 minutes. Now it takes me under 5!!

Just take your time and allow plenty of it for each change in the early days. Before you know it you'll be a pro :D

I use Inset II sets, which are teflon 90 degree straight sets. They fire in when you push a button. I love that I can leave them 3 days (4 if I need to move my change day for a special occasion etc) and they are very comfy. However did try straight needle sets, which were great in other ways but didn't work for me as I felt the needle and had high BG with them.

I would start off with the set that you feel most comfortable with and give yourself time to get used to it. We all make mistakes in the early days, no matter which set. When you are used to the pump and feeling more confident try out other set options.

The best advice I can offer is to say you should pump for 6 months no matter what. It took me 3 months before I wanted to keep my pump and I'm glad I didn't give up early on. Also we are all here to offer you help and advice when you need it :)

Good luck!!