Cannula problems

[gavinbeckett]

Hi all, first post for me - looking for some help and hopefully shared experiences I can learn from.

I’ve been T1D for 18 years, diagnosed in early 30s, and on a pump for the past 4.5 years. Always had problems with my cannula sites on and off, and always had to change them more frequently than 2 days, but recently really escalated to the point of having to replace them every 24 hours, sometimes even less. Switched from Teflon (Accuchek Insight Flex) to the recently re-issued steel Insight Rapid but still finding I can’t tolerate them past 24 hours - painful site, usually leaves a slightly hard red point where the cannula has been, plus I’m getting a rash from the adhesive

Main problem is that this is accompanied by sugars rising when the site gets tender, as I assume the insulin isn’t being absorbed well. Has anyone else had this problem, and if so did you find a solution? (I have spotted advice on the adhesive rash already, and got some Skin Tac on the way to try as a barrier)

 

[sleepster]

Hi @gavinbeckett, the skin tac sounds like a good start. I use a medtronic pump so I'm not familiar with Accuchek cannulas, but could it be that the cannula itself (the bit that goes under the skin, not sure if that bit's called a cannula..) is not long enough so the insulin isn't going in deep enough? I use 6mm cannulas but medtronic also do the same infusion set with an 9mm cannula.
Edited to say I've just had a look and they actually do various cannulas, some are 17mm!

 

[Juicyj]

Helol @gavinbeckett I am also not familiar with Accuchek however I had issues with the Teflon Medtronic sets so switched to steel tip cannula sets - had sore red welts, insulin absorption issues and since switching all these problems have gone, speak to both your diabetic team and Accuchek and see if they have a steel tip set you can use, for reference Medtronic do the sure t set which is the steel tip set and it’s manually inserted.

 

[Chas C]

Hi @gavinbeckett hope skintac works for you, I would advise using something like liftplus wipes to help remove cannula's as skintac holds very well and you will probably cause more skin damage removing each after few days than before without something to release the adhesive.

I use skin tac for Dexcom's and it works well for up to a month, so pretty sticky.

Have you thought about increasing length of cannula ?

 

[gavinbeckett]

@sleepster @Juicyj @Chas C thanks all for your suggestions

I’ve switched to steel cannulas as of last week, and they are better than Teflon but still not trouble free sticking with them for the foreseeable future though as definitely less trauma on insertion.

I’ve got Tac Away wipes already so will use those to remove cannulas when the Skin Tac arrives

And as for length, Roche sent me 6mm and 8mm steel cannulas. I tried the 8mm yesterday for the first time and had a lot of painful sensations that I was being jabbed under the skin when I breathed in or bent over!! So I’ve gone back to 6mm for now and seems to work fine... plenty of insulin flowing, typically I ended up with multiple hypos!! Trying to pin control down in the middle of range is so tricky right? So easy to drop low when trying to prevent high spikes.

 

[Chas C]

@sleepster @Juicyj @Chas C I tried the 8mm yesterday for the first time and had a lot of painful sensations that I was being jabbed under the skin when I breathed in or bent over!! So I’ve gone back to 6mm for now and seems to work fine... plenty of insulin flowing, typically I ended up with multiple hypos!! Trying to pin control down in the middle of range is so tricky right? So easy to drop low when trying to prevent high spikes.

Hi @gavinbeckett I could not get on with steel ones, due to skin movement causing discomfort so switched to teflon there are at least two or more teflon lengths also ;-)

Take the adjustments in small steps as its too easy to over adjust and swing the wrong way, then the yo yo'ing from high to low makes it awkward too. Best wishes as I'm sure you will get there.

 

[gavinbeckett]

Hi @gavinbeckett I could not get on with steel ones, due to skin movement causing discomfort so switched to teflon there are at least two or more teflon lengths also ;-)

Take the adjustments in small steps as its too easy to over adjust and swing the wrong way, then the yo yo'ing from high to low makes it awkward too. Best wishes as I'm sure you will get there.

Thanks, trouble is I am trying steel ones because I’ve had so many problems with Teflon! It’s a pain. I really don’t want to go back to MDI... I’ve been on the pump over 4 years and in all other respects I’m so much happier than injecting...