Type 1 Cannula adhesion issues

[Janine Bignell]

Greetings!

I am the mother of a 14-year-old type 1 diabetic. She was diagnosed at the age of 4 in 2009. We switched to the Medtronic 640g pump a couple of years ago and are facing a recurring issue that has been getting worse recently - cannula adhesion!

Over the past few weeks - and more than likely made worse by the heat - my daughter has lost a bunch of cannulas due to them becoming unstuck. We are cleaning the area thoroughly, using an alcohol wipe on the area where the cannula is to be inserted and have tried many different techniques to keep the cannulas in place. My daughter uses both the Mio and the Mio 30 cannulas and this is an issue with both. The cannulas are simply lifting up off the skin.

Just to add, we are allowing the skin to dry after using the alcohol wipe and are allowing the Skin-Tac to become tacky before applying anything else. We have also tried just cleansing the skin without the alcohol wipes but were asked to try using them to remove potential oils from the skin. We rotate the sites we use and she uses both thighs and her abdominal region (bar the area around her belly button). This issue is happening regardless of the site we use.

Things we've tried:-

• Alcohol wipes to remove potential oils, placing the cannula in as normal
  
• Alcohol wipes to remove potential oils, placing the cannula in as normal then covering the cannula with IV 3000
• Alcohol wipes to remove potential oils, placing an IV 3000 directly on the skin with a cutout for the cannula
  
• Alcohol wipes to remove potential oils, placing an IV 3000 on the skin with the cutout for the cannula and placing another IV 3000 on top of it to secure the cannula (sandwich method)
• Skin prep as above, skin-tac, IV 3000, cannula insertion
• Skin prep as above, skin-tac, IV 3000, cannula insertion, another IV 3000
• Trying with and without a non-moisturising antiperspirant, recommended to us by her diabetes team
• Trying all of the above with and without medical tape to hold the edges

As you can see, we've tried a lot of techniques to get these cannulas to stick and are having absolutely no luck. We're literally losing at least 1 cannula a day, some days we're losing more. My daughter lost her cannula in school recently while she was in P.E. and didn't notice until she was on the way home, got to our door, burst into tears when I opened it and we did checks and she had ketones of 5.5 and ended up in the hospital.

As I'm sure you can all understand, this situation is creating a lot of anxiety amongst us and we are kind of at a loss as to what to do and where to go from here. My daughter has very smooth skin and I don't know if this is creating an issue. I've spoken to her diabetes team directly about it and they're perplexed too, but have told me that there are other families under their care experiencing the same issues.

If anyone could provide any information or advice, perhaps share some tips on how you get your cannulas to adhere, I would really appreciate it.

Kind regards.

 

[Robinredbreast]

Hi I will tag @Mel dCP and @helensaramay who may be able to help.

 

[Marie 2]

There is a product in the states that is called Grif Grips and it's patches that help hold pumps and CGM's on. While the adhesive doesn't seem to be that strong, (you can peel them off if needed) they seem to give a bigger area of a patch around the original . They worked really well with my Dexcom CGM which I was having a huge issue with it coming off. Unfortunately I became allergic to them and just use Skin Tac and keep applying more as needed. They are also quite fun and come in different shapes and sizes. But there are other patch items too like tegaderm etc you can use.

 

[LooperCat]

Thanks for the tag, but I’m afraid I have the opposite issue with my Omnipod sites - it can be quite painful getting the **** things off! I use olive oil soap to keep my skin moisturised too, but theybarick to me like limpets. I use skin tac under my Libre sensor and MiaoMiao transmitter, and they last a full two weeks, so I’m out of ideas, sadly. I do sometimes use kinesiology tape over the top to stop them getting ripped off at gigs etc but that’s been the limit of extra sticky stuff for me. Hope you find an answer x

Post edited by moderator for offensive language

 

[Seacrow]

I have the same problem on hot days. I sweat like crazy, and the cannula adhesive just dissolves. I got so frustrated the last hot snap that I superglued it back on. The diabetes nurse was horrified.

If the cannula site is a little higher on the torso, over the ribcage, I find putting a pump belt over the site keeps it in place even when the glue goes. The type of belt I mean are the ones that are basically a strip of lycra sewn into a loop. It doesn't work lower down the belly for me, possibly because my belly is well wobbly.

 

[LooperCat]

I’ve been thinking about this, and it might be an uncomfortable thought - is it possible that your daughter is pulling them off herself as a self-harming behaviour? If she’s concerned about being “different” to her friends, or even as a way of reducing her insulin to lose weight? It’s a hard age to have a chronic condition, let alone one that have the physical accoutrements diabetes brings. And in a way we type ones have a “magic weight loss pill” - where by not taking your insulin you can eat what you want and still lose weight - I’ve fallen into that trap myself in the past. I had a girl of that age yesterday practically passing out from heat in my class yesterday (I’m a teacher) rather than take her cardigan off, because she was so body conscious.

I hope it’s “just” a slippery skin issue, but it may be worth giving it some thought. Best wishes x

 

[Janine Bignell]

Thank you so much for all of your responses so far.

I did forget to add that my daughter uses the Hid-In body bands for her pump. The cannula that came out in school was when she was playing hockey and the cannula was knocked out during the game (the school had actually written a note that the accident in hockey had happened and had acknowledged it but my daughter carried on with her day, thinking nothing else of it). She goes to a school where she is really happy and the minor issues she has had have been resolved very quickly and were a very long time ago (mainly children making comments about diabetes that didn't understand the condition, I told her to use this incident to educate them, which she did).

I've been with her all day before and seen them come loose while we've been out and about so it's definitely an ongoing issue with the adhesion. It's extremely frustrating. I checked on her last night and her bloods were being a bit off so I checked her site and it was a bit warm but looked fine. She was fast asleep (she's a very heavy sleeper) and I went back to check a couple of hours later due to the unexpected reading (11mmol) and it was still 11mmol after the correction I'd given her so I checked the site and the tape had all come loose. I managed to save the cannula this time by applying the skin-tac to the area the adhesive patch was meant to be stuck to and she's had good readings all day.

I can understand that her age is a tricky one but she's a very happy girl and we have a very good relationship and any time she's ever had an issue, she's been able to express it to me very well. We're both mega frustrated by what's been happening. I don't think it helps that she sleeps with a duvet in summer either LOL.

 

[alohanicky2009]

Having the same problem with cannula , over last few weeks the shortest time before cannula came away was 3 hrs , used 5 cannula sun 7 days , was trailing a new pump so losing the cannula that are used with that pump has made me wary of choosing that pump ,

 

[MangosteenElbow]

For running long, running vigorously, heaps of strength exercises in gym and in park and orienteering with all of its variables, in sweaty summer or rain or cold ...

When using infusion sets for my animas pump I would sometimes add Opsite Flexgrid tape over the infusion site.
Usually it would just be a small strip. Once I put a large piece over it but regretted that when I had to remove it.

If any Opsite tape overlay was still tightly adhesive when I had to remove it, I would use a Reynard adhesive remover wipe.

I'm sure if you Google those products you could follow up any local equivalent.

After I changed to my current t:slim X2 pump, I experimented with different infusion sets. Currently I prefer a manually inserted steel cannula set. This uses a tethering site which is 10 cm or so away from the cannula site, so I end up with two attachments. This has been better than the one site, angular Teflon cannula site I had been accustomed to for years.

I had been advised against the normal steel, 90° cannula but now I think the person who advised me did not appreciate the superior outcome of having a tethering site separate from the cannula site.

It has given me more confidence to move sites to all places, which has been good since I'm lean.
I suppose I could still add a bit of Opsite Flexgrid tape over the cannula site if I was especially concerned, but so far I have not experienced it coming off even with vigorous sport and humid conditions, or after getting wet.

I apply the two things in a sequence which is the reverse of the instructions.
I first manually insert the cannula and if course fix that to the skin.
Then I fix the tethering site. I could put it more centrally towards the midline to make it easier to fit the pump in either side's pocket. I have also put it lower down the thigh, so there is hip joint movement between the two sites (cannula and tethering).
Mentally, this works better for me because I focus in where I want the infusion site then I have flexibility where to tether it.

When running or orienteering I use a belt (pouch or flip) to hold the pump. No strain on the sites.
When doing a range of exercises I tend to clip the pump to shorts, so I can move it away if needed (from bar, floor).

PS, I have found it better to have my Dexcom G5 sensors somewhere on the buttocks (despite no fat there!).
I was reluctant to move away from the torso but I took advice (from an active T1 kady) and experimented and it's been great - adhesion better, stable, forgettable ...

 

[Nomi]

Hi, I have different canulas (insight pump) but find that hot weather and/or sticking it in an area that moves or bends a lot (like the side/top of the spare tyre when you sit down) makes them come un-stuck faster. I use kinesiology tape, and cut it into the right shape. You can get it online and in some sports shops.
It’s like the grip grifs mentioned about but cheaper as you cut it yourself.
Hope you get sorted
X