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Different sites and absorption rates

Discussion in 'Insulin Pump Forum' started by jgordon5, Mar 28, 2016.

  1. jgordon5

    jgordon5 · Well-Known Member

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    I'm very new to pumping (Animas Vibe) and I'm struggling with the variations I'm finding. I haven't managed to test basal rates properly because I've had difficulties with hypers and hypos, partly due to kinked cannulas and difficulty with insertion.

    My basal rate is 0.3 dropping for a few hours in the night to 0.2. When I inserted an Inset 30 above my navel yesterday, I found that I couldn't get my BGs up. I was on 3 rising to 4.4 before bedtime. This was after bananas, dates, toast! My I:C is 1:12 but I'm thinking, maybe I should change that? It was if anything not low enough with cannulas below my navel.

    So I just wondered if anyone else finds this and how you cope with it and how you get level enough to properly test based rates?
     
  2. himtoo

    himtoo Type 1 · Well-Known Member
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    hi there
    not got enough experience yet to really comment but thought i would give the thread a bump to see if we get some people on to help.

    one thought though is to talk to your DSN to see if they might be able to offer any suggestions -- they deal with loads of people that potentially have similar issues and are getting paid to help you.

    all the best !
     
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  3. tim2000s

    tim2000s Type 1 · Expert
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    Unfortunately, site is critical in pumping (and injecting) insulin. Have you previously used your abdomen for injections? I'm tagging @iHs and @CarbsRok as I'm sure they have a load of useful advice in respect to this.
     
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  4. jgordon5

    jgordon5 · Well-Known Member

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    Thanks - I saw my pump clinic nurse last week and she said that I need to test my basal rates to sort it out... Catch 22! That's why I thought I'd ask for help here :)
     
  5. jgordon5

    jgordon5 · Well-Known Member

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    Yes, I have and far too much! Absorption seems much better above my navel but although I've changed I:C to 1:15 and dropped basal slightly, I had 3 and dropping yesterday evening too...
     
  6. tim2000s

    tim2000s Type 1 · Expert
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    I'm guessing that you didn't used to inject much above your navel?

    Unfortunately, heavy use of your abdomen for injections is likely to cause a level of hyperlipotrophy which will affect the absorption levels you see from a pump. It would be worth talking to your care team about that and using alternative sites.
     
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  7. CarbsRok

    CarbsRok Type 1 · Well-Known Member

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    No1 rule for pumping is sort your basal first. If you start changing ratios etc., before the basal is sorted then you will have one complete mess and wont have a clue what's going on.
    Kinked or bent cannulas are not helpful and can lead to making basal testing a non starter so sort your cannula's first then basal test.
    Different sites quite often have different absorption rates so find where your absorption is best and use that area for basal testing. Once this is sorted then if you know you need say for example 10% more basal if the cannula is in your bum then you can set a temp basal with +10%
     
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  8. Mrsass

    Mrsass Type 1 · Well-Known Member

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    What kind of cannula's are you using @jgordon5
    I had plastic cannula's when I first started with my pump and had loads of issues with them, tried another type (still plastic) and had same issues so switched to steel cannula's and never had any problems, not saying that's the way forward for you but just wanted to let you know :)
    As @CarbsRok said I wouldn't go changing your I:C until you're sorted with basal, I know it can be really frustrating but if you get the cannula's sorted the sooner the better you can crack on with it all :)
     
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  9. iHs

    iHs · Well-Known Member

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    Basal rate testing and adjusting them correctly is hard going if you dont know how much to adjust the basal rates by to achieve the target bg that you want so have a look at the Basal Rate Adjustment guide by Think Like A Pancreas (google it) as it explains the adjustment needed a bit easier than Pumping Insulin especially if a small daily dose is being used.

    Regarding insulin absorption.......best to keep to using one type of infusion set inserted in the same area and basal test for that than changing set types and areas as it gets confusing. Try getting up in the night about 2am and then stay up until morning and bg test every hour while watching tv and then see what the bg levels do every hour. Remember that any basal rate adjustment will have an impact on bg control up to 4hrs later so some basal time slots you will need to adjust and some you wont. Much is trial and error just like using MDI

    I only basal test if I am due to go in hospital and wont be able to drink any tea or coffee but otherwise I just tweak my basals according to when my bg levels start changing and the same pattern happens over 2 days. I then tweak the offending rates so that day 3 is a bit better but sometimes I have found it better to leave the basal alone and just alter the carb ratio.
     
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  10. jgordon5

    jgordon5 · Well-Known Member

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    Thanks @CarbsRok . That's very helpful and I agree - it all feels like a mess at the moment. I'll try to sort my basals out....:(
     
  11. jgordon5

    jgordon5 · Well-Known Member

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    Thanks @iHs. I've got Think Like a Pancreas, so I'll start with that. I couldn't get any infusion set to stay in without bending except the metal ones and those hurt so much wherever I place them, that I just can't use them. I've now had success with Inset II and Inset 30 but I'll try sticking with Inset 30 to do basal testing. I can cheat because I have a Libre on which is pretty accurate? That's ok isn't it. I'm a bit too old to stay up all night...

    The last couple of nights I've had a very accurately carb counted early dinner but found on going to bed my BGs are on 3 and I had to eat so that I felt safe to go to sleep. So that's been two night basal testings that I've had to cancel. Maybe tonight!

    Thanks again for your help.
     
  12. Snapsy

    Snapsy Type 1 · Well-Known Member

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    Being left-handed my absolute favourite spot for injecting was the right hand side of my tummy. I found very quickly once I started on a pump that this was a really bad place to have my cannula - there was so much scar tissue in there that the cannula would just leak insulin because my tummy couldn't take it in.

    I now site my cannula on the back right or back left of my spare tyre - it seemed utterly mad to have it there when it was suggested to me, as for instance I'd never have injected there when on MDI, but I've had no problems at all and I find absorption is the same with each cannula change.

    With hindsight I should have figured that decades of injections favouring a particular area (I did rotate but would most often use my 'favourite' area) would have been having an adverse effect on the tissue beneath my skin - but with no actual outward sign of hyperlipotrophy it hadn't occurred to me.

    Spare tyre cannula siting also means that my pump hosepipe isn't in the way, and I'm less likely to knock it or accidentally 'wipe' it off when towelling off after a shower or swim.
     
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  13. jgordon5

    jgordon5 · Well-Known Member

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    Thanks, that's helpful to know. :)
     
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  14. rockape37

    rockape37 Type 1 · Well-Known Member

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    Just an idea, you could ask your nurse if she could put you on a CGM Continuos Glucose Monitor, with this you could then see when your bg drops during the night. Another good book is Pumping Insulin the author a diabetic specialist and also a diabetic on a pump can't remember his full name but his surname is Walsh.
    It covers everything you need to know and shows you how to calculate your basal rates.

    I'm waithing to go on a pump and have been given a date in June where i have a 3 hr appointment and will also be fitted with a cgm for a week for diagnostic purposes to see when my bg rises (Dawn Phenomenon).
    I don't expect it to be plain sailing but the benifits out weigh these initial problems.

    Regards

    Martin
     
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