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High after pump site change

E

Emck

Well-Known Member
Messages
170
Type of diabetes
Type 1
Treatment type
Pump
Hi everyone,

I’ve been experiencing high blood sugars, intermittently, post-infusion site change.

The odd things is that the site does eventually start working, but maybe not for 6hours+.

As a work around, I’ve been leaving my old site on and then swapping to the new site later in the day.

I don’t know whether it’s to do with the insulin absorption (it doesn’t seem to be leaking) or to do with the site itself.

I use the Autosoft 30s and the t-slim x2.

I’ve emailed my diabetes nurse but she doesn’t seem to know anything about this issue

She has suggested that I swap to steel infusion sites. I’ve tried them before but found them quite painful.


Anyone else had this issue?
 
Hi,

Yes, I experience this exact same problem.
It is so predictable for me that I try to organise changing my site for early in the morning as I don't eat so much for breakfast as I do for my evening meal.

Because I consume so much insulin per carb 1u Insulin to 4g carbs I have to replace my cartridge and canula every two days.
What I do is take a BOLUS from my existing canular as soon as I get up, ensuring that I have taken into account my bowl of porridge (33g).
I wait for the BOLUS to complete, then I remove the canula and head for the shower.
Being a "hairy gent" I have to shave my tummy every two days before putting in a new canula. If I don't then I itch like crazy after putting in the new canula.

After my shower and shave, I change the cartridge and canula.

This small routine allows me to have a good "hit" of insulin on my "old canula site", which will keep me going for a few hours.
I check my readings at 10am and usually dump in an extra 5 units, because, like you, the new canula site isn't yet working very well and the smaller BASAL amount is not enough.

By lunchtime, the new site has usually settled down enough for me to have lunch.

I have to be careful to take the right amount of insulin at lunchtime, because at about 4pm my readings always start to go downwards quite quickly.
This ONLY happens on the first day of changing the canula. Don't know why. I am assuming that by mod afternoon all the insulin is travelling through my fatty deposits quite happily and therefore putting insulin IN as either BASAL or BOLUS will actually have an effect.

Just for completeness. I also have a t:slim x2 and I use Steel Cannulas. I found that the Autosoft cannulas kept kinking for me.
I guess my fat tummy is a bit too resistive to Teflon cannulas.

In light of the recent advice from NICE concerning Type 1 diabetics and CGM's, I am hoping that my diabetes team will allow me to swap from Libre FGM sensors to Dexcom G6 CGM sensors on prescription. Then I will be able to switch on the Control-IQ function of my t:slim x2.

Good Luck
Chris
 
When I first started on a pump, I was advised not to take the old cannula out for a few hours after inserting and using the new one, so that insulin given through the old cannula had time to fully absorb.
 
Hopeful34 said:
When I first started on a pump, I was advised not to take the old cannula out for a few hours after inserting and using the new one, so that insulin given through the old cannula had time to fully absorb.
Click to expand...
That's very interesting. I have never been told that by my Diabetes team. How does removing the physical cannula stop the site from absorbing the insulin that has already been pumped into your body? I am not arguing, I just don't know how it works. I have had a trawl of the internet but cannot find anything, but i am probably asking the question incorrectly. Any tips on finding it, or perhaps you could send a link. Thanks.
 
It was just mentioned at my pump training, so don't have a link or anything, sorry. I assume that it prevents any insulin that hasn't been fully absorbed leaking out of the hole the cannula initially leaves, but it's too long ago for me to remember.

Strangely I had a sore cannula recently, and removed it before inserting a new one, and a very small amount of insulin did leak out. Others may not find this, I don't know.
 
Thanks Chris

I actually have very similar insulin requirements to you, so change every two days. I also have really sensitive skin, so two days is generally where is starts to get too sore to keep going.

I have completely unexplained insulin resistance. Every time I go to the hospital, everyone remarks on how much insulin I’m on as it doesn’t match up to my size/weight. Moving from pens to pump has reduced my insulin requirements by about 20% which is good.

I have some theories as to why I might have this resistance but that’s probably for another thread!

Today I changed my site before lunch, shot up to 18mmol about 3hours after lunch. Clipped back on to my old site, corrected and got back in target. Before dinner tonight I clipped on to the new site and it’s working fine now.

I saw some theories on Reddit about the site needing to be saturated with the insulin before it will start working. It’s just so unpredictable. Sometimes the site works, sometimes it’s just abysmal.
 
It does depend upon how much insulin your putting in just prior to removal, in rough terms the hole the cannula leaves after removal is twice the size of its internal hole feeding insulin so any insulin under the skin that's not absorbed and under small amount of pressure could be pushed back out, I've seen this. If bolusing just prior to a change I leave the old cannula in for an hour or so, if its just normal basal with no corrections then I remove on replacement.
 
I too have this annoying problem. Sometimes I don’t remove the old ‘plug’ for hours but I don’t find it any better. I also find the d nurses look at me like I’m obviously doing something wrong when I mention it. I’ve been on a pump for 12 years and never had this problem with my Medtronic. I now have a t:2 and find it’s great for the professionals in the clinic - but awful for users. I’d swap back in a heartbeat but my area doesn’t offer a Medtronic now.
 
I was up at the clinic today and spoke to the nurse about this. She didn’t really have any experience of it happening with anyone else, so encouraged me to call tandem.

I called tandem this afternoon and they weren’t much help to be honest. They suggested that the cannula may be kinked and that it might not be obvious to the eye when first removed. They were more interested in getting me replacement sites then suggesting fixes for this.

If the cannula was kinked, then surely it wouldn’t work after a few hours? I’m going to double check that the cannula is pushed down the needle before adding any new sites in the future, in case that helps avoid kinks.

I’m going to try the trusteel and vari soft to see if they’re any better.
 
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