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Ideas for a lean pumper?

Discussion in 'Insulin Pump Forum' started by Colin of Kent, Feb 7, 2019.

  1. Colin of Kent

    Colin of Kent Type 1 · Well-Known Member

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    I use Medtronic Silhouettes or Mio 30's currently, in my abdomen. My problem is that I'm lean (about 17% body fat, according to my scales), so when changing infusion site, I often hit a blood vessel or muscle, both of which usually sting a bit. So I often end up trying two or three different sites before finding one that 'feels right'. The result is that my abdomen is covered in spots and bruises, and I'm running out of places to jab!

    Does anyone have any ideas about how to tackle this? I used to use the 90-degree cannulas in my buttocks, but after ten years, they were getting a bit of lipohypertrophy and unpredictable absorption. I like using my abdomen because I can see what's going on and I get predictable absorption. I normally tilt the insertion device backwards slightly to get a shallower angle, but this doesn't always work.

    Any thoughts, comments or ideas gratefully received.
     
  2. sophc

    sophc Type 1 · Active Member

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    Hi Colin!

    I am in a very similar situation to yourself, I am also very lean and areas to put my cannula are limited. I’m on the mio 30s as the standard mio and sure t were constantly hitting blood vessels/ muscles and were rather painful!

    Have you tried using the mio 30s in your kidney area ? I find this to be successful. Although not recommended officially by Medtronic, I have also found the ‘fatty’ part of my arm to work well too. It’s a bit of a faff to get it in but once it’s in it seems to work well * touch wood *
     
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  3. kitedoc

    kitedoc Type 1 · Well-Known Member

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  4. Deleted Account

    Deleted Account · Guest

    Alas, once I migrated to the Animas Inset 30s, I have had no problems with leanness and pump compatibility in my abs - bones rather than muscle seem to be more of a problem but, as long as I keep away from my hip bones (hint - do not try to insert your cannula into a hip bone!) I am ok.
    However, I am watching this thread with interest as I expect to me transitioned to a Medtronic later this year.
     
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  5. Jollymon

    Jollymon Type 1 · Well-Known Member

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    I struggle with infusion sets too. I’m extremely lean, and very thin skinned. I use angled infusion sets. I push them in by hand so I can determine the angle. I also have a prescription to change them daily. My sites don’t last 3 days.

    I know I cannot wear a 90 degree cannula. I tried- they are easy to put in (like using a stapler!) but they won’t last through a workout. I know I can bend them over sideways within an hour.

    Metal cannulas have the benefit that they don’t bend, but depending on how thin your skin is, they may go down into the muscle layer. And that will hurt. I can’t use them because of this. For those that like them, if the site location fails, they peel them up and can insert them somewhere else, which is a huge benefit! A soft cannula would be wasted in the location change.

    For how to insert an angled set, the other day into YouTube for someone on another d website. There are some really good YouTube videos on how to insert angled sets manually. When I struggled with them, I found a local nurse close to me that showed me how it insert them- not a pump rep, but a user just like me. If it had not been for her help, I would’ve shelved pumping.

    I still wish that angled infusion sets were about 4 mm shorter, especially when I get near the end of a riding season when my wgt is down. 17 mm is the only length that they come in; a shallower insertion angle is the only way to make them shorter in going through skin.

    I have tried cutting them down with a razor knife- after you cut the chamfer off they won’t insert through the skin. So don’t waste an infusion set trying this... I’ve tried it!

    Locations for these things are a variable too. My legs are strong and lean- I cannot insert them into my legs. On upper body days, I don’t plant them into the back of my arms. On core workout days I struggle with anything in my abdomen. So keep the sites rotating depending on your workout schedule.

    I workout every day- one of my workout mantras is there is not rest for the wicked. So I keep moving.

    A happy bike = a happy life
     
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    #5 Jollymon, Feb 9, 2019 at 4:12 PM
    Last edited: Feb 9, 2019
  6. Jollymon

    Jollymon Type 1 · Well-Known Member

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    Sorry for the long post @kitedoc. This is just my experiences.
     
  7. Colin of Kent

    Colin of Kent Type 1 · Well-Known Member

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    Which ones are you using? My Medtronic Silhouettes come in 13 mm...
     
  8. Jollymon

    Jollymon Type 1 · Well-Known Member

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    Sorry- you’re right. I use 13mm angled cannulas. I still need them 4mm shorter.
     
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  9. kitedoc

    kitedoc Type 1 · Well-Known Member

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    No rest for the wicked @Jollymon, even less for the righteous !!
    Hopefully pump companies will look at providing shorter cannula lengths, especially if the demand for such lengths for children can add to your cause.
    I believe that Cellnovo do a 5.5 mm cannula but the connections are proprietory to that brand.
    Shorter 30 degree insert angle cannulas sounds like the way to go.
    It has been a while since I saw any of the butterfly cannulas used in Palliative care for subcutaneous infusion of medications. Some steel, some plastic cannulas. The steel ones are used sometimes to take blood.
    Unfortunately the tubing is stretchy so not suitable for pumps but the cannula length might be closer to what you are looking for. In Palliative Care they are usually inserted in a 45 degrees but that is by convention and the angle may vary as sadly many of the patients have loss a great deal of weight.
    Just a thought. I cannot find out much about the tubing variations on the web but will keep looking !!
     
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  10. Colin of Kent

    Colin of Kent Type 1 · Well-Known Member

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    I also often have problems with Libre sensors. I'd say roughly one in five gets taken out again because it's too uncomfortable. I hate to waste them.

    My wife suggested inventng some type of medical-grade silicone patch which could be stuck onto the skin, that one would inject through. I know there's something like this mentioned in Dr Bernstein's Diabetes Solution, but it's aimed at people who can't handle injections. Not sure if it would help.
     
  11. kitedoc

    kitedoc Type 1 · Well-Known Member

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    So the silicone layer makes the usual 6 mm 90 degree cannula sit at maybe 4.5 mm depth??
     
  12. MStreet89

    MStreet89 Type 1 · Member

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    I’m due to see my diabetes nurse next week for this very issue. I’d worried about it a while ago after losing a lost of weight due to diet changes and sort of stopped worrying.
    Roche seemed to suggest that it’s not the length of the needle that’s the issue but the angle. Either way they couldn’t change it without consent from the diabetes team.

    I’ll update on here what they suggest next week
     
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  13. Deanc883

    Deanc883 Type 1 · Member

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    I am slim simular to you, I have been pumping for a couple of years and only recently started placing cannula in the fleshy part of my buttocks. More to the top and side of my buttock. Needed a change from my abdomin but was reluctant (not sure why) to use this area. I had to change my ratios slightly, but it's working great now. Only issue I've had is when undressing, need to be a bit more careful.
     
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  14. Jollymon

    Jollymon Type 1 · Well-Known Member

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    Here’s a question for this lean bodied pumpin group- we kink cannulas pretty good, right? Have you ever had one kink and break off inside of you? I can happen.

    Since these things go into us clean, after they break off they come out clean. The body will eventually shed them. But it is weird when you see a little cannula tip pop out from under your skin.

    The 1st one that I shed gave me the inspiration to try to cut a cannula down to the length that I need. With a razor knife. Again, the shorten cannula without a chamfer is impossible to push through the skin. The insertion needle stops at the cut edge like a car hitting a curb.
     
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  15. kitedoc

    kitedoc Type 1 · Well-Known Member

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    Hence the idea then of a silicone or other pad that could adhere to skin, only let the cannula going though in to reach say 4 mm depth, another 'patch' is a thin oval dic of duoderm - used as a wound dressing the thin oval disc is thinnest I think.
    The other Duoderm patches may be too thick for this purpose.
     
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  16. Colin of Kent

    Colin of Kent Type 1 · Well-Known Member

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    That's the idea, yeah. Judging by the number of responses to this thread, I'd say the pump makers ought to come up with a solution for us, really...
     
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  17. Deleted Account

    Deleted Account · Guest

    That would be a lovely idea.
    But, if clothes manufacturers are anything to go by, I am not going to hold my breath: as the average person gets larger, clothes choice for me (average height and "healthy BMI") gets less and less. I just have to face that I am in the minority and live with the small choice and/or tweak what is available for someone larger and/or make my own ... but I can't see myself making cannulas just yet.
     
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  18. Jollymon

    Jollymon Type 1 · Well-Known Member

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    Omnipod was supposed to be a fix for me. It has a slightly shorter cannula, that I can’t find the length of right now. But we cannot control the insertion angle to lay it in longer between the skin-and-muscle layer. The pod plants that. So I still had issues and kinks, and it wasn’t a fix.
     
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  19. kitedoc

    kitedoc Type 1 · Well-Known Member

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    Hi all thinnish pumpers,
    An experimental result: in pictures:
    Douderm, .............sticky side..........cut out piece.........cannula in situ.. connection...entire set up
    dressing 1-2mm...............................with central hole &........................patch looped.taped
    ...thickness...........................................a steel cannula
    IMG_4554.jpg .... IMG_4568.jpg .... IMG_4539.jpg .... IMG_4544 (1).jpg .... IMG_4545.jpg .. IMG_4548 (1).jpg

    2 1/ 2 days later.........underside of duoderm.........state of skin.....BSL was same as with my use of 6 mm
    .............................................patch...........................beneath.........or 8 mm 90 degree steel cannulas
    ....................................................................................................Next up: duoderm with 6 mm steel cannula.
    IMG_4553.jpg ................ IMG_4560.jpg .............. IMG_4564.jpg
     

    Attached Files:

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  20. kitedoc

    kitedoc Type 1 · Well-Known Member

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    Hello pumpers - 2 more reports to make.
    A) one duoderm patch plus 6 mm 90 degree cannula on top - failed at 22 hours
    B) triple stack duoderm for 30 degree 17 mm cannula (no 11 mm one available) - failed at 24 hours

    A) Duoderm patch.........set up with 6 mm.... very fuzzy image but cannula failed at 22 hours
    situated near rib line......cannula, and note....about 3 to 3 1/2 mm to cannula tip under skin
    .......................................incorrect taping
    ...... IMG_4574.jpg ............ IMG_4585.jpg .......... IMG_4588.jpg

    B) 3 stacker parts...location....close-up of...............full set-up.....failure at 24 hours....underside of duoderm
    for 17 mm 30..........................triple stacker............cannula not......................................cannula bent. tip 3 1/2
    degree cannula.........................................................easy to place.... ..............................to 4 mm depth
    IMG_4595.jpg ......... IMG_4607.jpg ......... IMG_4609.jpg ......... IMG_4612.jpg ............... IMG_4610.jpg ................. IMG_4616.jpg
     
    #20 kitedoc, Mar 8, 2019 at 7:25 AM
    Last edited: Mar 8, 2019
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