Discussion Insulin Infusion Set: The Achilles Heel of Continuous Subcutaneous Insulin Infusion (2012)

[Spiker]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440169/

Diabetes Sci Technol. 2012 Jul; 6(4): 954–964.
Published online 2012 Jul 1.
PMCID: PMC3440169
Insulin Infusion Set: The Achilles Heel of Continuous Subcutaneous Insulin Infusion
Lutz Heinemann, Ph.D.1 and Lars Krinelke, M.D., Ph.D.2

My summary - infusion sets are critical to the performance of insulin pump therapy, but no unbiased data exists on their reliability. Anecdotal reports from the patient community suggest frequent problems. More research is needed in this area.

Continuous subcutaneous insulin infusion from an insulin pump depends on reliable transfer of the pumped insulin to the subcutaneous insulin depot by means of an insulin infusion set (IIS). Despite their widespread use, the published knowledge about IISs and related issues regarding the impact of placement and wear time on insulin absorption/insulin action is relatively small. We also have to acknowledge that our knowledge is limited with regard to how often patients encounter issues with IISs. Reading pump wearer blogs, for instance, suggests that these are a frequent source of trouble. There are no prospective clinical studies available on current IIS and insulin formulations that provide representative data on the type and frequency of issues with infusion sets. The introduction of new IISs and patch pumps may foster a reassessment of available products and of patient problems related to their use. The aim of this review is to summarize the current knowledge and recommendations about IISs and to highlight potential directions of IIS development in order to make insulin absorption safer and more efficient.

 

[donnellysdogs]

Totally agree. Sets are not 100%.
I wasn't even told initially 4.5 years ago that plastic teflon ines aren't recommended for lean muscly people like me. Only found out after the insight only having the flexi ones initially and having problems with them.
They really ought to analyse the fat that people have before telling people to have plastic ones....

 

[Spiker]

You've got some amazing stuff in that article like people being told in some parts of the world that 6mm sets are only for infants, adults should be on 10mm, and in other parts of the world that 6mm sets are fine for adults. Personally I doubt it matters, but the disparity in advice is a worry. As is the lack of evidence on so many aspects of infusion sets.

Interesting that is says 90 degree sets have a lower infection risk. And that steel sets have a lower failure rate.

 

[donnellysdogs]

Definitely agree with the stainless steel having a lower failure rate... But thats only my experience and many others get by on the teflon....
Its amazing though from the people I know that have had high readings intermittently that have gone to shorter length steel ones have had amazing lowering of bg levels....
It really does need further research.

 

[iHs]

The common sense part of me .....a stainless steel insulin pen needle on the end of a pen, delivers insulin all ok most of the time so a stainless steel
needle infusion set, should also be the same

 

[Spiker]

I got on very well with steels. They go in easily and stay in. But for me they bleed too much on the way out. Otherwise I would still be using them.

 

[donnellysdogs]

Bleeding for me on the way out is rare.. And only if they've given me a higher reading in the first place which generally would alarm me.

I can only wear sets in my bum.. They bleed horrendous in any other part if body, but that is because no other part if body has enough skin and fat in it to avoid the blood!!

 

[iHs]

I would not want to use a well stuck down steel needle set unless I could soak in a hot bath or use an adhesive remover to loosen up the stickiness.