Slim teenage Insulin Pump user

[FITZSURF]

My 16 year old son uses a Paradigm Veo with Medtronic 13mm Silhouette cannulars. Overall he thinks this is great compared with doing 4 or more pen injections daily . He is slim (not much fat anywhere) and keen on sports. He prefers to insert his cannular into his "muscly" abdomen, although we think there is barely enough fat here, even for 13mm flexible cannulars.

Problems inserting new cannulars are as follows, noting that as soon as we diagnose the problem, we switch back to the "old" cannular temporarily and insert a new cannular shortly afterwards.

1 - Kinked cannulars (caused by muscle?) resulting in reduced or no insulin delivery.
2 - On most occasions when we have a recently inserted cannular problem, we don't get a "No delivery" alarm on his pump, and only realise the problem with quickly increasing blood glucose over successive blood tests.
3 - Occasional slight bleeding following cannular insertion.
4 - Occasional painful cannular insertion.

Any advice or solutions to the above would be appreciated.
Is there a better infusion set for the very slim :?:
Thanks.

 

[Clorinda]

My 12 month old is using the Quick set and whilst he is not slim (he's a chubby baby) the quick set seems to stay put more than the Silouette did despite the shorter canula. He is very active and almost walking, so lots of movement.

Regarding pain - we use a numbing cream called "Emla" we have a prescription now. Could he ask about trying it? You put a small blob on about half and hour to an hour before swapping and wipe it off just before you insert. Use a tegaderm to cover the blob whilst it's working.

There are other numbing creams he could try too.

hth

Clorinda

 

[jopar]

Give Medtronic a phone and ask if the can send you a samples of the other infusions sets they do, see if he gets on with a different type..

I use a different pump and manufactuer, but Rouche have two types of canulars a metal and Teflon, I use the Teflon (13mm angled tender links) as I am very slim indeed and like your son would have problems with hitting mucles..

The Teflon is more flexable than the metal, and I haven't had any problems with bending hitting muscle, but I do insert by hand at a 45 degree angle though.. So the canular is more likely to slide across the muscle rather than hit it..

It may be his actually technique that may be causing some of the problems, it would be well worth contacting his pump team, and see if they can run through this side of things with him again, and they may have some more tips they can give him about looking at possible insertion sites to determin if high risk for hitting the mucsle underneath and bending the canular..

 

[mary123]

I'm certainly no longer a teenager but I am quite slim and found the straight cannulas caused me problems not dissimilar to your son; kinking being one of them. I have switched to the angled ones since when I have had no further trouble. My reply may not be too helpful as I think the variety of pump your son is on has specific infusion sets? However, if it helps I use the Inset 30's produced by Unomedical for Animas. Of particular comfort to me is the fact I can actually see the cannula sticking into my skin through a clear patch in the adhesive patch. Mary

 

[phoenix]

I use silhouettes, what I like about them is that I can vary the angle. (Medtronic literature says 20-45 degrees, I am active and found the straight insertion sets didn't always stay in place. I can determine the angle by inserting the cannula manually, not with the 'serter'. I vary my sites a lot and vary the angle according to the site and amount of fat.
I have a fair amount of fat on my stomach and hips and bottom (post menopausal, woman with 2 children)so I use a steeper angle there and the set is comfortable and seems to work well for 3 days or when I get lazy sometimes a little longer.
I also use the top of my legs where I have comparatively little fat as I do a lot of running . I use a very shallow angle there and insertion does sometimes hurt a little. The site works well but for less time... the third day I may begin to feel it, glucose levels may be a bit less predictable and when I change the set I sometimes find a trace of blood in the cannula.
So from my experience I would suggest inserting manually with a shallow 20 degree angle and changing site at least every 2 days.