Trusteel cannula questions

[EllieM]

Just had a morning struggling with my pump (tandem tslim x2) and my bg.

Woke up round about 6.30am to notice my bg in the teens and rising rapidly, gave myself a correction dose and rolled back over for 30 minutes. Still going up at 7.30am so got up and saw the problem, had managed to pull out the cable from my cannula overnight. Oops.

NO problem, was due a set change that morning anyway, so new insulin was waiting for me out of the fridge. Gave myself a quick 3 units from my trusty insulin pen as a stopgap measure. Change was OK though I did have a momentary panic when trusteel needle went in a bit strangely. Blood sugar started to go down and I thought all was well. After an hour or so bg started to go up again, despite a minor amount of rage bolussing, and after testing the pump to check that it was delivering insulin I rang tandem support.

I learnt lots of things

1) did you know that trusteel cannulas (cannulae?) are only supposed to be inserted for 48 hours max? (My diabetic team suggested that I should make them last 3.5 days as PHARMAC, the New Zealand medicines funding body, only pay for 130 cannulae a year.

2) It's OK to take the new cannula out and reinsert it if I think the positioning is off.
3) other stuff probably not relevant to this post. But her spreadsheet told her I should consult a medical professional. (My diabetic clinic doesn't work at the weekend).

Anyway as a result of all that I decided to move the cannula. Lo and behold, the needle was at a 45 degree angle and I hadn't removed the needle cover. So, needle cover now removed and cannula reinserted and my bg is coming down.

Am a little concerned that 13 units of insulin went from my pump into the cannula while it was misinserted and have no idea whether it will eventually be absorbed into my body. There's a red mark where the cannula was.

So, two questions
1) how often do you replace your trusteel sets ?
2) anyone know if those 13 units are likely to hit my system later??? (Not expecting anyone to have an answer for this).


(edit for typos)

 

[searley]

I no longer use trusteel as I pulled everyone out the adhesive just doesn’t seem as strong

I was told only hours for them

yes you can even reapply them if you pull them out, however the adhesive is never as good second time around so you may want some tegaderm or something

 

[EllieM]

Thanks @searley , bg back to normal now but the rise while disconnected was scarily fast. I actually pulled the tube out from the cannula without disturbing any of the tape so I think I'm OK with the truesteel.

But am very concerned as to whether I should believe customer support about the 2 days. Pharmac won't pay for more than 130 cannula a year so am puzzled as to why they would have approved the trusteel if they should be changed that quickly. I guess I could change to a different cannula but as I'm already using humalog (supposedly should be changed every 2 days) if I do that I should probably change to novorapid. I guess I could try out the autosoft cannula?

Really puzzled as to how minimed has a 7 day cannula.

 

[Finnlee]

I'm in Germany and in my Tandem T:slim training, I was told that Autosoft 90s can be used for 3 days, but TruSteel should be changed after 2 days.

The reservoirs are good for 3 days, so when I use TruSteel, my reservoir changes and infusion site changes get offset.

Does it say anything in the booklet that comes in the infusion set box about how long the TruSteel infusion set can be left in? I think I've seen it there, but I throw my booklets away when I open a new box.

 

[EllieM]

Does it say anything in the booklet that comes in the infusion set box about how long the TruSteel infusion set can be left in? I think I've seen it there, but I throw my booklets away when I open a new box.

Just got a new box so pulled out the instruction booklet

 

[EllieM]

So it looks like the New Zealand health service recommends 3 days (actually my DN recommened 3.5 as PHARMAC has a hard limit of 13 lots of ten per year, and the supply is 10 per month).

This is the first (of 3) cannulas that my clinic have available for the two NZ pumps, minimed 780g and the tandem tslim.
As yet no T1s get free cgms so if you want to go closed loop you need to fund it yourself. (I'm used to that, but very indignant that not even children or pregnant women get free cgms.) I'm definitely getting better health care because I can afford to fund them. (Sorry, rant over)

 

[Finnlee]

This is the first (of 3) cannulas that my clinic have available for the two NZ pumps, minimed 780g and the tandem tslim.

I might have missed this, but have you tried AutoSoft 90 infusion sets? They are good for 3 days (at least in Germany) according to the documents in the box. I sometimes go 3.5-4 days on one AutoSoft 90 when I'm close to finishing off the reservoir and I've had no issues. I found AutoSoft 90s work as well as TruSteel for me, but everyone reacts differently.

 

[EllieM]

I might have missed this, but have you tried AutoSoft 90 infusion sets? They are good for 3 days (at least in Germany) according to the documents in the box. I sometimes go 3.5-4 days on one AutoSoft 90 when I'm close to finishing off the reservoir and I've had no issues. I found AutoSoft 90s work as well as TruSteel for me, but everyone reacts differently.

Funnily enough I was just watching a youtube video about that before I noticed your post. It looks a little complicated but am guessing it's easy enough in practice?

Not sure I understand why extra priming of the tubing has to be done? And do you always have to put a stopper on the cannula when you have a shower? (I don't bother with the trusteel.)

 

[sninge]

Hi Ellie
I use trusteel and was told to change every 2 days but I change mine every 2-3 days depending on life ( if I remember ) and also if I feel they are uncomfortable or itchy. 2 days does feel a waste if all is comfortable.
I have once pulled mine out and reinserted, I was working ( physical job ) and for no reason it kept feeling like a bee sting so I pulled it out and moved it, it stuck fine until I got home and then I put some rock tape on top to be safe, it is a handy feature of trusteel, also if you ever accidentally pull it out and not near you spares then you simply reinsert!
The other cannulas need extra prime because you insert before filling up the small amount of tubing in the cannula unlike trusteel when we see the drips coming out before we insert!

 

[EllieM]

The other cannulas need extra prime because you insert before filling up the small amount of tubing in the cannula unlike trusteel when we see the drips coming out before we insert!

Doesn't that mean you end up injecting air into yourself?

 

[Finnlee]

Funnily enough I was just watching a youtube video about that before I noticed your post. It looks a little complicated but am guessing it's easy enough in practice?

The only difference between AutoSoft 90 and TruSteel infusion sets (besides the material), is the AutoSoft 90's insertion mechanism.

I wouldn't say it's complicated at all, just different. I prefer the AutoSoft 90 applicator to the manually inserted TruSteel since you can be certain the AutoSoft 90 will go in at 90 degree angle every time.

And do you always have to put a stopper on the cannula when you have a shower? (I don't bother with the trusteel.)

I use the cap/stopper when I shower for both AutoSoft 90 and TruSteel. It's meant to keep dirty water and grime out of the site when you're not connected to the pump.

I don't think there's a difference not using it for AutoSoft 90 if you don't use it for TruSteel now.

 

[Juicyj]

I use mine for around 3-4 days and just go off my readings, if things are looking off then I replace sooner, but prefer to use my insulin up before changing, and hasn't been an issue, I think the advice is based on the insulin efficacy in the container itself as supposed to only last xxx long which is why checking your readings and replacing when you know things are going off the boil.

 

[sninge]

Doesn't that mean you end up injecting air into yourself?

I see what you mean Ellie, never really thought about that but its clearly never harmed anyone!