Tslim x2 infusion sets

[Emck]

Hi all,

Just if anyone has any experience with large insulin doses and the different infusion sets.

I think I’m getting my head around the best sites for absorption at the moment but one issue I’m having is sore infusion sites. I’m currently using the auto soft 90s and when I get to about 48 hours the site gets hard, sore and red. When I remove the set, the skin is tender and there’s a hard lump under the skin for at least 24 hours. Some sites have been bruised too.

I chatted to the rep, she thinks it might either be a reaction to the cannula or just the volume of insulin I use is causing the lump. When I used pens, I would have occasionally got lumps like this after an injection but they didn’t often hurt. My insulin absorption doesn’t seem to be affected by the lumps either.

The rep sent over some auto soft 30s (don’t know the benefit of these) and the trusteel sites. I tried the steel sites tonight and had to bail on 2 of them. The first seemed to have bled quite badly and my sugars were spiking so changed it. The second also bled a lot and was really sore. It was close to bed time and I didn’t want to risk another failed site so I popped an auto soft 90 in - probably should have given it a longer try but was too nervous!!

Should I keep going with the steel sites - is bleeding and pain on insertion normal?

 

[Chas C]

The auto soft 90 comes with either 6mm or 9mm deep infusion sets, I moved to the 9mm to improve absorption.

 

[Emck]

@Chas C - good to know! Did it help to distribute the insulin a bit better?

 

[Juicyj]

I used to get lumps with teflon infusion sets and they were really sore, so switched to sure t - which are steel tip sets and you manually insert them - haven't had any absorption/lump issues since and that was about 4 years ago, would never use the plastic/teflon sets again, can try the steel tips ?

 

[Emck]

I used to get lumps with teflon infusion sets and they were really sore, so switched to sure t - which are steel tip sets and you manually insert them - haven't had any absorption/lump issues since and that was about 4 years ago, would never use the plastic/teflon sets again, can try the steel tips ?

I’m going to give the steel sites another go on my next site change.

Do you have any tips for inserting them? Both that I tried hurt so much (way worse than giving an injection) and bled badly.

Ironically, after giving up after 2 tries with the steel sets last night and just using the auto soft, I ended up with a bent cannula! Was up until 4am making sure my site was working!

 

[Chas C]

@Chas C - good to know! Did it help to distribute the insulin a bit better?

Yes it seemed to work for me, if my BG's are rising and I can see the patch around the cannula is damp then I change. I seem to have same number of changes needed but when working the absorption is much better.

 

[Emck]

I tried a steel cannula again after my site started leaking last night. I couldn’t even feel it going in, so far very comfortable and sugars seem great so far. Maybe I picked the wrong spot for it the last time.

They are a bit more fiddly than the autosofts but I’m sure you get used to it.

 

[Juicyj]

I tried a steel cannula again after my site started leaking last night. I couldn’t even feel it going in, so far very comfortable and sugars seem great so far. Maybe I picked the wrong spot for it the last time.

They are a bit more fiddly than the autosofts but I’m sure you get used to it.

To be honest I rarely get pain with my inserts, but always best to slightly pinch the skin where it's to be inserted to get a good area, once it's in and settled in then there shouldn't be pain unless there's not much fat there. They are bomb proof though in regards to lumps, am unsure why the reps seem so keen to get everyone on teflon sets as patients should be given the option, it's quite common to get lumps with them too.

 

[Emck]

I really liked the steel set initially but a few hours before I was due for a set change, it just stopped working. It was about 5/6am and I got an alert from my libre that my sugars were running high. I had a massive spike and obviously hadn’t eaten anything at that time of day, so changed the site and it fixed it.

When I removed the set my skin was very bruised and sore underneath. This set had come unstuck a bit during the previous day and I fixed it back down with a few plasters. It had also unfortunately been located on my abdomen at the exact same height as my kitchen counters and bathroom sink so it got knocked a few times and really hurt!

I’m trialling the auto soft 30s now. I had to abandon my first auto soft 30 site after about 33hours as it was getting very painful.

I’ve asked my diabetes nurse for any advice she might have but i’m starting to fear that pump life might not be for me, physically. I don’t know whether it’s my skin, my high insulin doses or the fact that I’m using Fiasp (which is off licence for the pump) but I’m finding all of the pain, alerts, failed sites and set changing quite challenging.

I never imagined that a pump would be more hard work than MDI!

 

[Juicyj]

Hello @Emck Unfortunately sounds like a bad site, this can happen when it gets knocked or comes unstuck and the set re-inserted and so it's no wonder the site ended up sore, you just need to locate another area, just find a site where you don't think it will catch or bump ? I wouldn't give up so easily, steel tipped sets have been great for me with the odd one catching but easily fixed with a set change.

 

[Emck]

I talked to the dsn and have settled on trying the autosoft 30s. I liked the few that the rep sent over as I could tell whether the cannulas were actually under the skin and they were a bit more comfortable.

I can always move to the steel sets if these don’t work - I just found them very sore.

the dsn suggested that the insulin that I’m using might be causing some of the problems. I’m using Fiasp at the moment, which is not in licence for the t-slim pump. They have given me some novorapid to try.