Each time an infusion set is changed, the new set should be inserted at least two inches from the previous site, and an insertion site should not be used again for 7–10 days. Any rotation pattern that helps you remember where to insert next can work effectively. Some people use the “clock method,” in which sites are rotated in a circle from “12 o’clock” to “3 o’clock” to “6 o’clock” to “9 o’clock,” while others rotate from side to side. The important thing is not how it is done but that it is done. Meticulous site rotation can prevent serious complications (such as infection, breakdown of skin, and poor absorption of insulin) down the road.
An infusion set should be changed immediately if marked high blood glucose levels occur and are not corrected by a bolus dose of insulin. If ketones are detected in the blood or urine or there are signs of infection, insulin delivery may be impeded, and it is imperative that the infusion set be removed and a new set inserted at a different location.
Keeping the set in place
It is often not necessary to use more than the adhesive patch that is part of the infusion set to keep it in place. However, people who are very active or who tend to perspire a lot may require additional tape or other adhesive products to keep the set in place. Different tapes and dressings have different looks (transparent, white, or colored), and certain ones may adhere better in wet conditions (due to perspiration, swimming, showering, etc.) or may be more comfortable for people with sensitive skin. People with skin sensitivities and/or adhesion problems may also benefit from skin barrier preparations, which are liquids that are applied to the skin to form a barrier between the skin and tape or dressing while also helping it adhere better. Tape removers dissolve tape and adhesives before the infusion set is removed, reducing damage to the skin. However, tape removers can potentially cause skin irritation and should be avoided if there is any skin breakdown at the infusion site.
Trial and error is the best way to determine which products work best, and more than one product may be used in combination to provide maximal adhesion with minimal irritation. Talk to your health-care provider about options currently on the market.
Some manufacturers’ pumps are compatible only with their own infusion set systems, while others are compatible with a variety of product lines. The availability and universality of supplies may be a consideration in your pump selection, so it is wise to check on this prior to making your final pump decision. Usually an insurance company that covers a certain insulin pump will cover compatible infusion sets, but because coverage varies greatly it is important to check on this issue as well. Insurance companies usually cover 30 days’ worth of infusion sets at one time.
When choosing infusion sets and tubing lengths for children who use insulin pumps, comfort and security are issues to consider. The buttocks seem to be one of the most comfortable infusion sites for children since they have the largest amount of fatty tissue. Also, because a child cannot see this area, it is less likely that he will tamper with or remove the infusion set. Products and techniques for numbing the insertion site are also available and can be useful for both children and adults with needle phobia.
What works for you
It is a well-known fact that tight control of blood glucose levels can prevent or delay the progression of long-term diabetes complications. There are many treatment choices for achieving this level of control, and finding the option that best fits your lifestyle usually requires trial and error and most of all, patience and perseverance.