If you see this happening, take (or give your child) a correction dose of insulin, then monitor to see what is happening. If blood glucose numbers do not begin to drop within an hour of taking the correction dose, change the site. Although some pump users just change the cannula and insertion site when they have apparent site problems, most diabetes educators recommend changing the tubing and reservoir (or pod) as well, just in case the insulin delivery problem involved the tubing, reservoir, or connections between the various parts.
Hints from Parents:
“Bad sites have been a problem for our nine-year-old. Move to the other side of the body, find some fat, and change often. We had to try a bunch of different cannula products from different companies until we found one that worked well for us.”
“Test often after a change of site. If you have a very high number twice in a row, change the site again.”
“We were told not to change the pump site right before bed. We ignored that once or twice, and wouldn’t you know that that was when we got a bad site and she was high all night and sick in the morning. We quickly learned to change the site right after dinner so we could see what was going on before bedtime and change the site if we needed to rather than go all night with a bad site.”
“We thought our son was having a series of bad sites, but when we went back and checked the procedures, as it turns out, he was forgetting to prime (fill) the cannula with insulin after the steel introducer needle was pulled out. He was requiring such a small amount of insulin at the time that it took 2 or 3 hours for insulin from the pump to fill the cannula, then he was high after every site change. After we got into the habit of priming, the problem went away.”
Note: Your pump manufacturer and trainer will provide instructions for priming the cannula as well as the tubing if your pump uses tubing (all but one currently do).
Site falls out
Probably every child (and adult) who has used a pump has had a site pull out at some time. In kids, this happens most commonly when kids are very active and sweaty, playing contact sports, or pulling on or taking off tight clothing such as jeans or items made of spandex. It can also happen at night in restless sleepers. The most dangerous of these is at night, because a child could go for hours without insulin if it goes unrecognized.
Although all pumps have built-in alarms for “no delivery,” the alarm sounds only if there is a blockage in the cannula or tubing. As long as insulin is flowing freely, the pump does not know whether it is being delivered under the skin, as desired, or into the air.
Sometimes a pump user will see that a cannula has pulled out, feel it, or notice that clothes or skin are wet from insulin. Sometimes, however, a cannula will pull out under a layer of tape and not be visible. There are times when the only way a dislodged cannula gets noticed is because of high blood glucose or symptoms of high blood glucose.
If you’re having trouble getting your child’s sites to stay in, ask your health-care provider or your pump’s customer support line for tips on tapes, adhesives, and other solutions to sites pulling out.
Hints from Parents:
“Try to secure the pump in a pocket or waistband at night, and keep the tubing rolled up and out of the way so that it cannot pull out. When our son had it loose in the bed, he’d get all wrapped up in the tubing, and the cannula pulled out.”
“We recently went to the tubeless pump, and that has solved the tubing problem at night. You have to make sure that the insulin pod is in a comfortable spot, although it seems to stick pretty good.”
“In the summer, we put IV prep [an antiseptic product that cleans the skin and leaves a tacky surface when dry] on, let it dry, put it on again, let it dry, etc., so that the adhesive really sticks well. Sometimes it is hard to get off, but we’ve learned that there are products to take off the adhesive, or even Avon Skin So Soft does the trick.”