Not changing site on time
All pump users are advised to replace their cannula, tubing, and reservoir (or pod) of insulin every 2–3 days and to insert the new cannula into a different place on the skin. However, it’s not uncommon for children and teens to get lazy or busy or to otherwise forget to change their sites at the recommended intervals. They may still have insulin in the pump (and you or they may not want to waste it), and of course they are not eager to poke themselves or take the time to change it. However, not making site changes at the recommended intervals can lead to skin infections and to high blood glucose, for a variety of reasons, including the following:
• The insulin in the reservoir and tubing is degrading because of warm body and outside temperatures.
• The tissue at the cannula site is saturated and cannot absorb additional insulin. After several days, a depot, or accumulation, of insulin develops under the skin; it can sometimes be felt as a hard lump. Insulin is not well-absorbed into the tissues from these depots.
• The reservoir is so low that there is not enough pressure to deliver the remaining units of insulin.
• The reservoir has been allowed to become completely empty.
Hints from Parents:
“We had a problem because in our scramble to get kids out the door to school in the morning, our son never remembered to change his site until it was time to leave for school. We had to write it on the calendar, and even then he forgot. We’ve been in the mode recently of doing it on the odd calendar days.”
“My son (who is four) doesn’t like to change or rotate sites. We just reason with him and explain why it has to happen. We’ve been trying some behavior modification techniques so that if he allows us to change the site without a fuss or tries a new site, he accumulates stars, and he is saving up his stars for little Lego Star Wars action figures.”
Disconnecting the pump
When your child is extremely active and/or involved in a contact sport, it is often best to disconnect the pump (if you use other than a tubeless pump). In most cases, the cannula can be left inserted and a plastic cap attached to it to keep it clean. This makes it possible to simply take the cap off and reconnect the tubing when you’re ready.
Recommendations for disconnecting include taking an hour’s worth of basal insulin before disconnecting, and not leaving the pump off for more than an hour. Even so, there is a window of time during which no insulin is infused, and practically speaking, many kids and teens stretch the one-hour rule as long as they can. This often leads to high blood glucose later.
Hints from parents:
“It can be a little tricky if you want to take the pump off for more than an hour, like when we go to a water park or the beach. We always keep it in a ziplock bag so sand doesn’t get into it. Usually we check blood sugar about every hour and 15 minutes and take some basal (maybe not the full basal) insulin every hour while he’s off his pump. That has worked best for us although it’s not perfect.”
“When you disconnect, always put your pump away in a purse, backpack, or somewhere where it won’t get lost. A pocket is not a good idea [pumps in pockets have been known to end up in washing machines], nor is a very hot car.”
“When we go to the beach, Jason is so active and such a water lover that he is in the pool or surf all day long. We have found it easiest for him to take an injection of long-acting insulin (Lantus or Levimir) for those days and disconnect the pump completely except for bolus insulin for meals or snacks.”
Not all kids do well with an insulin pump, and as these comments from parents demonstrate, switching to a pump does not reduce the diabetes self-care workload. For those families who are able to stick with it, however, the positives of pump use outweigh any negatives, such as the additional time and effort that must be put into learning new skills and trying different approaches to see what works best. Here are some parent perspectives on pump use: