Mobile Infusion Set Site Change

A person with diabetes who’s tasked with writing an entry each week about his life with Type 1 diabetes might, at certain times, have those days when finding something to write about seems extremely difficult. Diabetes writer’s block, maybe? Or a creative roadblock in which the vast well of material that diabetes offers seems to have dried up.

Rarely is this the case with me. However, yesterday evening as I drove home from work contemplating what it was I’d write about, I peered into that diabetes well, dropped a few pebbles, some stones — anything that might elicit a splash — and got bupkis.

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That is, until a few hours later when Kathryn and I were setting out to walk to the Corner Brewery for some microbrews and Wednesday evening conversation with good friends.

Typically when I have a series of high blood glucose readings, one of the usual suspects is the bad infusion site. An infusion site, for those of you who aren’t insulin pump informed, is the place on my body through which the insulin is delivered at a continuous basal rate throughout the day, as well as where the bolus amount of insulin I need prior to meals is infused. Here’s a picture of someone’s infusion site so that you have a visual. (Please note again that this isn’t my site. That’s not me. I believe this person is female. I am not).

Once I explore other variables and possible reasons for a high blood glucose and determine that all things diabetes-related are (for the most part) constant, I proceed to the supposition that my numbers might possibly be caused by a malfunctioning medical device. I assume, or hope, it’s something as simple as a bent cannula, a clogged cannula, or maybe just somewhere that the insulin, once entering my body, isn’t taking. In short, the insulin can’t work because it can’t get in. Thus the higher blood glucose.

Earlier yesterday, while at work, I changed my infusion site due to a series of high glucose numbers over the previous day. This new site placement was higher on my abdomen than usual, about an inch north of my belly button and to the right about three inches. There is less fatty tissue there, and I hoped that particular site remedied the high numbers.

By evening, by the time we were headed out the door to walk the three blocks to the brewery, the discomfort at the new site had become pretty pronounced. Halfway down the block I complained to Kathryn that it hurt, and that maybe I’d just infuse a small bolus of insulin in anticipation of a snack I’d have at the brewery and then rip off the irritating site and go it pumpless for the next couple of hours.

Kathryn was curious about just how much pain I was in. I wasn’t doubled over, but it hurt, and that hurt was constant — it was as if a wasp or bee had gotten into my shirt and kept stinging, constantly, in the same place. (For you smart alecks, yes, I do know that a bee can only sting once!)

Kathryn said she had an extra infusion site in her purse. I had forgotten she often carried one of the Cleo sites with her, so I said that yes please, I’d like that. I immediately ripped off the old site as we were walking. We were about a block from home, of a winter evening, during twilight.

I took the new set from Kathryn. The device looks like this with the cap off; you can see the needle behind the purple plastic, and it’s that needle, sheathed in the cannula, that plunges into the skin, deposits the cannula subcutaneously, then retracts quickly leaving only cannula and the circular adhesive base on my belly. To this little nub that protrudes above my skin is where I attach the insulin pump reservoir surgical tubing.

I slid the device under my shirt, found a suitable location lower on my abdomen on the other side, and plunged it in, all the while maintaining my pace on the sidewalk. After ten or fifteen seconds, after allowing the adhesive to adequately stick, I eased the application device from beneath my shirt, leaving behind a new site. Then I reattached the tubing from my insulin pump, and we continued on to the brewery, all without breaking stride.

And I was pain-free!

  • miss kitty

    Eric,
    i know exactly how you feel. Been there.
    i wasn’t the best candidate for an insulin pump but my endo & i were stumped about what to do.
    i’ve been wearing for 3 yrs now, finally getting the hang of it.(about time says my mfg rep!)

    Now, if i can be stricter w/ myself…….

  • Mary Rempp

    I too have experienced that “ouch” after a site change. I have only had my pump since October and have found that using the Sure-T infusion set works very well for me. No “snap” sound to react to. After 35 years of insulin injections, one little needle like this was nothing. I enjoy reading your columns.

  • Bev

    I’ve been wearing a pump since 1988. I will never forget the first “leaving it in the bad site too long” it landed me in the hospital for 4 days. Now even the slightest hint of multiple highs and I have a new site. Had a few of the ouch factors too, usually it’s been hitting a small vein, sometimes that pain goes away fast but other times you just need to get it moved right away. Happy to hear you didn’t stop walking! One of the best things anyone can do for themselves and it’s easy!

  • Aaron

    Yes, repeated highs that won’t come down are a red flag for me that something in the equipment must be wrong. Usually I do two correction boluses a few hours apart, then if it still doesn’t start coming down, I immediately change infusion site, tubing, and sometimes fill a fresh cartridge with new insulin from the fridge. Often if I have let my site go too long, I can feel a little pool of insulin right at the end of the canula, under my skin. The longer it goes, the more painful it gets. I have tried “massaging” the pool away to disperse it, but it doesn’t seem to help much.