Monday, February 7, 2011

The Saga of the Bad Sites..... and a Silver Lining

** If you want to listen to the playlist .... you gotta hit play!  It's right there to your right!  Silver Lining is the first song!**

Reyna reminded me after my A1c Sauce post that I never explained what exactly happened with all those bad sites....  So here it is!  The Saga of the Bad Sites....

For those of you that don't know, we had a run of BAD LUCK in the fall concerning pump sites.  It seemed that every sight we inserted had a bent cannula.  Which, of course, led to high blood sugar and ketones before we could get it corrected.

And I'm not talking moderate or small ketones either.  I'm talking LARGE, Jumbo sized ketones.

It all came to a head on World Diabetes Day.  Ironic, isn't it?  ( You can read that post HERE.)  That morning Sweetpea got up after a site change.  Her blood sugar was not all that high.  Mid 200's.  Not too high considering she had no insulin all night.  So I wasn't SURE the site was bad.  And she's actually come down a bit.  But then she threw up.  Uh-oh.

I find it interesting that she threw up with a LOWER bg and LOWER ketones than she had the previous week.  And that week she was fine - or as fine as you can be with all that.  Just goes to show that D does not ever play by a set of rules.

Anyway, after spending the day in the hospital, we made an appointment to meet with a CDE later in the week to discuss our issues.

When Sweetpea started pumping with her Animas Ping (to read about our Ping - click HERE), we were using the comfort short infusion sets.  We were told that she was too small to use the straight in kind.

The comfort shorts were fine.  But it was REALLY hard to insert.  It would not have been so hard if Sweetpea held as still as the fake skin did while I was practicing.  But no... in true Sweetpea fashion, she flailed and fussed.  This made manually inserting that needle difficult.

It kind of grossed me out that when you insert at that angle that you can kind of "see" it under the skin.  And I was always afraid that I was not going deep enough or that I was going too deep.

We went back to the hospital a few weeks after pump start to meet with the CDE again and see how we were doing.  We discussed our issues with the infusion sets.  The CDE we met with was considered to be the "pump guru" so we totally trusted her judgement.  She suggested that we try the Inset infusion set.  She thought that we would like the automatic insertion and she also thought it was a little smaller and would take up less room.... which really matters when you're short on tush real estate!

Sweetpea was with us at this appointment and she did not like the sound the Inset makes when it automatically inserts.  It scared her.  The CDE suggested that we just put in on her skin and push the middle down ourselves.

We tried it... and it worked!  Sweetpea had no noise to be afraid of.  It was easier to insert on a wiggly little body.  It was good all around.

And it stayed good.  For an entire year.

Then the bad sites started.

I thought maybe it was a bad batch.  I called Animas and they overnighted me replacements.

We still had problems.  BIG problems. 

At our appointment with the CDE after our hospital stay, we discussed the infusion set we were using, our insertion technique, etc.

She thought the problem was that we were manually inserting the inset.  "I've heard of people having trouble with bent cannulas when they insert this way" she said.

"Well, FANTASTIC!"  I thought.  "We only did that because YOU told us it was ok!"
(I did not actually say this because I did not want to hurt her feelings.  J and I just gave each other knowing looks.)

She also brought out some of the other options.

She showed us the new automatic angled inserter - The Inset 30.  We practiced with it a few times and I thought it seemed workable.  The only difficult thing was getting the tape pulled back so it didn't bunch up on insertion.  Apparently, this feature was fixed in the newest model.  We were using ones that we almost ready to expire!

(That's totally me demonstrating!  Check out my abs!!  NOT)

Click HERE to see the Inset 30 product overview!

She also showed us the Contact Detach.  I liked the fact that it would NOT have a bent cannula - as it's steel.  But... it's steel.  OUCH!  That sounded painful.  I've HEARD that it's painful.  It has to be changed every 2 days instead of 3.... And I wasn't sure about having two places of tape "sites".  We hardly have enough room for one.  But I took a sample just in case.



To read more about the Contact Detach click HERE!

So.... We went home and tried the Inset 30's.  They worked!  I liked them just fine!  It was a little difficult to place the automatic inserter correctly on the skin... but nothing major.

However... we had all these Insets.  So we decided to give the inset and go - and do it the automatic way.

Roll the dice and see what happened.

It worked.  And we haven't looked back since!

I think the Inset is the easiest to use.  There are no issues with the tape.  And Sweetpea is asleep now when we do site changes so the sound doesn't bother her!



Click HERE to see the Inset product overview!

The silver lining?

We were afraid, at first, that the problems with the bent cannula were a result of scar tissue on her tush.  We ONLY used the tush for pump sites.  Then we got Dexie (the Dexcom 7 Plus CGM) and we used tush for that, too!  Now, that's a tiny tush.  Cheeks were not getting a break.

The CDE felt Sweetpea and she did not feel any scar tissue at all.  *Whew*

But it encouraged us to try some different sites.  We tried Dex on the arm first.  But Sweetpea did not like Dex on her arm.  She thinks Dex is too big for her arm.  It DOES cover the entire back of it... but it worked fine there.  Since it's her arm - she made the call.  Dex goes on the tush and her pump sites go on her arms.

Now we are rotating and areas are getting a break!  This is good.

The best part?  Arm sites are proving to be the "sweet spot" for the pump!

And to think... all it took was a half a dozen bad sites and a trip to the ER to figure it out!


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10 comments:

  1. Lord knows we took a LONG trip around the failed infusion set block!

    But the Insets saved us as well. We've been using them for almost 4 years with no trouble :)

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  2. I laughed at the caption to the first photo! Props to you for finding the silver lining in all that. I'm all about finding the silver lining, even in the messiest messes diabetes throws our way!

    Oh, and Sweetpea is braver than me for using the arms. I gave injections in my arms for 20+ years, and it's still my least favorite place. Now that I have a pump and CGM, I don't even use my arms. It will be a last resort if the real estate I'm using ever becomes uninhabitable.

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  3. Glad to hear about your experiences with the various sets. We started with infusion set issues a little over a year ago and switched to the Contact Detach. It's worked well for us overall, but then a few weeks ago we ended up with a site infection and I'm thinking of switching. My sweetie seems to have a serious issue with the adhesive...her poor bum hasn't been the same since the issues that started it all for us a year or so ago :(
    Anyway, I've been fearful of the Insets, but may have to give them a try...esp seeing as we have a few "samples" from our awesome Animas rep!

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  4. Im lmao at the abs...i dont like that model. Haha.

    Glad things all got worked out! Sites for us were a challenge as well. We switched to contach detach and no pain J said!!

    Also just an fyi contact detachs can be changed every 3 days just like an inset. We used to use accu chek steel sets that were every 2 and then got told about these due to longevity.

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  5. look at you seeing the positive out of such a difficult time...thanks so much for sharing how it worked out. I am currently noticing that Isaac has one side of his booty that gets better numbers than the other and am wondering about different types of sites to use other places on his body, too. It's so tough with these little guys and I am happy to hear that you found a great solution.

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  6. I have a question about the arms too. Josh has always been ok with shots in the arm but not in the "back" of the arm which he says hurts really bad. It looks to me like that is where they say the site should go if you do it on the arm though. So far he has done 3 butt sites and two front thigh sites. Both of the thigh sites were a bit more painful whenever he got a bolus. He also said he could feel the canula in one now and then. He also didn't have great numbers during those site times. Not sure if that was just coincidence or what. I think I'd like to try the arm as another possibility, but I'm pretty sure he will not want to do a back of the arm site. Can we just do it on the lower shoulder like where you'd punch someone?

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  7. I TOTALLY thought that pic was of you!! You shouldnt have said anything! ;o)

    We have always manually inserted Sugar Boy's sites... and it has always been me that does it as no one else in the family feels comfortable with it. I would LOVE to go with an automatic insertion... but at the same time we have had no trouble, so I have to think "if it isnt broke..."
    But still...

    I am so glad you guys got it figured out! Even if it did take a trip to the ER and a whole lot of other junk to get there!

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  8. That's a whole lotta abs going on in this post! Is there any fatty tissue on those models?!

    Does anyone wonder why I am not overly anxious about getting going on a pump?!

    You have endurance, my friend!!!

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  9. My 6 y.o. has been pumping with the Ping for almost 2 years, and we've used inset 30s exclusively. We have very little problem with the set--except for my daughter's wiggling. We rotate spots along her tummy. We've tried her backside but she claims that it hurts too much, and she's terrified of using her arms. Sigh.

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  10. It is very sucky that we have to try the "trial and error" technique on our children! Very sucky indeed!

    But how awesome is that that it is all figured out now! We just keep swimming for sure!

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