Are some infusion sites more absorbent than others?

[Diabetesnet.com]

I have been pumping since January of 2007. I "did" the OmniPod for one year; had bad infusion site issues with it. Switched to the MM522 with Real-Time CGM in January 2008. I like it a lot. My issue is this: it seems as though some infusion sites are far more absorbent than others. Last night, during the night, I was awakened by my CGM at 1:30 a.m. BG was 69. The night before, with the same basal rate and the same before bed BG (120) all was well. This kind of variation drives me crazy. Though pumping is infinitely better than taking MDI was, the absorption of injected insulin seemed to be much more consistent. Do you have any tips for me?

J

[John Walsh, PA, CDE]

I'm not a big believer in "site absorption" or "site scarring" problems. When I show patients which infusion set to use and how to insert and anchor it, the "site" problems they seemed to have been having disappear.

Most infusion set problems, unfortunately common, come from poor infusion set design or from the user not anchoring the infusion set line to avoid line tugging that eventually causes insulin to leak back along the Teflon to the skin surface. One day I searched for infusion sets online. After looking at dozens of pictures people had posted, I did not find a single one that was anchored properly with tape. Most current infusion sets do not put enough distance between the Teflon line and the infusion line, so any movement of the infusion line can loosen the Teflon beneath the skin.

If you currently use QuickSets, switch to the slanted Silhouette infusion sets (http://www.minimed.com/products/infusionsets/silhouette.html). With the Silhouette, don't use an inserter as they often bungle the insertion. Insert by hand and then anchor the line with a short piece of one inch tape (Micropore, Durapore, Hypafix, etc,) an inch or two beyond the adhesive. When you change clothes or roll around in bed, you'll no longer be tugging directly on the Teflon beneath the skin. I think you'll find your absorption problems disappear.

The Rapid C set for Medtronic users, or better the Rapid D metal sets for luer lock pumps is also a great choice. Put a piece of IV3000 adhesive over the infusion set and also as much of the infusion line as you can. This anchors the set and the line at the same time.

Another alternative is to use the reservoir replacement by Applied Diabetes Research (http://www.applieddiabetesresearch.org) which lets you use any luer lock set with a Paradigm. There are three straight-in luer lock sets that work well (again, only when anchored): the Inset (http://www.animascorp.com/animas-insulin-pumps/inset-infusion-sets) by Animas, the Accu-Chek UltraFlex (http://www.disetronic-usa.com/dstrnc_us/rewrite/content/en_US/20.40.20:20/article/DCM_general_article_46.htm) by Disetronic, and the Orbit (http://www.icumed.com/orbit-90.asp) by ICU Medical. Again, remember to always anchor your infusion line if you want reliable insulin delivery.

Give us feedback. If problems continue, send a picture to better see where any issues may be coming from.

Plumbing is always the weakest link in pumping,

John

Useful Links:
Pump Prep (http://www.diabetesnet.com/diabetes_technology/insulinpumps_prep1.php) | Infusion Set Comparison (http://www.diabetesnet.com/diabetes_technology/infusion_sets.php) | Pump Infusion Sets Offer Lots of Choice! (http://www.diabetesnet.com/ruths_corner/?p=3)