Diabetesnet.com https://www.diabetesnet.com Where the world learns about diabetes Thu, 08 Oct 2020 10:26:22 +0000 en-US hourly 1 https://wordpress.org/?v=5.4.2 https://www.diabetesnet.com/wp-content/uploads/2019/09/cropped-site-icon-32x32.png Diabetesnet.com https://www.diabetesnet.com 32 32 175243344 Lyumjev, A New Fast-Acting Insulin https://www.diabetesnet.com/insulins/lyumjev-a-new-fast-acting-insulin/?utm_source=rss&utm_medium=rss&utm_campaign=lyumjev-a-new-fast-acting-insulin https://www.diabetesnet.com/insulins/lyumjev-a-new-fast-acting-insulin/#respond Wed, 23 Sep 2020 21:07:14 +0000 https://www.diabetesnet.com/?p=4788 A new ultra-rapid acting insulin from Eli-Lilly, Lyumjev (LOOM-jev), is now available. Lyumjev contains Humalog along with extra ingredients, absorbing faster and reducing post-meal spikes ... Read more

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A new ultra-rapid acting insulin from Eli-Lilly, Lyumjev (LOOM-jev), is now available. Lyumjev contains Humalog along with extra ingredients, absorbing faster and reducing post-meal spikes in blood sugar. Tiny amounts of treprostinil, an analog of prostacyclin, and sodium citrate were added to relax blood vessels near the injection or infusion site, speeding up its action. It is unknown which of these additives may be causing some pumpers’ site issues, discussed below.

You can inject Lyumjev at the start of a meal, but taking it as suggested by Lilly after a meal makes no sense unless the meal has really slow carbs. Bolusing at the start of a meal is really convenient when you don’t know exactly when your food will arrive. Mealtime flexibility and peace of mind increase, while post-meal high glucose episodes disappear.

Lyumjev joins Fiasp from Novo Nordisk as another fast (or ultra-rapid) acting insulin on the market. Both are faster than the rapid-acting Novolog, Humalog, and Apidra. Although not yet approved for use in pumps, reports from users indicate the Lyumjev, unlike Fiasp, might be more stable in pumps. However, a loss of action and site issues are being reported. The use of a Lyumjev pen for occasional high readings may be one solution. If you are using or have used Lyumjev in your pump, share your experience in the comments section below.

Lyumjev’s action time (blue) compared to Humalog (gray)

PK Versus PD

Lyumjev shows up quicker in the blood (its pharmacokinetics) and is out of the system faster than Humalog, as illustrated by the first graph.

To set your duration of insulin action (DIA) or insulin action time (IAT) in your pump or bolus calculator, use the pharmacodynamic graph below. Rather than how soon it appears or disappears in the blood, pharmacodynamics shows how long Lyumjev will actually lower your glucose. FYI, the 15 unit time gives the most accurate time for setting DIA or AIT. For more information, visit Insulin Stacking or see our article on Confusion about DIA.

Lyumjev pharmacodymics for selection of DIA
How long Lyumjev actually lowers your glucose. Use 15 unit dose time for the best accuracy.

Pricing

Available in U-100 and U-200 pens or U-100 vial, Lyumjev is sold at the same $287 list price as Humalog. The Lilly Insulin Value Program caps the price of insulin at $35 per month for insurance coverage. Find more information at Insulin Affordability. For those without insurance or eligible financial assistance, Lyumjev will be just as unaffordable as most other insulins on the market.

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Protective Masks now available in the store https://www.diabetesnet.com/news/protective-mask-now-available-in-the-store/?utm_source=rss&utm_medium=rss&utm_campaign=protective-mask-now-available-in-the-store https://www.diabetesnet.com/news/protective-mask-now-available-in-the-store/#respond Thu, 20 Aug 2020 04:02:39 +0000 https://www.diabetesnet.com/?p=4672 The Diabetes Mall now carries quality protective masks and other Personal Protection Equipment (PPE) to help during these trying times. With KN95 masks that filter ... Read more

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The Diabetes Mall now carries quality protective masks and other Personal Protection Equipment (PPE) to help during these trying times. With KN95 masks that filter out 95% of airborne particles and disposable surgical children’s masks, we have the best mask for going back to work or school. For more information on masks, take a look at our Overview of Facemask Options for COVID.

PRD KN95 Mask

PRD KN95 Protective Masks

PRD KN95 masks filter out more than 95% of airborne particles that are considered equivalent to N95 masks and provide strong protection against the spread of viruses and bacteria.

As low as $9.95 for 5 masks

Disposable Children's Mask

Disposable Mask for Kids

These protective facemasks for kids reduce the transmission of airborne infectious droplets. Elastic ear loops make it quick and easy for kids to put on and remove.

As low as $4.25 for 5 masks

3M 9501 KN95 Masks3M 9501 KN95 Masks

3M KN95 masks filter out more than 95% of airborne particles, are considered equivalent to N95 masks and provide strong protection against the spread of viruses and bacteria

As low as $16.75 for 5 masks

Makrite 101W Dust Masks

Makrite 101W Dust Masks

These lightweight and comfortable premium dust masks easily handle dust and pollen. With a 99% Bacterial Filtration Efficiency (BFE99) rating and although not medically approved, they are widely used in medical and dental environments, as well as in industry.

As low as $10.25 for 5 masks 

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Time in Range: A New Standard? https://www.diabetesnet.com/uncategorized/time-in-range-a-new-standard/?utm_source=rss&utm_medium=rss&utm_campaign=time-in-range-a-new-standard https://www.diabetesnet.com/uncategorized/time-in-range-a-new-standard/#respond Wed, 19 Aug 2020 18:45:44 +0000 https://www.diabetesnet.com/?p=4588 Increased access to technology like CGMs gives us different metrics to measure what a “good control” means in diabetes management. Low-cost options like the Freestyle Libre 2 make this ... Read more

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Increased access to technology like CGMs gives us different metrics to measure what a “good control” means in diabetes management. Low-cost options like the Freestyle Libre 2 make this technology more available and less specialized. No longer is it only for those with Type 1 diabetes or those with enough money or insurance to purchase the technology.

 

Time in Range has gained attention because it provides a more accurate picture of control than the numbers we have previously relied upon. Average Blood Glucose or A1c numbers can mask wide swings in the glucose that may create more harm than the same average glucose with fewer extreme ups and downs. For an easy-to-grasp graphic depiction of what this means, see Diatribe’s Time in Range illustrations.

 

 If you are on an insulin pump and CGM, check out our Guide to Pattern Management for in-depth information about using CGM reports to improve your readings.

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Medtronic Buys Companion Medical and its InPen https://www.diabetesnet.com/news/medtronic-acquires-companion-medical-maker-of-the-inpen/?utm_source=rss&utm_medium=rss&utm_campaign=medtronic-acquires-companion-medical-maker-of-the-inpen https://www.diabetesnet.com/news/medtronic-acquires-companion-medical-maker-of-the-inpen/#respond Thu, 13 Aug 2020 20:26:26 +0000 https://www.diabetesnet.com/?p=4616 InPen, the only FDA-cleared smart insulin pen, is a refillable pen for rapid-acting mealtime insulin. It lasts one year without recharging, tracks the amount and ... Read more

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InPen, the only FDA-cleared smart insulin pen, is a refillable pen for rapid-acting mealtime insulin. It lasts one year without recharging, tracks the amount and timing of doses, and even monitors your insulin temperature. The InPen app has a bolus calculator, keeps track of Insulin on Board (IOB), and has reminders if it thinks you missed a dose.

With the acquisition by Medtronic, plans will move forward to integrate with Medtronic’s Guardian CGM, with the goal to “deliver a powerful smart CGM + pen combination” that can “deliver many of the proven benefits of an automated pump, but in the form factor of a pen.”

Currently, the InPen is only compatible with Dexcom G5 and G6 CGMs. Dexcom customers on Facebook were wondering about what this news means for integration with their Dexcom CGMs. Companion Medical said they do not have plans to discontinue the current ability to use Dexcom with InPen. You can see a quick video below or visit the companion medical website for a quick FAQ regarding the InPen.

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Tandem Introduces t:connect Mobile App https://www.diabetesnet.com/technology/tandem-introduces-tconnect-mobile-app/?utm_source=rss&utm_medium=rss&utm_campaign=tandem-introduces-tconnect-mobile-app https://www.diabetesnet.com/technology/tandem-introduces-tconnect-mobile-app/#comments Thu, 16 Jul 2020 00:18:41 +0000 https://www.diabetesnet.com/?p=4416 Tandem Diabetes Care just announced the release of the t:connect Mobile App. The app allows users of the t:slim X2 to view pump and CGM ... Read more

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Tandem Diabetes Care just announced the release of the t:connect Mobile App. The app allows users of the t:slim X2 to view pump and CGM data on their smartphone, enabling wireless cloud data sharing between patients and providers.

You can’t bolus with it, but you can view basal and bolus insulin events, insulin on board, carbs, current settings, and both pump and sensor status. The app also lets you view pump messages and alerts as push notifications on your phone. And accessing the app on the phone is more discreet than pulling out an insulin pump, especially when it’s worn in a hard to reach place.

Data gets uploaded in real-time to your cloud-based t:connect account for easy access by your health care provider. This eliminates the hassle of connecting the pump to a home computer and uploading data or waiting in the doctor’s office while data downloads before the doctor can view your information. No longer does your Personal Care Physician need to be a computer guru to see your data. During the Coronavirus pandemic, when many healthcare visits are done remotely by telehealth, this is especially big news. Data can also be shared with family sharing, up to 6 users.

The app is available for Apple iOS versions 12 and 13 and Android OS versions 7.0, 8.0, 9.0, 10.0.

Learn more about the t:connect Mobile App here. or watch their explainer video on Youtube.

 

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NightRider BluCon turns Libre into real-time CGM https://www.diabetesnet.com/technology/nightrider-blucon-turns-libre-into-real-time-cgm/?utm_source=rss&utm_medium=rss&utm_campaign=nightrider-blucon-turns-libre-into-real-time-cgm https://www.diabetesnet.com/technology/nightrider-blucon-turns-libre-into-real-time-cgm/#comments Tue, 07 Jul 2020 19:53:13 +0000 https://www.diabetesnet.com/?p=4380 Connectivity transforms good into better on the way to best. The NightRider BluCon from Ambrosia Systems uses Bluetooth to turn a Libre Sensor into a ... Read more

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Connectivity transforms good into better on the way to best. The NightRider BluCon from Ambrosia Systems uses Bluetooth to turn a Libre Sensor into a real Continuous Glucose Monitor. Every 5 minutes, NightRider sends Libre glucose readings to a smartphone or watch without the wearer having to scan the sensor.

The reusable NightRider Bluetooth transmitter can be attached to the top of any Freestyle Libre Sensor, including the Libre 2. Blood glucose readings go to its LinkBluCon App (Google Play or App Store) on a smartphone or watch (Apple Watch). The user can set alarms for out-of-range, high and low readings, rise and fall rate, or no reading for 20 minutes. Up to five people can share readings using the FollowBluCon app (Google Play or App Store), and caregivers can also set alarms.

The wearer can record events like exercise, medication, and food on the app, sharing this data and their glucose readings with their doctor. The doctor can then correlate glucose levels and activity-related information with sudden spikes or falls in glucose levels. When others log into Ambrosia.care, all this information can be viewed.

NightRider BluCon is available in waterproof and non-waterproof models.

For total cost, Ambrosia says the Nightrider BluCon and Libre sensors are one-third that of other CGMs. This makes it a more affordable option for people with diabetes who have no insurance.

Find additional information at AmbrosiaSys.com

Click here for a comparison of CGMs and their prices.

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Abbott’s Libre 2 CGM approved by the FDA https://www.diabetesnet.com/technology/abbotts-libre-2-fda-approved/?utm_source=rss&utm_medium=rss&utm_campaign=abbotts-libre-2-fda-approved https://www.diabetesnet.com/technology/abbotts-libre-2-fda-approved/#respond Wed, 17 Jun 2020 04:31:41 +0000 https://www.diabetesnet.com/?p=4360 Abbott’s Libre 2 CGM, approved in Europe since October 2019, received FDA approval for use in the U.S. on June 15, 2020. Approved for adults ... Read more

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Abbott’s Libre 2 CGM, approved in Europe since October 2019, received FDA approval for use in the U.S. on June 15, 2020.

  • Approved for adults and children ages 4 years and older who have diabetes.
  • Measures glucose levels every minute, rather than every 5 minutes with other CGMs.
  • Still not a full CGM. Alerts sound on the receiver/wanding device for high or low readings. The user then scans the sensor with the wanding device to see the glucose.
  • Abbott is developing a future version (Libre 3?) that provides a continuous stream of data, including glucose readings, without any sensor-scanning. This would allow integration into Automated Insulin Delivery (AID) systems.
    • Competition to Libre 2 includes Dexcom’s next-gen G7, developed with Verily/Google. This mini-sized no-calibration, 14-day, low cost, throwaway CGM should be released later in 2020.
    • Medtronic had planned to use a 7-day, calibrate-only-on-the-first-day Guardian sensor for use with the 780 pumps, but is expected to readjust these plans.
  • Carries the iCGM (interoperable CGM) designation from the FDA. This allows it to eventually operate with pumps like Tandem t:slim (mid-2020) and Omnipod Horizon software (late 2020) that have previously achieved the interoperable designation from the FDA, as well as the Bigfoot Asante hybrid pump (2023) and smart insulin pens like Companion Diabetes InPen.
  • Highly accurate with a mean absolute relative difference (MARD) of 9.2% in adults and 9.7% in children. (lower is better). Its accuracy is similar to the Dexcom G6 iCGM and better than the Medtronic Guardian 3.
  • Shown to substantially improve A1c levels in both Type 1 and Type 2 diabetes.
  • The user can choose sound or vibrate for alerts, loss of connection with the receiver, and adjust thresholds for high and low glucose.
  • List price is $54 for each 14-day sensor and $70 for the reusable handheld reader, identical to the current Libre with 4 days longer wear. (Pharmacies often discount these retail prices.) Cost is roughly one third that of other CGMs. Those with commercial insurance may pay as little as $10 for 2 sensors, 4 weeks of readings.
  • High-dose vitamin C (> 500 mg/day) may falsely raise sensor readings. Acetaminophen (Tylenol, etc.) does not affect readings.
  • Remove the sensor before MRI, CT scans, X-rays, or diathermy treatments.

Read the full release here.

Download a Medicare Standard Written Order for your doctor to fill out to obtain a Freestyle Libre 2.

Download a PDF Get Started Guide for more information about the Freestyle Libre 2.

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Control-IQ-Approval Enables Full iAIDs https://www.diabetesnet.com/technology/control-iq-approval/?utm_source=rss&utm_medium=rss&utm_campaign=control-iq-approval https://www.diabetesnet.com/technology/control-iq-approval/#comments Tue, 31 Dec 2019 22:02:49 +0000 https://www.diabetesnet.com/?p=3505 Tandem Diabetes and Dexcom – Big Winners with Control-IQ + World’s First Interoperable Closed Loop The FDA approved the long-awaited Tandem Diabetes’ Control IQ AID ... Read more

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Tandem Diabetes and Dexcom – Big Winners with Control-IQ + World’s First Interoperable Closed Loop

The FDA approved the long-awaited Tandem Diabetes’ Control IQ AID software on December 13, 2019, and it became available in January 2020. This made the Tandem t:slim the world’s first fully interoperable closed loop. Interoperability means the user can change one part of the system when a better version of one component becomes available without replacing the entire system. They are no longer saddled with outdated and less accurate equipment for years until their insurance company replaces everything.

A full artificial pancreas requires three components: an interoperable CGM or iCGM (currently only Dexcom’s G6), an alternate controller enabled pump or ACE Pump (currently Tandem’s t:slim X2 and Omnipod Dash), and an interoperable software controller or iController (currently Tandem’s Control-IQ). Tandem Diabetes and Dexcom are the first companies to create a fully interoperable system with the needed i-components.
Tandem was the first to integrate Device Updater software into the t:slim X2 insulin pump in late 2016 to enable convenient software upgrades over the internet without the need to replace the pump itself.The iController automatically adjusts insulin delivery from an insulin pump in response to glucose readings from a CGM.

How Control-IQ Works

Control-IQ uses the TypeZero/Dexcom hybrid closed-loop (HCL) algorithm that relies on all the normal pump settings (basal profile, insulin-to-carb ratio, insulin sensitivity factor). However, users must still bolus before meals and match bolus doses to carbs consumed or some other food measurement system. The duration of insulin action (DIA) or active insulin time (AIT) is pre-set at a saner and much safer 5 hours to minimize insulin-stacking as glucose levels improve. Although other AID systems allow the user to set their DIA between 2 to 6 hours, the shorter times do not accurately reflect how long the insulin works in the body, often resulting in hidden insulin stacking and low glucose readings. Using the predicted CGM value in 30 minutes, Control-IQ improves time between 70-180 mg/dl (3.9 to 10.0 mmol) with these strategies:

  • For predicted glucose above 180 mg/dl, it adds as much as 60% of a full correction bolus with a target of 110 mg/dl, besides increasing the basal rate
  • For predicted glucose above 160 mg/dl, it increases the basal rate
  • Between 112.5-160 mg/dl, it maintains the default user settings
  • For predicted glucose below 112.5 mg/dl, it decreases basal insulin
  • For predicted glucose below 70 mg/dl, it turns off basal insulin

During the day, the system targets the 112.5 to 160 mg/dl range but becomes more aggressive at night with a breakfast goal of 112.5-120 mg/dl. Control-IQ also offers an “exercise mode” that changes the target to 140 to 160 mg/dl in order to reduce hypoglycemia.

Control-IQ Research Results

Tandem’s Control-IQ HCL pivotal trial evenly divided 168 participants ages 14-71 into those on the Control-IQ HCL compared to those on the same pump and CGM without the Control-IQ algorithm. Unlike most research studies, all 168 participants completed the six-month study and spent 92% of the six months in active closed-loop mode. Results for all 168 participants on Control-IQ:

  • The time between the 70 to 180 mg/dL range improved by 2.6 hours per day with Control-IQ (70% vs. 59%), with most of the improvement resulting from less time spent above 180 mg/dl.
  • Time-in-Range improved for both those with initially low A1Cs and those with high A1Cs.
  • A1C was lowered by 0.3% from 7.4% to 7.1% with Control-IQ.
  • The average glucose was 14 mg/dl lower at 156 mg/dl vs. 170 mg/dl with Control-IQ.
  • Time below 70 mg/dl was reduced by 13 minutes a day or more than 6 hours per month.

What Participants Thought about Control-IQ

In a post-study questionnaire, people scored Control-IQ:

  • 4.8 / 5 on desire to continue using
  • 4.7 / 5 on ease of use
  • 4.6 / 5 on usefulness
  • 4.5 / 5 on trust

History of iAIDs

Previously, wearers of diabetes devices tolerated outdated, less-accurate equipment for years until their insurance replaced the entire system. If a more accurate CGM became available, it would not work with other components nor those from another manufacturer. This shackled device wearers to one manufacturer when another offered improved technology.

The Juvenile Diabetes Research Foundation (JDRF) addressed this issue in August 2017 when it encouraged the FDA to consider an Open Protocols Initiative that would allow plug and play iAID components to be readily interchanged. This initiative was designed to give device wearers more choices and better access. Seven months later, the FDA approved the first plug and play iAID component as Dexcom’s G6 CGM. The G6 became the first (and so far only) interoperable plug and play iCGM.

Dexcom earned the iCGM designation by demonstrating sufficient glucose accuracy and the ability to work interactively to share glucose data with an ACE Pump or iController. Neither of the other components existed in 2018. Tandem added the second component in February 2019, when the FDA awarded its ACE designation to the t:slim X2 pump. Friday, December 13, 2019, became a landmark for people with insulin-requiring diabetes with approval of Control-IQ and the first iAID. See our complete analysis of Current Closed Loop Options.

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Tandem Expands Choices by Partnering with Abbott https://www.diabetesnet.com/news/tandem-expands-choices-by-partnering-with-abbott/?utm_source=rss&utm_medium=rss&utm_campaign=tandem-expands-choices-by-partnering-with-abbott https://www.diabetesnet.com/news/tandem-expands-choices-by-partnering-with-abbott/#respond Mon, 28 Oct 2019 07:10:33 +0000 https://www.diabetesnet.com/?p=3103 Tandem Diabetes‘ innovative insulin delivery systems have acquired a new partner. Adding to its current partnership with Dexcom and the Dexcom G6 iCGM (interoperable CGM), Tandem ... Read more

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Tandem Diabetes‘ innovative insulin delivery systems have acquired a new partner. Adding to its current partnership with Dexcom and the Dexcom G6 iCGM (interoperable CGM), Tandem has added a simultaneous partnership with Abbott’s world-leading CGM technology.

The need for interchangeability and interoperability between diabetes devices is widely recognized in the industry. Tandem’s t:slim X2™ insulin pump was the first to produce a pump with Bluetooth Low Energy (BLE) communication in 2016 and to receive U.S. Food and Drug Administration clearance for a new device category called alternate controller enabled (ACE) infusion pumps earlier this year.

The special controls for ACE pumps allow for reliable and secure communication via BLE with compatible external devices like the G6 CGM and Abbott’s next-generation FreeStyle Libre 2 CGM system, as well as with smartphones and personal digital assistant devices. Interoperability allows people with diabetes to more rapidly update the components of an Automated Insulin Delivery (AID or closed-loop) system.

For example, newer pump features can be directly downloaded directly from the pump manufacturer, as well as the addition of connectivity fo an improved CGM software or device technology or a more advanced AID software. Faster updates and cooperation between interoperable device companies are anticipated to greatly reduce the daily burden of diabetes.

Tandem and Abbott are currently in discussions regarding a final agreement for the technical implementation of device integration and associated commercial support activities. After announcing their partnership, Tandem Diabetes Care stock (TNDM) surged 9.5% to 61.99 and Abbott Laboratories (ABT) advanced 2.7% to 81.98.

Read the full press release

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Injection Sites on Kids https://www.diabetesnet.com/ask-john/injection-sites-kids/?utm_source=rss&utm_medium=rss&utm_campaign=injection-sites-kids https://www.diabetesnet.com/ask-john/injection-sites-kids/#respond Tue, 08 Oct 2019 21:03:08 +0000 https://www.diabetesnet.com/wordpress/?p=2702 From: MM My granddaughter is 3 years old and uses the pump. Unfortunately, the only place she can use right now is her bottom. Is there ... Read more

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From: MM

My granddaughter is 3 years old and uses the pump. Unfortunately, the only place she can use right now is her bottom. Is there any cream made that can help soften injection sites? At this point, she has no fat available on the tummy or otherwise to use different areas. We would appreciate any help.

John

Hi MM,

For a young child like your granddaughter, I always recommend one of the short straight-in metal infusion set like the Contact Detach, Sure-T, or Rapid-D. Metal sets are thinner then Teflon and the easiest to insert by hand and less likely to fail than a Teflon set placed with an auto inserter. Plus, more skin areas can be used. If she is not already using one of these, that would be the way to go.

Keeping sets attached is critical. For children, always place an adhesive like IV3000 or Tegaderm over the metal needle area after it has been inserted. Place any excess adhesive over the infusion line to make the set really secure. If more adhesion is needed for water or sweating, cover the skin with Skin-Tac before inserting the needle, and then overlay with an adhesive material. This makes the set close to failure-proof. Another nice thing about metal sets is that if they do fall off or get pulled off, you can re-insert them again after cleaning with alcohol.

Bottoms are usually best for the young. As she grows, her parents will be able to use other areas like the flanks or abdomen. Short metal needle sets are usually the best way to extend useable infusion site areas.

Hope this helps,
John

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