3am change
>Why are having to change sites at 3 AM? Are the alarms going off or do you
>awaken with a high BG?
High BG is the problem…apparently both times were because of "a bad
site" (says the CDE). But there doesn’t seem to be any way of KNOWing
it’s a bad site until the sugar goes high and stays high.
Laurie
September 17th, 2004 at 10:15 pm
I have also been noticing a series of high BG’s after installing a new set.
My endo (also a Type 1) said that he routinely primes 1.5U on a new set and
that it is often location dependant. Below the waistline often requiring as
much as 3U prime. I plan on trying a 1U prime on my next change.
Scott
September 18th, 2004 at 2:37 am
> I believe the Silhouette takes 0.75u.
I prime 1.0u for the Silhouette (as instructed by my trainer).
The opinions expressed are my own and do not necessarily represent those of
my wife who runs this house and makes more important decisions than I do.
September 19th, 2004 at 4:28 am
Jan,
I am like you I have always taken a bolus after changing my site. I take 1
U. but I know I am more resistant than you. I think my first CDE told me to
do this.
Gail
September 20th, 2004 at 8:16 pm
I also use routinely a 1u prime, but it is also very important to be sure
that the tubing is primed fully before installing, and that at least 0.6u
bolus taken for the pump backlash. This backlash prime should be done
before installation.
David
September 22nd, 2004 at 2:53 pm
"pump backlash" ??
fp
September 23rd, 2004 at 5:09 am
Didn’t your CDE tell you about pump backlash when you were trained? If
not, a terrible oversight.
The pump leadscrew exhibits backlash (movement of the leadscrew will not
take effect until the backlash has been removed. The backlash is
introduced following insertion of a new syringe into the pump. Most people
suggest that 0.5 units should be added for this purpose. I always do this
before installing the set at the new site.
David
September 24th, 2004 at 4:53 pm
I have worn a pump for nearly 17 years. I am now using the MiniMed 507.
In order to have reliable delivery I do the following when I change an
infusion set:
1. Using a new reservoir I draw up about 2.3 ml of insulin.
2. I tnen attach the infusion set tubing to the reservoir and I press the
reservoir plunger until insulin squirts out of the end of the tubing (out
of the quick disconnect).
3. I then install the reservoir in the pump (with the tube attached) and
select a manual bolus of 8 units of insulin on the pump. I start the bolus.
4. I insert the infusion set under my skin and remove the needle (I am
using a Silhouette).
5. After the bolus of 8 units is complete I check to see that a drop of
insulin is hanging on the quick disconnect half of the tubing and then
attach the quick disconnect half to the infusion set portion pasted to my
skin (in other words I couple up the tubing).
6. I then select one unit to prime the cannula and the quick disconnect
half and go about the business of living normally.
It is suggested that infusion set changes be made well prior to bed time so
that kinked cannulas and improperly installed set will be detected prior to
going to sleep.
I can attest that this process works but I want to assert that this isn’t
the only way to get good results. YMMV
September 24th, 2004 at 9:48 pm
This procedure is similar to mine, with the following differences:
1. Using a new reservoir I draw up about 2.3 ml of insulin.
I fill it up to the 3 ml line.
2. I then attach the infusion set tubing to the reservoir and I press the
reservoir plunger until insulin squirts out of the end of the tubing (out
of the quick disconnect).
I push until it comes out of the bent needle; I do not detach the QR.
3. I then install the reservoir in the pump (with the tube attached) and
select a manual bolus of 8 units of insulin on the pump. I start the bolus.
I do a bolus of 0.5 units for the backlash at this point. Sometimes I
will increase this
a bit, and insure that I see insulin emerging at the tip of the bent
needle.
4. I insert the infusion set under my skin and remove the needle (I am
using a Silhouette).
I then install the bent needle, add a Polyskin II tape to hold it in
place. Then add a
piece of tape (any old tape will do) after forming a loop for strain
relief.
5. After the bolus of 8 units is complete I check to see that a drop of
insulin is hanging on the quick disconnect half of the tubing and then
attach the quick disconnect half to the infusion set portion pasted to my
skin (in other words I couple up the tubing).
I skip this step.
6. I then select one unit to prime the cannula and the quick disconnect
half and go about the business of living normally
I do a bolus of 0.8 units to form a pool (prime the site) of insulin
under the skin.
I too, then go about the business of living normally…..
I have been doing this for 10 years, and it works every time. When I was
using the soft set, however, it failed about 2 times out of five, not from
the procedure, but from the soft set not functioning properly.
David
.
September 28th, 2004 at 5:11 am
Laurie-
Again, this is just what I would do–I’d bolus whatever your sliding scale
says to use (I use 1 unit for each 70 points over 100, i.e. if BG is 180,
take 1u, if 280, take 2.5, etc.), go back to sleep and check it again in the
morning when you get up. If it’s still really high, maybe then consider
changing the site. If I changed the site every time I had a high BG, I’d be
changing several times a day! As far as I’m concerned, a "bad site" is just
one that takes a little longer to allow diffusion of the insulin. Unless
there’s blood in the catheter and/or tubing or redness or swelling, I just
bolus and check again an hour or two later (or 3 if it’s after a 3 a.m.
surprise!) I suspect your CDE is a "normal" person and has no concept of
what it’s like to have to get up and change an infusion set at 3 a.m.–even
if you’re an old pro like me and can do it half-asleep in 6-7 minutes. I
think you are also "wasting" infusion sets, which are not cheap–either for
you or your insurance company. Try a few other options before yanking out
that set you just went through stress and some pain to insert!
Janet
September 28th, 2004 at 1:18 pm
Jan-
All this time and I hadn’t heard that one about the .5 once the catheter is
in. I always prime the tubing, but hadn’t been told about after the
insertion. I’ll either go with that or the .7 that one of the other pumpers
mentioned. Thanks!!
Janet
September 30th, 2004 at 7:54 pm
<<
High BG is the problem…apparently both times were because of "a bad
site" (says the CDE). But there doesn’t seem to be any way of KNOWing
it’s a bad site until the sugar goes high and stays high.
Laurie
>>
Try doing a baseline bg before site change, record boluses…I use 1.5-2.5
units after site change….insulin resistance can be a problem too, so if the
site has to get saturated with insulin to get it jump started, just keep that
in mind. We all experimented to see which sites worked better than
others…Joan:)))
October 3rd, 2004 at 5:51 pm
Janet,
When I first joined this list last year I asked if anyone had high BGs for
several hours after a site change. Some did, most didn’t — then after a few
months I caught on or someone came right out and said the 0.5u prime goes
INSIDE you to take up that slack from introducer needle. DUHHH. Since I
learned that (16 years late), I have had terrific BGs with a change. What we
learn from one another.
Today I went to Bayer for a user study with a new lancet device they have.
They tested my level of pain on 6 of my fingers - new lancet each poke. I
told her I change mine once a year. She asked if it is dull. I said I don’t
know, but when I change the blood sure flows. BTW, got $25 which will help
me print BASH booklets. 8^)))
Jan
October 6th, 2004 at 4:00 am
Very good Bob, only one question ….Why point #3??? What does this
accomplish?
fp
> 3. I then install the reservoir in the pump (with the tube attached) and
> select a manual bolus of 8 units of insulin on the pump. I start the
bolus.
October 12th, 2004 at 1:03 pm
<< I’ll either go with that or the .7 that one of the other pumpers
mentioned. Thanks!!
>>
I use 1.0 I’ve never had a low w/this but everyone is different. Chrissy
October 14th, 2004 at 2:03 pm
I have gotten up and changed sites at 3 or so in the morning. When my high
BG has woken me and I am sick. Usually because of a bad injection. I have
not had to do that since I have been using the "soft serter".
Gail
October 16th, 2004 at 2:49 pm
Jan,
I can’t believe you go one year with one lancet. Why? Does your insurance
not pay for it? That cannot be good on your fingers, like using the same
inj. needle for a year.
Gail
October 17th, 2004 at 3:05 pm
Well, I and about 2000 others do the same thing. We get a reminder 2x a year
(New Year & July 4th) for everyone to change. I did in April so I can skip
7/4 and go on to N.Y. (~_^) I won’t get AIDS from myself and so far so good
like David reusing his infusion sets, I guess. But on a much lesser scale.
In case anyone missed all the replies I made to a previous post, I intended
to e-mail Laurie a pic of Gail and me and another ‘netter. Wasn’t going to
spend one red cent on her - sorry. lol I still can if Gail doesn’t mind,
though.
Jan
October 18th, 2004 at 12:29 am
Naw, they last and last and last………!!!
fp
October 18th, 2004 at 6:37 am
I let common sense prevail; if it hurts, change it!
October 20th, 2004 at 2:28 am
<< One a year does seem a little long but I often go one a month or two. It
just never occurs to me to change the puny little thing! The diabetes
supplies person asked me if I wanted lancets when I ordered 900 strips
for three months. I said "OK" and got 900 lancets! Probably a lifetime
supply for me.
Bob
Bob Blakely >>
Well gang, the lancet may last that long, but I find it much more comfortable
to change each time I test. If I use a lancet for a day, by the 3rd or 4th
test I notice a difference in ease of getting a drop and the comfort level
Patrick
October 23rd, 2004 at 1:15 am
I don’t mind Jan.
Gail
October 23rd, 2004 at 9:23 am
Do you do the same thing fp?
Gail
October 25th, 2004 at 10:09 am
Thank you Patrick, I was beginning to think I was alien because I changed
Gail
every test. You’re not green are you?
October 28th, 2004 at 12:27 pm
Depends on the finger pricker you guitar picker. LOL
fp
October 28th, 2004 at 8:34 pm
Yupper, but like somebody said if it feels uncomfortable change it. It’s
not the expense it’s just a nucience changing ‘em all the time.
fp
October 29th, 2004 at 3:26 am
I went to Bayer last week for a user study of their new poker. They did 6
fingers with a new lancet each time. I had to rate the pain as compared to
my present system. They wiped blood on a cloth and weighed it to see if
there was sufficient for their testing equipment. I saw hardly any
difference in 6 new lancets compared to my months’ old one at home. (I got
$25 to help print BASH booklets <gr>)
Jan
November 1st, 2004 at 3:12 pm
<< Thank you Patrick, I was beginning to think I was alien because I changed
Gail
every test. You’re not green are you?
>>
No, but if I went a year with one lancet my fingers might be!
Patrick
November 1st, 2004 at 11:20 pm
<< Depends on the finger pricker you guitar picker. LOL
fp >>
Well, fp, I guess it depends on whether you finger prick or flat prick. And
don’t forget to use some Gorilla Snot!
Patrick
The NC bluegrass pickin’ pumper
November 2nd, 2004 at 5:19 am
I agree with patrick. It goes to figure the lancet is dulled each time you
check BG’s. If I use the same lancet several times in a row (because I
forgot to change it), I can’t get a drop out, but received the same amount
of pain, if not more. Would you use the same guitar strings constantly? Your
tone and tuning would be noticeably affected.
Kevin
Well gang, the lancet may last that long, but I find it much more
comfortable
to change each time I test. If I use a lancet for a day, by the 3rd or 4th
test I notice a difference in ease of getting a drop and the comfort level
Patrick
-
November 3rd, 2004 at 7:51 am
<< I agree with patrick. It goes to figure the lancet is dulled each time you
check BG’s. If I use the same lancet several times in a row (because I
forgot to change it), I can’t get a drop out, but received the same amount
of pain, if not more. Would you use the same guitar strings constantly? Your
tone and tuning would be noticeably affected.
Kevin >>
How does this guitar stuff keep coming up?
Patrick
The NC bluegrass pickin’ pumper
(who changes both lancets and guitar strings frequently!)
November 3rd, 2004 at 10:53 pm
LOL LOL
fp