I've had it with Quick sets

[Mojo's mommy]

I know a lot of you swear by them but I will never use another again. My poor kid is starving waiting for dinner. She had a bath before a site change..she was 21.4 afterwards.That I cannot seem to get around, she always shoots up while bathing, she was disconnected for 1 hour. At the last minute she decided she would like me to try the quick set instead of the Silhouette and stupid me agreed. I corrected her and made her wait to eat for 1 hour so that she could start coming down. Checked her post 1 hour and she is now 23.6:eek:

Needless to say, Emla is on again, gave her an injection and now she is mad at me because she has to wait longer for dinner. I could just cry! I hate D:(

[kiwikid]

I swear by the Rapid D or Sure T sets. To me they are just perfect (:rolleyes: )
I always have trouble though, with Rachel being disconnected for a bath. I always have to replace the missed basal insulin. Early evening is the time of Rachels highest basal rate (0.65) and she really does need all of it.

I know how you feel about D:cwds:

[thebestnest5]

I am so sorry. I have always had my "back up plan" to use Sure T sets if we start having problems with quicksets.

I really want CGM to get Liv's nighttime basal set. Ugh!!! She seem to need so much more insulin over a short 3 hour period...but not every night...:confused: Many times it looked like a site failure and it was that her basal needed a big increase over a short period in the middle of the night. I was blaming Lantus...now I just blame diabetes. :cwds:

[Mojo's mommy]

Courtney I think is also going to require a lot more basal between 11PM and 2 AM. She is consistantly high so far this week at midnight but I have yet to have a night that there has been a) good # going to bed
b) snack on board
c) something eaten that had a delayed
effect
d) a correction bolus on board
I am finding it next to impossible to get it right. Now, tonight is not going to be any different of a scenario because she has all this confusion with injections and late dinner and etc. etc.

The nurse is going to strangle me when she call for the weekend numbers and I have nothing good and solid to report.

[thebestnest5]

Liv appears to need a lot more insulin between 11pm-3am...that's very interesting. She's currently at .55 u/hr and that's not cutting it. We put her to bed at 10 pm at 139 and by midnight she's 240. :rolleyes: It we correct that and get past 3am we can get to morning with decent numbers.

Many times that 11pm-3am number has looked like a site failure...I am afraid to increase her basal too high during those times because it's most nights...but not *every* night! *sigh* I wonder if DH or I will ever get more than 4 hours of sleep in a row.

Today, I was in such a "mood" about our insurance not wanting to pay for CGM! I jokingly told DH we should go to our Dr.'s and gets all the expensive prescriptions for nighttime sleeping. Dr.'s seem to be so concerned if you go to them and tell them you "can't sleep"...Well, I "can't sleep" when my daughter's a 60 mg/dl at night and I can't sleep if she's a 350 mg/dl...I have to be up checking her number to make sure it's going up or down and she's safe....

Anyhoo....I told DH we should get a handful of these expensive prescriptions for "sleeping issues" and present them to the insurance...either pay for these or pay or CGM....with CGM it keeps Livia healthier too...so I feel it would be to insurance's benefit. Oh well...these are are third trimester, sleep deprived rantings about insurance coverage. :p

[jpb286]

I know a lot of you swear by them but I will never use another again. My poor kid is starving waiting for dinner. She had a bath before a site change..she was 21.4 afterwards.That I cannot seem to get around, she always shoots up while bathing, she was disconnected for 1 hour. At the last minute she decided she would like me to try the quick set instead of the Silhouette and stupid me agreed. I corrected her and made her wait to eat for 1 hour so that she could start coming down. Checked her post 1 hour and she is now 23.6:eek:

Needless to say, Emla is on again, gave her an injection and now she is mad at me because she has to wait longer for dinner. I could just cry! I hate D:(

I see a couple of potential problems here, none of which are the fault of the Quick-Set.

1.) She was very high to begin with.
2.) She was disconnected for an hour and was very high to begin with.
3.) Ripping the set out right after putting a new one in can cause high BG's due to the fact in a lot of people there is still basal/bolus insulin that has not yet been absorbed by the tissues that now leaks out of the "site" where the infusion set was a minute ago.
4.) Correcting for a BG THAT HIGH should be done with a syringe INITIALLY, not the pump. Without correcting then troubleshooting, it is impossible to know what is causing the high BG.
5.) Insulin may be defective. Try a new bottle with a syringe, and use the new bottle to do a NEW set change.

Here's what I would do:(please don't hurt me)

1.) Try another set change, with the Quick-Set, ideally when her BG is in the normal range.
2.) Leave the old site in for about 2 hours after you put the new one in, THEN remove the old one.
3.) Try it, and see what happens. Post your findings.

N.B.: Most problems like this rarely have anything to do with the actual infusion set being used; rather a combination of other factors leading people to blame the infusion set rather than the other factors listed above.

[WestinsMom]

I have to add that it CAN be the infusion set! We started pumping at 4. That was 5 years ago. Until the Sure T came on the market, I tried every set on the market for MM and 90% of the time we were changing sets due to site failure and not time for a change. I thought it was normal because I had an active little boy.

When we hit first grade and he was in school all day, his assistant (that did his bolus, etc) got so tired of the high numbers and doing corrections by injection that she decided "she wasn't into the shot thing" and would only do one injection a day. So if he was high again at snack or lunch or whenever, I would have to come in and do the injection. (She happend to be type 1 by the way!) That is when I pulled him out of school! Remember, I thought this was normal for an active boy!

Now with the Sure T we have hardly ever had a site problem! This is what being on a pump is suppose to be like! I can assume now when numbers are high that it is food or a basal adjustment that needs to be made. Before, it took me a long time to figure out that it wasn't the site.

Does my son have an issue with the cannula?! That is my guess.

Please try the Sure T!!!!

[luvmytwins02]

Where can you get the SURE T and what pump does it go with? What makes that one so much better?

We had trouble with Hannah's site cannula bending again, and she ran high all afternoon yesterday!

[EmmasMom]

I know a lot of you swear by them but I will never use another again.

It's all about what works for you and your child!!

I wrote almost exactly what Paul wrote last night, but it never posted, (stupid computer), I think he made some really important points. High numbers after a site change can be the result of several factors, not always related to a malfunctioning site, so give it time to come down before jumping into another site change.
In the early days of pumping it's very easy to always question the site for highs, but in time you'll find, (most likely), that the site isn't usually the issue. With the quick-sets the most important thing is making sure the cannula is short enough and has enough padding so it will not hit muscle, hitting muscle will cause it to kink.

Liv appears to need a lot more insulin between 11pm-3am...that's very interesting.


Emma's highest basal needs are between 10p-2am, I think it's pretty common for kids who are growing rapidly to need more insulin at night.

Where can you get the SURE T and what pump does it go with? What makes that one so much better?

We had trouble with Hannah's site cannula bending again, and she ran high all afternoon yesterday!

The sure T is from MM, you can order it on their web site. The cannula is steel, so it can not kink. You have to insert it manually and make sure you aren't near a muscle. It works well for some people who have trouble with kinks.

[Stacey Nagel]

Are you prebolusing for the 1 hr of basal that she's missing while in the bath??

[Tommo]

..is the sure T the same as the Silhouette or is this another sort?

[Boo]

2.) Leave the old site in for about 2 hours after you put the new one in, THEN remove the old one.

My son just started pumping, and we have not had problems with the quicksets, but I am curious why you recommend leaving the old site in for a while before removing it.

Teri, have you discussed your site problems with your minimed rep? Maybe they will have suggestions or advice. It doesn't hurt to ask. I hope you can get things worked out soon...the poor girl must be feeling a bit like a pincushion about now. What are her feelings about the rocky pump start?

[mischloss]

Definitely pre-test bg before going into the bath. Keep the bath short. 1 hour to soak seems awfully long to me. We found now with my son being older, a quick 10 minute shower is fine and doesn't disrupt bg as much. He does LOVE to soak in the tub and once a week is fine. Again for about 15-20 minutes and not until he looks like a prune! :D

And then, as soon as new site goes in after bath, time for another bg check and any corrections that are needed. We might even kick up the basal by 10% for about a hour after the bath just to be sure bg's will be down by let's say 10pm before he hits the sack!

[Hollyb]

My son doesn't bath usually but the shower will drop him down as a rule. I would have thought baths the same? Maybe only if there's fresh insulin in there.

Leaving the old site in for a while is a good thing to do if you have just taken a bolus or correction, to make sure the insulin from the last infusion is fully absorbed before you give it a chance to leak out.

We, too, seemed to have quite a few problems with Quick-Sets at first and virtually none lately. I don't feel like we're inserting them any differently but there does seem to be a learning curve of some kind to get through.

I agree it's very hard to know whether to blame the set when the BG is that high to start with. Once Aaron's over 15, we often see very little progress from a correction the first hour -- maybe just a point or point and a half. Then it moves faster after that.

The one time we KNEW it was the set it went like this:

Aaron was 15 3 hours after dinner. We did a correction, and a half hour after that the meter read "hi." Just shot up there, because he hadn't got really any of his dinner bolus.

[jpb286]

My son just started pumping, and we have not had problems with the quicksets, but I am curious why you recommend leaving the old site in for a while before removing it.

Leaving the old site in for a while is a good thing to do if you have just taken a bolus or correction, to make sure the insulin from the last infusion is fully absorbed before you give it a chance to leak out.

EXACTLY.

My son doesn't bath usually but the shower will drop him down as a rule. I would have thought baths the same? Maybe only if there's fresh insulin in there.


Because with a shower you arent FLOODING the site with water and moisture. You are just "spraying" it indirectly and intermittently. If you are taking a bath and you are on your 3rd day of that site, then the tape probably isnt adhering as well as it could have, water gets up under it and does all kinds of crazy things to insulin absorption and BG's go up big time.

I wasnt saying that 100% no-questions-about-it the INFUSION SET cant be the problem, its just that 95-99% of the time is ISNT. But if your child is high all the time and you think its "the infusion set", it more than likely ISNT. But as Holly mentioned, if it can be isolated to a single random occurence, the it probably IS the site.

I am now running 100's-150's for the first time in years (courtesy of CGMS), and now I CAN say the site has a problem if all other causes can be eliminated because I have consistent BG's with which to form an accurate, testable hypothesis. So I will do a set change, and if that fixes it before I get to 200-250 then great, I solved the mystery. If not, then no harm-no foul, I have a good site for the next 3 days and probably drastically underestimated the amount of carbs in something I ate, and can treat accordingly.