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Arms for pump site question

Discussion in 'Parents of Children with Type 1' started by dpr, Apr 24, 2014.

  1. dpr

    dpr Approved members

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    We're having lots of site overuse problems with my daughters stomach and upper butt area. I've almost got her convinced to try her arms. She is really really thin with very little body fat. I'm looking for advice on which Medtronic infusion set to try. We are currently using Quick-Set's but I'm concerned that the inserter needle might get into her muscle and be really painful. We also have Sure T's with the stainless needle. The Silhouette would probably be perfect, but she had a really bad, painful experience with them a few months ago and now even with lidocaine I don't think I can get one near her. There's going to be a lot of bribery to get any of this to happen...
    Thanks for any thoughts and advice!
     
  2. wearingtaci

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    I haven't seen a lot of infusion sets,but our skinny daughter will only let us to angled sets on her arms. We have had really good luck with comfort shorts
     
  3. KHS22

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    Yup, we use comfort short on her arms, which is similar to the silhouette 13mm...
     
  4. Connie(BC)Type 1

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    I use all areas, arms, legs, butt, hips and belly, all types of sets work for me, I'm not a skinny kid though :)
     
  5. quiltinmom

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    As I started typing I realized I don't know how old your dd is, but here goes....

    We use quick sets on arms all the time. Ds isn't super skinny but he isn't fat by any means. I'd say he is normal. He sometimes says he didn't even feel insertion at all. It is definitely worth doing what you must to get her to try it. :). Hope this helps.
     
  6. dpr

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    Thanks for all the replies. She's 8 and some times I look at the needles and at her and think she just doesn't have enough room or fat to fit some of these things. I give the Quick Set a try when I can raise enough bribery booty to get her to try it.
     
  7. acoppus

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    We use the Sure T's on our 5 year old, and did even when he was 3 and pretty skinny. We have used them in his arms.
     
    Last edited: Apr 25, 2014
  8. mmgirls

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    my oldest is 9, but only barely 60 lbs on a almost 54inch body, so very thin.

    Honestly it comes down to me looking at her arms and asking her to "flex" so I can see where she has some sub Q to comfortable go into. But we rarely have an issues with 90 degree 6mm sets, every once in a great while we have a bent cannula and even more rarely do we actually have a kinked one.

    If your child can handle a manual inserted angled set then I think that is the best, but mine has issues when she is not in control of the insertion so we just have to deal with what she can accept.
     
  9. Ali

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    The shortest straight in steel set gives you lots of options. If you poke it in and it hurts pull it out and push it in an inch away. The angled sets look great also, as you can insert at a variety of depths. I know hard core athletes with like 2% body fat use pumps so get your diabetes team to do the research and help/work with you for a set/site solution. I am so tired for all of us, having to work this out on sites like this. What are our Docs doing for us. I hate to say it but I have been a patient at some big name facilities and not had some of the feedback I have gotten here. It is ridiculous. Ali
     
  10. rgcainmd

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    I hear you, Ali! I am finding myself in an uncomfortable position on both sides of this fence as a physician and a mother of a daughter dx'd with T1D 01/24/2014. My daughter currently gets her care at a BNF (big name facility) and my impression is that, in their attempt to take the comprehensive team approach, all the duties have been divided and subdivided into smaller specialty units/sub-teams (e.g. endocrinologist, general diabetes educator, psychologist, social worker, pump specialist, etc.). Definitely comprehensive, but not always so cohesive; we've run into two issues already that resulted from one of many hands not being up-to-date with what the other hands were doing, and/or one team having little to no knowledge about what another team was covering. For example, I believe our endo understands Type 1 inside and out, but has a relatively limited knowledge base about pumps (because Joannie, "the pump person", handles that particular area). We don't always see every sub-team at every visit, so questions go unanswered because we have to schedule another appointment to see that specific sub-team which can mean another 8 weeks of waiting. This is when I end up getting answers to my questions at this Forum or elsewhere on the www. I can appreciate the fact that Type 1 is an extremely complicated disease which has led to the need for all of these teams (and believe me, I'm happy that we have these sub-specialists that know their particular areas quite well), but I wish we could just get everyone together in one (larger) room at one time in order to put all the puzzle pieces together (or at least have everyone make sure that all the pieces are there and none have fallen off the table and are hiding beneath a chair). This is why I had hoped we would have been assigned to the peds endo fellow who has Type 1 himself and utilizes a pump. But no such luck... I have become extremely frustrated because our particular comprehensive diabetes center is very rigid with their protocols, one of which is "Thou shall not pump until a bare minimum of six months past diagnosis." As a physician, I can appreciate the reasons behind this commandment, I mean protocol, but as a mom, I just want my daughter on the damned pump yesterday because I can't stand watching her cry one more night when her Lantus is especially sting-ey, or having to make her wait one more time when she asks for a snack containing more than 30 carbs 45 minutes after her last meal bolus. Looks like we are going to get her pump a little after the 3-month mark, but the hoops I had to jump through (phone calls and emails to pump companies, phone call after phone call and email after email after email to our endo in which I eventually resorted to begging, etc.) seemed endless. (Turns out our insurance company was willing to cover the cost of a pump by week three post-dx).

    While I can fully understand (and at least partly appreciate) that many problems lie in the fact that our endo has too many patients to see in too little time, it often frustrates me when I cannot get the answers or assistance I need from our diabetes specialists in a more timely fashion. So I am extremely thankful for the exceptionally knowledgeable and compassionate members on this Forum who very often can tell me more than our diabetes team can due to their own personal experiences.
     
  11. dpr

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    So we ended up trying an arm with a Quick Set. I gave the lidocaine a good hour to soak in and it actually went really well. No fighting, screaming or anything. It was almost like having a new kid :) It cost me a new stuffed animal and a doughnut for a treat. She's a really healthy eater so the doughnut was a rare treat.

    The worst part was the site just didn't work well at all. Her numbers kept creeping up all afternoon and evening. By 8:00 the temp basal was at 180% and she would never get below the mid to high 200's so we did another site change to her upper butt. 45 minutes later she was in the low 100's, so definitely the site. The set that came out of her arm looked perfect. I looked it over really hard. No kinks or anything weird at all. She said her arm was really sore after taking it out. Maybe slightly into muscle? Any ideas? She said she is willing to try her arms again as long as we don't use Silhouettes.. But maybe 2 doughnuts could make that happen we'll see...
     

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