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Site choice and insulin efficacy- what do you notice?

Discussion in 'Parents of Children with Type 1' started by forHisglory, Nov 4, 2015.

  1. forHisglory

    forHisglory Approved members

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    We've been pumping since July. Am I imagining things or has anyone else noticed significant differences in insulin absorption with different sites? We rotate as suggested by our endo by making diagonal zig zag changes in succession in one area before switching to another. The theory being that you get less scar tissue long term because you are fully using an area vs switching back and forth (say left to right leg) each time has therefore forgetting exactly where the last site was. Anyhow, this gives me a good chance to observe and perfect basals, I:C, etc while in a site area. However, I have noticed a pattern of pretty dramatic insulin usage when switching from thigh to buttocks. The TDD is 25-30% less when using a thigh site vs an upper buttocks site.

    Endo says there shouldn't be much difference. So, what are my other differentials? It happens every.single.time we switch locations (about every 2 weeks). I have recorded one set of basals/ratios for the thighs and another for the rear!
     
  2. kiwikid

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    absolutely... some sites are just really good - even if only mm's away from another that wasn't so good.
     
  3. Abby-Dabby-Doo

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    Totally can make a difference! If you use an arm or leg site even more so, IMO. We get the best luck using the backside. We got so frustrated with ruling the cannula (kinks) out of the mix of questions regarding how good the site was or wasn't that we only use the SureT site by MM (steel needle stays in).



    PS My signature is WAY out of date. :glee:
     
  4. kim5798

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    Site location definitely makes a difference. If you use an arm or leg site...and then are very active, ie tennis, or running...you will definitely see a difference in the way the insulin performs. For this reason, I really don't like thigh sites in my ballerina daughter. We get much better results with stomach or buttocks & she really likes the arm sites.
     
  5. forHisglory

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    The muscles in the thigh being more active could explain why his basal rates and ratios are so much lower compared with the backside. I've commented to my DH before how it just seems like thigh sites absorb so much quicker. The bonus is it saves on insulin use, but the downside is having to reconfigure things every time we move to a different body area. Thanks for the insight!
     
  6. forHisglory

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    Thankfully no kinking here, just different rates of absorption. I didn't expect such big drops in usage when using thigh vs other areas. Welcome back since it's been a while!
     
  7. msschiel

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    This is interesting and I am glad I read it because hopefully we will be pumping soon and this is good information!
     
  8. Dad_in_Canada

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    Oh yes, absolutely. And just to make things even more "interesting", the site location + infusion set type combination makes a difference for us.

    For example, we get best absorption using an Inset2 on the side of the belly. Using an Inset2 on the lower back is OK, not great. Using a Contact-Detach on the lower back is highly variable (some days absorption is great, other days it's terrible). Bad bruising too with Contact-Detach.

    Like you, I've had to increase basals on the order of +30% when absorption is poor. And no lows with this +30% either.

    So I'm wondering, what is happening to this extra insulin? If absorption is poor, is the body breaking down some of the insulin, rendering it ineffective?
     
  9. forHisglory

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    That is a really good question. The insulin is not "leaking" out anywhere......so where DOES it go?? I read about "insulin pockets" forming on one board. Then, when you remove the site, the insulin is freed up to be absorbed, but I have no idea if there is any truth to that theory or not. I'm glad you have observed the 30% difference too. I wrote down numbers just to convince myself that I wasn't imagining things. These sites are very well rotated and considering we just started pumping/recently diagnosed, it can't be scar tissue causing decreased absorption/efficacy.
     
  10. MEVsmom

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    We most certainly have a difference. We hardly use the backside if we can help it because the absorption is so different.
     
  11. Dad_in_Canada

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    Bumping this older thread because the variability between set changes is driving me a bit crazy. Not only do we have to manage the usuals like carbs, activity, growth spurts, etc, but now we're regularly having to "manage the set". A given set (which we change every 2 to 3 days) can require a +/- 20% delta in basals to the prior set.

    I don't think it's my technique when changing the set, filling the cartridge, etc. I take great care to make sure there are no bubbles, and cannulas are never kinked when we remove the set.

    I'll throw out an idea: maybe it's the cannula length? We've only used sets with a 6mm cannula, because this is what I think is best for DS who is 11 years old and very lean. But could an 8mm cannula make things more consistent?

    Just wondering if someone has tested this idea and what you found.

    Thanks!
     
  12. Sprocket

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    We do MDI, but I just wanted to comment on the site issue. For a year or more, we were battling highs after breakfast. I kept backing up her pre-bolus time (up to an hour and a half), increasing dose, nothing seemed to work. Then after hauling out all my reference books to see what could be going on, it hit me like a ton of bricks - the site location. I felt like an idiot, because I've read it so many times! I would sneak in her room before she got up in the A.M. and give her a bolus shot (in the thigh) to have it get a head start. Turns out, if she puts it in her belly, about 20 min to 30 min is all she needs for pre-bolus. Also the thigh shot did not have a very favourable ratio compared to the belly.
     

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