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Site locations for lean kids & basal changes

Discussion in 'Parents of Children with Type 1' started by Hstntxag, Feb 25, 2014.

  1. Hstntxag

    Hstntxag Approved members

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    This post has 2 parts:

    1. My son has been pumping for about 6 months and things were going pretty smoothly until just recently.

    He is very lean and muscular and has only been using his rear for his sites (Mio 6 mm). We have been diligent to rotate.

    It seems lately we barely get 2 days out of a site (no kinks, no air bubbles in tubing and no pooling of insulin at site when site removed). My best guess is scar tissue and poor absorption are the culprit but I am at a loss for where to try to put a site as his legs, arms and stomach aren't an option. Love handles are my best option and I have been too chicken to try because each time we've had to do a site change early, it's been before school and if it went badly, I was avoiding drama before school. We have tried the silhouette site and although it's for lean kids, it hurt him worse than the Mios.

    Any insight regarding how to insert a site into lean kids? Any locations I'm not thinking of?

    2. Our endo recently went out on her own and hasn't hired a CDE yet. She is happy to answer any questions I ask her but I truly feel we are missing out on key support not having a CDE, specifically in regard to basal changes. I have the book Pumping Insulin and am about to hunker down and learn what I can, but are there any other resources you have come across that helped teach you how to change basal rates? I'm happy to make the changes when I understand the how, when and why.

    This has been a tough stretch. The pump was going so well..but lately? My son doesn't trust it at all because of all the highs. Having a broken pancreas is a big pain the train sometimes.

    Thanks for listening and your advice :)
     
  2. Austins mom

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    My son is 8 and very lean. We use his stomach most of the time on the sides of his belly botton. He sues the sure t sets and I have never (in over a year) had issues with them, they don't hurt him at all.

    Not sure about the basel rate thing sorry!!
     
  3. hdm42

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    I don't have any advice on the basal, sorry.

    For sites, my son is also very lean. We use the 90 degree insets on his bum and legs, and we use angled sets for his stomach and sides. That seems to work well for us.
     
  4. KHS22

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    The "Pumping Insulin" book - amazing. Read it, and you'll have a good sense of how to go about testing and changing basals!
     
  5. MomofSweetOne

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    My daughter is also very lean. We started on Silhouettes but switched because of the tissue damage. She liked Mios, but when kink after kink after kink happened, she decided to try a Sure T. Within two sites, she had me exchange all the unopened Mios for Sure Ts. The idea of the steel cannula staying in sounds dreadful, but she says it isn't. She sometimes says she doesn't feel the insertion at all. The only thing she really dislikes is that she can't get the longest length of tubing, which she prefers.

    Medtronic will switch out infusion sets purchased in the last three months.

    Think Like A Pancreas by Gary Scheiner is excellent for explaining how to do adjustments.
     
    Last edited: Feb 26, 2014
  6. susanlindstrom16

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    Thanks for mentioning that! We had a painful insertion process last night and it is making me me ready to explore the options right now. We use inset 30's. Is sure t the same as what Animas calls contact detach?? The insertion was described to me as kind of putting a push pin into a bulletin board. I was a little nervous about the steel needle staying in, that's good to hear that your daughter doesn't feel it. I wonder if animas would also switch ours out.

    To the OP, we are in the same boat! She refuses to use anything other than bum, not that she really has any fat anywhere else.
     
  7. ksartain

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    I make adjustments on the basal based on Dexcom and charting finger sticks. Chris just had a growth spurt and that threw everything out the window. He went from a 50% increase in basal for 4-5 days to a marked decrease for the past few days. It's a guessing game, but I tweak here and there as needed. There's nothing quite like seeing a nice straight line in a good range. I've only done it once overnight and I was so proud! That night, I was a good pancreas. The other 99% of the time, not so much. But that ONE time, I nailed it. LOL
     
  8. Hstntxag

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    Thanks for the input. We are going to try love handle are for a different site option.

    We ended up upping all 3 of his basal rates by .05 and it helped from midnight to 6 am but not the rest of the day. First time for us to really experience the stubborn highs..but he's 13, so we knew it would come someday. He doesn't feel bad..so at least I knew it wasn't a bad site..just not enough insulin. After the 2nd high number above 250, we checked for ketones and when none were present, it led me to believe the basal was the bigger issue.
     
  9. MomofSweetOne

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    She wants you to know that she tapes over it with Hypafix at insertion, which we've never done with other sites. She said otherwise she feels it moving; she grabbed a pen and started poking my hand to show me what that feels like.

    She also doesn't let me do the insertion. I've done the Sils and Mios, but never a Sure-T.
     
  10. dpr

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    He definitely needs to try some new sites. My daughter, 8, is tall and narrow with very little body fat. She uses 2 places on her stomach and 2 on her upper butt area. All 4 places are about the size of a half dollar each. She has been strongly resistant to try other places. Now after 2 years of pumping all 4 places are giving VERY short infusion site life. 2 days tops. The endo told us to completely stop the stomach area she likes and not long after the butt area started going bad. So the more places you can get them to use the better! We are now using the upper stomach area but have to use lidocane cream because it hurts her a lot more. It's tough but you really have to work at getting them to try other areas or it can create some real problems.
     
  11. mmgirls

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    Even on my muscular dd we can do sites on the arms and legs, yet not the tummy. She says that she feels the site and the insulin in the tummy.

    I literally have my dd tense her arms and legs to find a softer spot to insert to. I do admit that we used the booty for a very long time , she was young and we had ample space there.
     
  12. Mish

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    Many of my adult type 1 friends (young men and women who are very active and fit) have all switched to the longer Mios. It sounds counter-intuitive, but at the urging of a CDE one of them gave it a try and had good luck, so others followed suit. It's worth a try if you have tried everything else.
     
  13. susanlindstrom16

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    Interesting, good to know. Please thank her for her input!
     
  14. kirsteng

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    Sure T's are the same as Animas's contact-detach.

    We have only been pumping 6 weeks or so, and that's what we use on our 4 yr old. He's a bit of a chunky guy though, so no problem with finding areas to put the sets. He finds them comfortable everywhere but the upper love handle area, for whatever reason.. so for now we're using stomach and bum (arms are for the dexcom). At some point we'll try legs but haven't so far as it seems like the tubing getting pulled might be more of an issue.
     

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