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What are causes for a site to be/go 'bad'

Discussion in 'Parents of Children with Type 1' started by Hstntxag, Sep 9, 2013.

  1. Hstntxag

    Hstntxag Approved members

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    Good morning!

    My son is new to the pump and I had a question about what makes a site 'bad'.

    For the second time, he woke up with a really high number after going to bed in range. This morning it was 450. Yowsa. Today is site change day but we normally change after school.

    So I corrected him via shot and changed his site. This time he saw a little insulin around the site but the last time, no signs of insulin leakage.

    So my question is this..what makes a site bad? I know a kinked cannula at insertion can do that but what about when you are 2 or 3 days into a site? The first time I thought maybe he slept on his tubing but this time..I am wondering if heat is to blame as he was outside a bunch on Saturday and it was crazy hot.

    Why is 3 days the magical number for site changes? What makes a site start to act wonky?

    Thank you!
     
  2. Mish

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    Well, first I'd ask what happened from bedtime till the morning? what we the blood sugars the rest of the night? Were there ketones with that 450? That's where I'd start first.

    Beyond that, sleeping on tubing won't do it. Sometimes sites go bad on day 2 for no reason. :) But I'd be more curious as to what happened the rest of the night.
     
  3. momof2marchboys

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    I would say just watch his numbers for the next few days and see what is going on - did you do a check after he went to bed and what were his numbers then? is he coming down with something? do you need to adjust his basals for overnight (we have higher basals from 1am-6am than we do during the day)? where was the site located at? could he have pulled on it a little bit and it started to pull out or got kinked? There are just too many variables sometimes that it is hard to decide
     
  4. Hstntxag

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    He was 134 at bedtime, and we covered his snack. We let him sleep (he prefers to check himself) and didn't check at 2 am as we have been checking a lot due to football and felt comfortable with his trend during the night..that he wasn't going to go low. His number had been rising overnight..waking in the low 200s but never this crazy high. We had just made a basal adjustment on Friday night.

    He woke up at 6:45 am and his BG was 455. I immediately corrected with a shot and he is now 265. He said he did see some insulin at the site when he removed it. Moderate ketones present and he was super nauseated...obviously.

    He is very lean/musuclar so at this point, his sites are in his rear. We have been careful to rotate each site change...Real estate is hard to find on him, that is another situation all together. No kinks that I could see but because of location, I could see how maybe it was slightly pulled out, although not totally..causing the leakage.

    Looking at his numbers over the past few days, I really think the site was just bad...just trying to figure out how to avoid in the future as he feels crummy and is missing school. Perhaps changing the site a day sooner after he's had extended time in the heat would be an option.

    Thanks for your input :)
     
  5. Sarah Maddie's Mom

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    I think that you don't have enough information to know what happened. Absent any bg check after bed - I'm assuming 10'ish - you have no idea if:

    there was a late dinner spike
    the snack was under covered
    you're looking at a growth hormone, sex hormone spike
    it was a waning site
    it was an air bubble
    or, or , or

    Sites last 2-3 days, we sometimes forget to change and inadvertently go 4 but seeing a site become less effective by day 3 isn't all that unexpected. I wouldn't think of it as "going bad" just reaching the end of it's lifespan.

    In your shoes I'd want more data so I'd check at midnight at again around 3 am.
     
  6. Helenmomofsporty13yearold

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    DD's sites last 2 3/4 days. She shoots way up if she leaves one in longer than that. My understanding is that the insulin causes scar-tissue to form which affects absorption.
     
  7. Shopgirl2091

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    we have sites go bad for a number of reasons - sometimes after 3 days our insulin is not as effective, sometimes my son sits on it wrong, lays on it wrong, or rolls around on the floor and it will kink.

    Mostly I am changing after 2 days, because after 2 and a half they just aren't as effective anymore (which is probably because he's 4 :) )

    I think the longer you pump you will learn which areas for sites work better, how long sites work for you, and it will be easier to trouble shoot.

    I am by no means an expert yet, but every day I feel more and more comfortable with knowing what is going on with my sons body, and what or why the reason is when something goes wrong. Then there are the times when there is no reason (just "Diabetes") frustrating, but we still keep going :)
     
  8. obtainedmist

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    After wondering the same thing three years ago, we bit the bullet and started switching out after 2 days. BINGO! Most of our problems when away! We also got better at inserting sets (using two hands with the insets, one pressing flush against the skin and the other squeezing the two "trigger" circles).

    I would encourage you to try a 2 day schedule for a while and see if it helps!
     
  9. obtainedmist

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    Have you tried the back of the arm? That has become the favorite site for dd. Any love handles?
     
  10. Mish

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    I think, considering you said he had a lot of activity the day prior, and a lot of heat, that you might have seen a rebound from a low. That seems like a perfect set up. Usually, it's not my first go to for random highs, but in this case, I think you have to get some middle of the night checks in just to verify , especially on heavy exercise days.

    I wouldn't worry about a little insulin leaking out when you pull out a site. It can easily just come out of the cannula, and it means nothing - just that you've pulled out the cannula.
     
  11. Hstntxag

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    Because of football...his rear is the most protected area at this point. Crossing fingers he'll be open to a few other areas once we get through this season.'

    I would go there with you but the activity was on Saturday and he had a very low key day yesterday, hence a higher number at dinner and then in range at bedtime.

    Thank you all for your thoughts..I know it could be SO many things. Just trying to wrap my brain around it so we can navigate better


    I bet the site change every 2 days would be beneficial...and with the heat, that will be on my radar much more.

    Thank you!!
     
  12. Michelle'sMom

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    This might give you some idea of what you're up against with infusion sets. :cwds:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440169/


    Side note: I had to giggle a little when reading this. New term: "boli" = plural of bolus. Silly, but it just sounds odd to me.:p
     
  13. Helenmomofsporty13yearold

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    Holy Smokes...that is an exhausting list of variables. I started to picture it as a mathematical equation that filled a whole blackboard!
     
  14. missmakaliasmomma

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    My daughter's very petite and we also have trouble finding places to put her sites. She likes them on her butt, but I can also do her leg. But again, the issue with the leg is that there's not a lot of fat at all so the cannulas will kink more in that area. I have to change sites every 2 days like some others.

    I haven't had much luck with making things easier on the pump but I would just make it a point to check the line for air bubbles, test often, change site often and make sure insulin is good.
     

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