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How much do numbers vary with a new site?

Discussion in 'Parents of Children with Type 1' started by Lisa P., Jun 17, 2009.

  1. Lisa P.

    Lisa P. Approved members

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    When you change out a new site on the pump, do you see very different basal and I:C needs?

    We're three days after going on the pump and last night we changed out, instead of being steady all night she went up all night. I'm pretty sure that means the lantus is finally out of her system and I need to reset all the basals a touch up, but should I look out that when we change the site the next time they could be set too high?

    We're on small amounts, of course, so a little makes a big difference.
     
  2. saxmaniac

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    Our I:C's and ISF do not change that much.

    To deal with site absorption differences, I have roughly three basal profiles that are all similar. Profile A is our basic profile that we use the most. Profile B is the SAME as A, except it is 0.05 lower across the board. Profile C is the same as A again, except it is 0.05 higher across the board.

    When he's high across the board we simply move to the higher profile. This means I also have to choose between changing profiles, and actually changing the profile shape. The profile shape does not change that often, either. Usually if he's high across the board changing the profile does the trick.

    Example:

    Profile A: 0.35 (8am-1pm) 0.5 (1pm-8pm) 0.45 (8pm-12a) 0.3 (12a-8a)
    Profile B: 0.3 (8am-1pm) 0.45 (1pm-8pm) 0.4 (8pm-12a) 0.25 (12a-8a)
    Profile C: 0.4 (8am-1pm) 0.55 (1pm-8pm) 0.5 (8pm-12a) 0.35 (12a-8a)

    (We can name the profiles on the pod, so we actually name A "low" and C is named "High".)
     
  3. hawkeyegirl

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    We do not see any differences when we put in a new site.
     
  4. danismom79

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    Do you notice these differences depending on where you put the pod?
     
  5. hold48398

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    We have a need for significantly LESS insulin for 4-8 hours after insertion of a new site (and even more so if we open a new vial of insulin). This is one of the reasons we try to avoid putting in new sites at bedtime :rolleyes:. We simply put in a 20% basal reduction to accomodate. Once we see the numbers going back up, we take it out, and things usually are back to normal. As with everything else diabetes, though, your child may have a completely different need... :cwds:
     
  6. Lisa P.

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    Thank you, I'll watch and adjust. And then watch. And then adjust. And then watch. ... . good to know it is a factor but that there are tactics.
     
  7. moco89

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    Have you tried leaving the old site in for a few hours after you change it?

    Sometimes there is a pool of insulin under the site that is not absorbed yet. That may be your problem right there. I usually do leave my site in for a couple of hours after the change because I experience this problem.
     
  8. saxmaniac

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    Not really. The differences even happen from day to day... there is no pattern for placement. I was hoping once we rotated better to the legs, that these issues would go away, but they have not yet.
     
  9. candise

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    We have been pumping for one week today. In total we have done 4 site changes (bad luck with a few- dog pulled and kinked cannula and one that would not reattach). We have not seen any different #'s with site changes.
     
  10. lynn

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    We used to see slightly higher numbers after site change until I changed his "fill cannula" to .4 instead of .3. Only a tenth of a unit makes a world of difference.

    I would caution you to be very careful raising basals across the board. That all adds up after a few hours. I learned that the hard way:eek:.
     
  11. Lisa P.

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    Hmmm.
    Since we saw high numbers (that did come down with corrections but headed back up in about an hour) all day yesterday and all night last night, I thought I'd go ahead and tinker it up.

    But, my husband is in charge this afternoon. Not that he's not able to take care of it all, but I'm not sure I want to ambush him! Maybe we'll explore temp basal. . . ..
     
  12. Charlotte'sMom

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    So this really doesn't have anything to do with what you're talking about, but making "aggressive" basal changes made me think of it. Now that I can see fractions of a unit on the pump, upping things even just one step makes me nervous. 0.05 looks like so much more than 0.025. But when I step back and look at the whole picture and realize that my "aggressive" basal changes only upped her total basal needs by less than 1/2 unit, it doesn't feel so drastic.

    I'm the same way with bolusing. It's silly, but all of the sudden 0.8 seems like such a huge bolus, when I used to give 1 unit without batting an eye. But now that I have the option of giving a fraction of a unit, if I have to do anything bigger I want to err on the side of too little insulin-- which is causing a lot of highs around here. It's stupid. And I need to get over it. :eek:
     
  13. saxmaniac

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    Very good point. The word aggressive doesn't mean "lots of insulin", it means changing it more quickly than you would on MDI. You're pumping, not only can you can do it, it's a major benefit of pumping.

    Also remember basal changes can be done for less than 24 hours. A 6-hour temp basal increase of .025u is only 0.15 units. It's amazing what 0.15 units can do when given as basal!
     
  14. kyles_mom

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    I have a similiar question. I'm starting to notice a pattern of Kyle going high the next day after a site change. I usually change out his old site first, and it would make some sense if he's not getting all of the insulin because some is left behind in the old cannula. I wonder if I shouldn't just do a small bolus immediately after we change???
     
  15. bisous

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    Hmm. Maybe we're doing something wrong or maybe we have too much scar tissue but I DO see a difference based on WHERE we put our sites. We use the bottom only and if I use the upper outer bottom we need more insulin than if we use the lower part of the bottom. We've been pumping for two years almost exactly to the day and I'm wondering if we need to move to an entirely new locale??

    Good points about the basal increases, guy.

    Lisa, are the steel sites working better? Didn't you have a bad initial pump start due to kinked cannulas?
     
  16. Mom264

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    The way the CDE explained it to me was leave the old site in several hours, just as pp mentioned. I leave in in at least as long as out DIA, which is 3 hour, this way I am sure that the insulin is finished. It is not such a big deal if you have not bolused in hours and are only dealing with a small amount of basal that.

    You don't have to worry about what is inside that cannula, that doesn't matter-- just what oozes out from the site. That may be one unit, which for use would increase BG by 160 points :eek:.
     
  17. hypercarmona

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    When I'm going from lantus back to the pump, I take anywhere from 20-30% off my normal basal amounts for two days, and usually by the third day, I can run my normal basals. Whatever basal adjustments that were needed during the time that I run the temp basals aren't incorporated into my normal basal pattern, because it doesn't reflect what I truly need. Once the lantus is gone, any basal changes that are needed are "really" necessary.

    I usually run low for a few hours after changing my site, but not everyone does. The idea of leaving in the old site is a good one, not only for the fact that there could be insulin still absorbing from it, but as a means of "insurance" in case the new site doesn't take. (that is, unless you're changing the site because it's obviously not working, falling out, bloody, etc.:rolleyes:) It makes things easier to have the old site to plug into to correct until you can get a new set in.
     
  18. Lisa P.

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    First, good info on leaving the site in. I don't think this has anything to do with what we're seeing, but it's good to know for the future, now if I see wiggy highs in the hours after the site change I'll know what to look for.

    Things are going much better now. I think I'm now in that "gee, starting the pump is hard and she's high for awhile" stage that most people talk about, not to the confused with the "hmm, so when you don't get insulin at all you hit 490 and stay there and scream until people at the zoo stare and then do it all over again in 8 hours" sort of game we were playing the first time.

    Clearly our basals were off. We started at 2.4 for the day, now we're up to 3.6 for the day and it looks from the night like we still need a little more. That's a huge difference for her. But I'm also convinced we kept losing the site and about four times she just wasn't getting insulin at all, or only a partial delivery. It's hard to tell whether the pump is delivering enough insulin when it never actually gets into her body! So I'm LOVING the steel cannulas. They are not flawless, but we have had two whole rounds of two days each without having to change out from highs. It's made all the difference. We also moved the site up a bit on her behind and used IV3000, etc.

    We're going to make the decision in the next couple days about which way to go. We have to order supplies for three months at a time, I wish we could try the pump for a couple weeks and then decide, but . . .
     
  19. Lisa P.

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    I did this just yesterday! Gave her over a unit for a meal and freaked out! But by syringe two units was not uncommon. How strange, eh?

    I think I got into a habit with MDI, I call it the Callista Flockhart affect. Remember when she was so skinny and everyone was chastising her? But she's a twig, and on tv -- so if you want to stay 100 pounds, it's impossible to stay exactly 100 pounds, right? You fluctuate between 95 and 105? If you're on tv, you have to always err to skinny, though, so you're likely to fluctuate between 90 adn 95 instead? (Do I digress?)

    So with MDI, I figure you can never be spot on, we learned to err (a little) on the side of giving too much insulin (normally) and checking and feeding her to correct the error, because with MDI you can't err the other way and easily correct it. With the pump, though, you can, so I am in danger of falling into that trap of going ahead and underinsulining her because I can give her more later. But you're right, that leaves her high most of the time. Maybe if I change my target range way down I can get away with that, but otherwise, no. . . .
     
  20. Lisa P.

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    We did move up -- maybe that's been a factor. Thanks. We won't move back down again without being on the watch.

    Yes, we had a bad pump start because her cannulas were kinked or something, and because her mother had no spine. We've corrected both! Thanks for asking, and yes, everyone was very very right about the steel.
     

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