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What causes sites to go "bad?"

Discussion in 'Parents of Children with Type 1' started by DsMom, Jan 18, 2011.

  1. DsMom

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    My kids and their and 2 cousins went for a much-anticipated sleep over at my in-laws on Saturday night. They live minutes away and have been very active in Daniel's care since his diagnosis. Long story short, the day was filled with weird lows and then super highs--and then he was in the 300s all night despite my mother-in-law's valiant sleepless supervision and calls to me. Was 420 (but no ketones) by the time I brought him home on Sunday AM and did a site change--and he went back to 114 less than 2 hours later. The old site looked okay before I changed it--but it was obviously not!

    This morning, he woke up at 308 with a tummy aches and had large ketones. Luckily, there was a 2 hour delay for school because of icing--and I could monitor him after I changed his site and cleared his ketones.

    He's been pumping for more than a year, but I realized I have no idea what makes a site go "bad." We change it every 2 to 3 days--if I slip and let it go further--he'll start going super high. The site this weekend wasn't even that old, only a day. The one today is 2 days old. I'll sometimes notice a small scab around the infusion site--on good sites and on "bad" ones. Is that the culprit?

    Good news--Daniel had a great time at the sleepover and slept through all of the nocturnal BG checks (he always does).

    Is there any way to avoid "bad" sites? I've never had 2 go bad in a row like this--but the fact that he stabilized after changing him makes me think it was the site. Could it be over-use of the site? My niece had to stop using her butt for sites because of that. I try to move them around as much as I can on his small tushy. Could the highs be due to something else entirely?
     
  2. Nancy in VA

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    What kind of site? Does it have a needle or just a cannula? We have had sites be good for 2 days and then go wonky and when I pull it, it has a major kink. I wonder if that happened after the first 2 days, or we just got lucky for the first few days

    Other than that, saturation and overuse are two things to watch for
     
  3. DsMom

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    Not sure I understand. Are there sites where a needle stays in?? Daniel just has a small cannula that stays in his skin--but it's way too small to kink.

    Changing my own subject--but I noticed your child has a CGM. How do you like it? I am seriously considering starting Daniel on one to help fight after-meal spikes and understand his BG trends better. Did your child's A1c improve after starting with a CGM?
     
  4. Ali

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    Just a FWIW but the short cannulas do and can kink.:cwds: There are steel needle sets which do not kink. Good luck. Ali
     
  5. Nancy in VA

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    Yes, there are sites where the needle stays in. And yes, the short cannulas can kink - we have had 90degree kinks in ours before and the first two days of numbers were beautiful so I don't know if we just got lucky or it kinked by her sitting in her duff the wrong way or something.

    We like the CGMS a lot. It isn't always perfect, but the trending is what's most important to us - and catching the lows. Emma has hypounawareness, so catching the lows at times we wouldn't otherwise be checking is really important.

    Our A1C has actually stayed pretty steady - going up and down - becuase we have reduced the # of lows that she is experiencing. Still working on reducing the # of highs
     
  6. nanhsot

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    We've had to switch from the straight in sets to angled ones because of kinking issues. So far the angled sets fail less for him, but as always YDMV, hopefully we'll continue to see that trend.

    Canulas definitely can kink.
     
  7. mom24grlz

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    we have sites go bad a lot. We've actually only had one where we could actually see the kink (canula was bent at a 90 degree angle). The rest of the time we don't notice anything wrong with the set, or there may be blood in canula. Most of the time our sets last 1-2 days, though the last one we were able to get 3 days out of it:D. We've gotten different samples from animas (steel set, angled set, i'm not sure what else). Ashleigh hasn't wanted to try them yet.
     
  8. StillMamamia

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    We use steel sets - the needle used to "puncture" the skin (sounds, awful, huh?) stays in. It's hollow inside for the insulin to flow through. But there is no chance of it getting bent.

    However, sometimes overusing a site area can cause slower insulin absorption. Sometimes also (and this is my own non-scientific opinion) there is build-up of whatever is under the skin and that blocks insulin absorption (or slows it down). A good example of this is when you see highs, but suspect the site is ok, then you give a correction and you see results, and a few hours later you see BGLs creep up again. The bolus, having more oomphiness "pushes" through the whatever is blocking the absorption and you see some results, whereas the basal is like a weaker push and doesn't cause much change, kwim?
     
  9. DsMom

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    Thanks so much for all of the info. As always, you guys know so much more than me even after 2 years. I wonder if I'll ever be an expert at this. I will watch out for the cannula kinks from now on. Must admit I don't really look at them when I pull them out. When kinks were mentioned, I was thinking more of a loop type kink rather than just a bend. It's entirely possible that's been happening. Guess there's no way to avoid them?
     
  10. KyleBugsMom

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    I see he is on the Ping. Maybe try the Contact-Detach infusion set, which has the steel cannula. I have worn one myself, just so I would know how it feels on DS and did not feel it at all. ;)
     
  11. ecs1516

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    We were always told to pinch up around the site then insert. That seems to have always helped us. We use 6mm Insets right now.
     
  12. Jacob'sDad

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    I see the same exact thing. I think it is either scar tissue or fat build-up, but whatever it is, it affects absorption. Not only that, but future sites in the same spot can absorb slowly as well. That is why is is important to change sites frequently even when they are still working well, and also to have a large selection of places to rotate to.

    Another thing you can see is if you change a poorly absorbing site and also remove that site, it can act like a drain that has just been unclogged and WHAM, you've got sudden stubborn lows. I think it is better to just leave that site still attached for several hours. You still can get slow absorption from the old site but at least it's slow.
     
  13. Yellow Tulip

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    I'm not sure what you mean here :eek: Could you explain more? Thanks!
     
  14. StillMamamia

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    I think what Dave means is that when you have a blocked site (under the skin), and you remove it, that "unclogs" the area (the action of withdrawing the needle/cannula acts like a plunger, making whatever insulin was pooling there flow). So you may get a double action of the unclogged insulin acting plus the insulin from a new site, causing lows. Personally I've not seen this, but then I never thought about it either.:D
     
  15. Yellow Tulip

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    Thanks! That makes sense. I've never seen that either, but I suppose if there is insulin pooling around the cannula it probably would get sucked in.
     
  16. StillMamamia

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    Ummm, my apologies for answering instead of Dave.:eek:
     
  17. mandapanda1980

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    Feel around a bit on his skin..slide your fingers over the tushy and press just enough to feel if its "lumpy" if so, the scar tissue you are feeling may be what's causing the highs. It pools there, like earlier stated :) if I feel dds skin and she's lumpy I avoid that area and move to another to let it heal a bit
     
  18. DsMom

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    Good advice. I will try that. Thanks!!
     

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