- advertisement -

When you guys say a site "fails" what does that mean?

Discussion in 'Parents of Children with Type 1' started by sszyszkiewicz, Mar 2, 2014.

  1. sszyszkiewicz

    sszyszkiewicz Approved members

    Joined:
    Dec 24, 2013
    Messages:
    842
    When you guys say a site "fails" what does that mean?

    Does the insulin not get absorbed? If not then where does it go? If the insulin is pumped in, but does not get absorbed, will it degrade within 4 hours like you gave a shot or does it lie in wait, get absorbed, and drop you like a rock sometime later?

    Does the insulin not make it in?

    Does the infusion set fall out?
     
  2. virgo39

    virgo39 Approved members

    Joined:
    Jan 8, 2010
    Messages:
    1,691
    We use the Omnipod system. For us, the "site" seldom seems to be the problem. I would say the site failed when the cannula came out, when we noticed a lot of blood in the cannula, and she we first started pumping and tried to attach the (then larger) pod to the back of DD's upper arm, where it seemed not as secure because her arms were small.

    All of those have been rare. Sometimes it will seem like a site is not doing as well by the third day, and we've opted to change the pod sooner rather than later (right after school rather than after dinner).

    We more frequently have a pod fail, setting off an alarm. Lately, it has been one or two a month, which is more than we experienced in the last year and a half. I don't know how those pod failures compare with issues with tubed pumps.
     
  3. valerie k

    valerie k Approved members

    Joined:
    Feb 19, 2008
    Messages:
    1,510
    for matt, it means no insulin is getting in, or such a miniscule amount, its not noticeable. Usually its a kinked cannula for us. His numbers soar, he gets ketones, we pull the site and usually its a bent cannula.
     
  4. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

    Joined:
    Sep 23, 2007
    Messages:
    12,521
    Generally our sites only "fail" when we forget and leave them in 5 days '-)

    Look at it this way - you stick something alien into the body like a cannula and after a few days the body is going to mount a reaction and try and "heal" the breach and that's going to interfere with the infusion and absorption of insulin. Since there's no background basal when pumping it doesn't take many units of disruption to notice a spike in bg. If the pump detects a back-up in the pressure, it will alarm, but people usually catch it before that happens. Where those units go? I don't know. Some may leak back out, or pool a bit so that when the site is removed there's some leak back but we've never had a low that I can recall that was due to AWOL insulin suddenly kicking in :)
     
  5. hawkeyegirl

    hawkeyegirl Approved members

    Joined:
    Nov 15, 2007
    Messages:
    13,157
    Yep. We rarely have a failed site, but usually they are a result of a "Oops...how old is this site again?" I don't know if we've ever had a kinked cannula. Maybe a couple in 6+ years of pumping?
     
  6. Nancy in VA

    Nancy in VA Approved members

    Joined:
    Jul 16, 2007
    Messages:
    7,308
    Ours is usually due to old site or kinked cannula. The symptom is higher BGs with no discernible reason. If its an old site, it's lack of absorption. Where does it go? It sits in "saturated tissues" and just not absorb. It rarely will slam later so just change site and correct. Kinked cannulas usually show because she will come down from a bolus and then creep up - meaning the bolus was strong enough to push through but the basal isn't. Pulling it usually shows a kinked cannula. We only can see this because of cgms
     
  7. StacyMM

    StacyMM Approved members

    Joined:
    Oct 22, 2010
    Messages:
    1,039
    I say fail for technical issues - things the pump alerts us to. On the OmniPod, it's the squeal of death or a pod that failed to prime. On the T:Slim it's an occlusion.

    We've lost sites, too - DD's had sites pull out but it's usually because the tubing got caught, and we've had DS's pods fall off, but it's usually moisture. I don't think of those as the pump's fault, though. I don't know that we've had kinks in awhile - back in our Medtronic days, perhaps?
     
  8. Guru_rb

    Guru_rb Approved members

    Joined:
    Jan 15, 2014
    Messages:
    27
    For my daughter a site lasts only 48-72 hrs. We start seeing a steady rise in her BG some time on the third day for no apparent reason and we immediately change site. Only on one occasion we have seen occlusion in the cannula. And her BG always drops more rapidly after the site change, so I concluded that the insulin makes it in but gets absorbed slowly. So we don't correct for about 3 hrs after the site change and take a call on correction only after that.
     
  9. Mish

    Mish Approved members

    Joined:
    Aug 20, 2009
    Messages:
    1,393
    Like many others,for us it usually means that the site itself hasn't been inserted properly, and hasn't worked right from the get go, or that we've left it in too long and it's stopped working well.

    where does the insulin go? just gets absorbed I guess. But we also have never had a phantom low from insulin that sat there waiting.

    It's one of those things that you sort of just get a feel for. If I've done a site change, bolused for a meal, and 6 hours later I see a very weird high that I can't attribute to the meal, sometimes I'll know it's just a bad site and I'll change it right out. Sometimes I try to force another correction through it, and sometimes it ends up working. Sometimes not.
     
  10. shannong

    shannong Approved members

    Joined:
    Sep 15, 2012
    Messages:
    568
    A true "failed" site for us, results in obvious high bg's that won't come down and pretty much skyrocket - like he is getting no insulin at all. When we used Inset 2's we saw these mostly due to a kinked or bent cannula. We use steel cannulas now and the only failed site we had was when we discovered that it had ripped out.
     
  11. mmgirls

    mmgirls Approved members

    Joined:
    Nov 28, 2008
    Messages:
    6,030
    Today's scenario, bg check before snack and after breakfast. 1st 360 then after washing hands to make sure 340.

    Bg this am was a bit higher than I like at 160, but she is fighting allergies or a cold.

    Not a normal bg they corrected and covered checking ketones (0.0), and called me to let me know.

    I decided to stop at school with a site change because it was so out of the ordinary. I do not expect her to run ketones with a bad site because 60%of her basal is from a Lantus shot. Checked out her site and I could see cloudy blood at the site, in the cannula window.

    By lunch she had dropped to 250 but stayed there even after eating, so while her bg dropped and she ate without rising, she obviously was not absorbing all her insulin. ( IOB was not really there)

    When she got home and removed the site, the cannula was bent but not kinked and filled with blood and other stuff. I believe that she got some of the insulin but either the rest of it did not go in or it was walled of by the body as it tried to heal itself when she must has hit the site.
     
  12. Ali

    Ali Approved members

    Joined:
    Aug 1, 2006
    Messages:
    2,223

    Bad site means unusual numbers. Sometimes it is true physical changes or a missed bolus etc but many times it is an issue of absorption of insulin for many reasons. I am now an adult but a T1 since teen years, this scenario is what happens to me. I now use a steel site cause I had so many bent sites and clogged sites with the teflon cannulas. Sometimes it is just a partial clog so a slow rise and sometimes a complete clog and a fast rise in BG. For me I can get a slow rise in BG with a bad site that just gets worse or a rapid change, it is so hard to determine if you just miscalculated carbs or there is a change due to exercise, hormones etc. If you can pay attention when you see an odd number then take corrective action and still see an odd number you should change, it is hard to not just keep correcting. When you are busy you can find you have gone twelve hours before really addressing the issue...after many many years I still make this mistake. I am now trying to be more strict and after two surprise numbers-high and corrections-I change sites. About 1/4 the time it is just a real change in needs and 3/4 he time it is a bad site. Sorry it often is just a guess, but always a pain the A.. Ali
     
  13. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

    Joined:
    Sep 23, 2007
    Messages:
    12,521
    I'll just add, we've been pumping for over 8 years and other than sites we left in too long to sites that had obviously been yanked ( occasional tubing + door knob encounters) we've had very, very few site "failures" and when we did it was usually our fault. Infusion sets do a great job doing what they are supposed to do - the vast majority of "site failures" are due to insertion errors (just an issue in the beginning) or some odd tugging incident or leaving them in too long.

    "Site failure" gets tossed around a lot, but in truth it almost never happens. :cwds:
     
  14. Ali

    Ali Approved members

    Joined:
    Aug 1, 2006
    Messages:
    2,223
    Sorry, but while I agree it is not a regular occurrence it was for me that the teflon sites failed 1/4 of the time due to kinks or my insulin clogging. I agree for most it is not an issue but for many of us, it is an issue and not due to tugging or insertion issue but simply the amount of fat tissue you have, type of sets, type of movements you make where the site is, type of insulin and individual reaction of ones body to the site and the sites material, plastic or steel, and the reaction of the plastic, steel or body of the person to the insulin. I did not get anything close to consistent absorption of my sites till I switched type of sets(from plastic to steel) and type of insulin. I still get the issues of hitting muscle or a quick anti body reaction to the site or insulin about every three weeks.Ali
     
  15. mmgirls

    mmgirls Approved members

    Joined:
    Nov 28, 2008
    Messages:
    6,030
    We have had numerous times when BG just gets stuck, correction, meals and no change. Decide to change the site and the cannula is good, but where it was inserted looks "wet" and there is a "hole" where the cannula was. They call it "tunneling", and I don' t know why it happens but sometime it does, and for the most part I wasn't t sure that it was a bad site until after it was removed and after a new site corrected the elevated numbers.

    But I have to say there also have been numerous times that I though it was a bad site and after changing it out did not bring numbers back to where I wanted them.
     
  16. mmgirls

    mmgirls Approved members

    Joined:
    Nov 28, 2008
    Messages:
    6,030
    I agree, we started to have insulin reactions to Homolog. Every site would get gunk'ed up with white stuff, even with steel sites.
     
  17. Ali

    Ali Approved members

    Joined:
    Aug 1, 2006
    Messages:
    2,223
    Quick comment, it is a pain to change sets, also a pain to go through trying different insulins and different sets, but once you get it down to the best sets and insulin for you then the trick is to deal with the PIA that changing a set is. Half the time it will make no difference there is something else going on and half the time it is the site, but you know for sure within an hour of changing the site. I have to push myself after many many years to do this.:redface:ali
     
  18. shannong

    shannong Approved members

    Joined:
    Sep 15, 2012
    Messages:
    568
    This was my son's experience too. We actually had lots of site problems with the Inset 2 teflon cannulas. We switched to steel cannulas and have not had these issues.
     
  19. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

    Joined:
    Sep 23, 2007
    Messages:
    12,521
    It's just that I wouldn't call that a "site failure". While it may have felt like such at the time, it was more a mismatch of technology. You saw a reaction to a certain material and switched to another option.

    It's important for people considering a pump to know that not every cannula suits every body, and luckily, we have options. :)
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice