FUDiabetes

Infusion sites: how long do yours last?

Someone in another place was asking about making infusion sites last. I am curious: do you ever keep yours more than 3 days? If so, how do you make it last? Or, on the other hand, do you have a hard time making yours last 3 days?

Accessory question: do you see a drop in site performance on the 3rd day? With what pump?

Thanks a lot!

Not sure if this is what you mean, but for tubed pumps, you can just leave the infusion set in and only replace or refill the insulin reservoir on the pump.

Or are you asking for tips on how to make the site stay fresh for longer periods of time?

Leaving it in for longer than 3 days is possible, but you get degradation after a few days. It is not a coincidence that all pumps have a 3 day limit that they advise you to change.

Imagine watering your lawn and leaving the sprinkler on. Eventually the ground gets saturated and you’d have puddles. Your tissue can only absorb a certain amount. The tissue will get saturated and eventually your insulin absorption will be horrible.

Pushing much past 3 days is not really a good idea. Eventually your insulin usage will become much different. Depending on your body tissue type, it might be 3 days, it might be 4 or 5. But at some point, it will suck.

I am wondering about some anecdotal stats:

  • how long do your sites normally last (for what pump)?
  • Do you see performance degradation on 3rd day (or later day in general)?

http://www.amsl.com.au/media/documents/Guide%20to%20Infusion%20Sets%20Site%20Selection%20and%20Care.pdf
"As sites deteriorate, you may notice that you need more insulin for boluses or you need more corrections and your blood sugars just keep getting higher"


http://capillarybio.com/wp-content/uploads/2016/08/JDRF_Capillary_Announcement_1.pdf

More than 500,000 people with diabetes in the U.S. on CSII pump therapy are required to change their insulin infusion catheter every two to three days. Many patients attempt to use their infusion catheters for longer durations, often resulting in poorer blood glucose control and hyperglycemia due to infusion set failure. The cause of these infusion site failures is not well understood.


This one is the opposite, but that has not been my personal experience. For this one they only used 9 patients which seems a bit light:

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We try to change our sites every three days. Sometimes my son has forgot and has gone to 5 days. We can get 4 days without much issue most of the time. At day 5 for us, we run into the need more insulin issue. In practice we see three kinds of failures.

1 - Leakage. This has happened to us on a few occasions, sometimes as early as day 2. When this one occurs, you can smell the insulin smell very strongly from the set where the tube plugs in, and he usually is running a high bg

2 - Kink in cannula - we have had these happen when we insert it incorrectly like when the inserter misfires or the cannula came off the needle when we were peeling the adhesive backing.

3 - We feel like we have also seen it as well after hard contact in sports.

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Incidentally, I have asked Glooko to make a report that lets you view insulin usage by day of infusion. So far, they have not done that. :frowning: Hopefully at some point they will make that available. I think that would be a very useful thing to look at.

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From what I have read, the pump you are using makes no difference. If you have a problem with an infusion after a certain time period, it’s an issue with how the insulin is absorbed on day 1 versus day 2 or day 3. The pump is not the issue. They all do basically the same thing.

It took me a while to figure out that I occasionally have a problem on day 3. Not too often, just sometimes (that’s what made it difficult to pinpoint). Some people who might have the same issue might not notice it, because you have to test a lot and pay attention to infusion day and things like that. So it’s possible this problem is more common, but just not known…

From reading other’s experience, some people have this issue a lot, and others never have a problem. So I believe it has to do a lot with a person’s tissue type and how well they absorb insulin.

While I have read many people report a problem on day 3, I can’t recall reading anyone saying “Day 3 and later is the best! That’s when my insulin really works well!” So it seems - simply from what I have read - that the issue is either a problem with a longer period of infusion, or no problem. I just don’t recall seeing anyone saying the opposite.

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There is a good thread on tuD that I was a part of a little while ago. Here are some excerpts that I think are relevant:

Joan 10: I diligently changed them every three days for a long time but for about three or four years have been changing them once a week and they work just as well with no problems!

Bowie: I did do a 5-6 day change for a while till I saw a slight infection when I removed my old site once - now I’m scared to let it go any longer than 3 days

Timbeak48: I did four days for a while and I HAD noticed a drop off in effectiveness after three days.

rgcainmd: There’s no way I’d let my daughter go longer than 3 days. The risks of developing lipoatrophy or lipodystrophy are not risks I’m willing to take.

Rphil2: With two minor surgeries to correct site infections, I switch at 3 days no matter. I also switch if the site itches or stings. Those two gashing wounds were terrible. I would never ever want to repeat that. 3 and out all the time. It only takes one. The second was the result of the first.

mee: I change mine every 2 days. I use contact steel inset- I do notice a difference with better Bg and avoiding highs

Jen: I use Contact Detach steel needle sets and change them once a day. Sometimes I leave it two days, but often my blood sugar goes high on the second day. I also sometimes change it more than once a day if the site gets itchy or irritated at all or if blood sugars go high and won’t come down.

artwoman: I notice a slight upward trend in bg’s (or downward trend in insulin performance) after 3 days. So I try to change every three days.

Scott_Eric: I used to let my Silhouette sites run as long as possible when I was in university and have significant scar tissue on my lower abdomen from being an idiot.

jjm335: I was struggling to get 2 days out of a site with Apidra and switched to Humalog.

Dessito: I change my Medronic sets every 6-7-8 days since that is how long it usually takes me to empty a reservoir (1.8U). I use Novolog and do not observe any lower insulin action in the later days of a set compared to the first days. I also don’t have infections, occlusions, or other skin reactions.

Beacher: you may not experience signs of lipohypertrophy or other tissue effects until some time later.

Jaime7: I have to change mine every 2 days my body rejects it quite rapidly.

Our pump nurse practitioner, who is a T1D, says she can always tell who is leaving infusion sets more than 3 days because of lipodystrophy.

Here is a good teaching paper on pump training and practical issues. There is heavy emphasis on site rotation every 2-3 days.

WE never go more than 3 days, because of the fear of lipodystrophy. However, i think the length of time a site can go before it gets occluded with gunk from the immune system is anywhere from 1 to 7 days for different people. Theoretically at least, then, there are people who can use a site for 6 days without a decrease in insulin in the short-term. In the long term though I think they’re still setting themselves up for scar tissue and fat accumulations that will reduce insulin absorption.

Personally I say why risk it unless you have major financial barriers to getting more supplies. In which case I’d just switch to needles.

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Oh, I didn’t know we were allowed to post quotes!

PamS
Some days my pod is sluggish and sometimes it seems to work perfectly.

Anthony
I experience this as well with the Pod. However, I don’t think it’s really the Pod. I’ve noticed that if I have been using one location a bit too much the absorption is less predictable. As soon as I move it to a newer location I get good results.

Jen
So interesting to read. I can’t believe so many people can leave their site in for 4-5 days!
I definitely have problems on day 3, and I always have.

John_C_A_Manley
Even getting to the third day was proving a problem for my wife; after 5-years on an Medtronic pump. She aims for very tightly controlled blood sugars. By day 3, the pump wasn’t providing those. Sometimes, it would fail completely, with blood sugars suddenly climbing.