FUDiabetes

Insertion site, Lipohypertrophy

Day 1 is a bliss, day1.5 BGs spike and insulin requirement 2X,3x,4x; As of day1.5, the insertion site is swollen/bump/bleeding.

Rotating sites frequently use up “real estate” on a child’s body. I use Cavillon skin barrier and do not place skin tac in insertion site. I also tried spray cortisone with no luck.

Please, any advice.
Podding for over 2.5 yrs

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Hi @Unstuck. I’m not a podder myself so I’m not sure if I’ll be very helpful. Where do you place the sites?

Abdominal, things, hips, upper bottox and back of arms . I’ve never compared the diameter of the canula of OmniPod vs other pumps…

:I don’t pod, but I think you can go to the next step, which would be to place a barrier such as a tegaderm on the skin and then stick the pod to the barrier film. Either punching a hole for the cannula first or just insert it through the barrier film. Here is a wiki about the Dexcom, same situation can apply to the pod.

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No reaction to Pod or Dexcom adhesive or the Dexcom sensor.
@Michel have you ever heard of mixing insulin with anti inflammatory? Also, any opinions on ultrasound probs to treat scaring tissues?
(Ps : incredible write up).

No, I have never heard about mixing an anti inflammatory with the insulin. I would remember that one. If your little one isn’t allergic to the adhesive, but is allergic to the insulin, I would try a different insulin.

Using ultrasound to treat tissue issues makes sense to me, but I have not heard of it in the context of Lipohypertrophy.

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It looks like you’re using Fiasp. Have you tried any other fast-acting insulins?

I’ve read some posts on forums such as this one that indicated some people have more irritation at their pump sites with Fiasp than they had with Novolog.

Humalog is another fast-acting insulin option. Fiasp is supposed to kick in faster than Novolog and Humalog, but people report mixed results.

@Katers87 thx for the reply. We tried novorapid insulin, same swelling/bump at insertion site. It was a scary time- Fiasp offers predictability for peek action and great for grazing food (insulin staking does not act like a bomb !!!)

@Chris thx for your reply. For the mix, a research group is actually testing it…very competitive in the pharma industry. I thought maybe DYI had tried it already.

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I find it remarkable how many of us either have or develop insulin antibodies. Fascinating.

I think my (antibodies) are attenuated as a result of the constant IVIG infusions I receive for another AI neuromuscular disease.

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I’ve noticed that ppl endure and suffer silently with hyperglycemia, feeling shameful and embarrassed about it…I’m a 24/7 caregiver. I know that BG in range is possible IF my tools are working (dexcom accuracy, pump reliability) and now insertion sites… what can I do for her body to to reject the canula …???

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You could try different brands of pump so you could play with steel cannula or with ones that have a different coating. Being tied to the Omnipod, I don’t think there is much you can do.

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Hi @Unstuck

Can you tell me a few things?

  • Has this been happening for the entire time you have been using pods, or just recently?

  • What is the total daily dose you are administering?

The omnipod cannulas are made from fluorinated ethylene propylene (FEP) 100. It is similar, but slightly different than Teflon (polytetrafluoroethylene - PTFE).

While not very common, there have been some rare incidents reported where people have experienced allergies to these materials.

In the case of the diabetics who have experienced an allergic reaction, they also saw their blood sugar rising, possibly from anaphylaxis at the infusion site.

I would be happy to discuss this with you in further depth if you would like, or you can post and ask. I can also provide some documentation of cases if you would want to review them.

You can get your child tested for these allergies to know for sure. That is a very simple thing to do to know for sure if it is an issue!

Let me know how I can help.

I’m curious what you have read about how to get tested for these allergies. I have a history of allergic reactions to infusion sets, but have never been officially tested.

I have heard of people being able to test by inserting a set and not infusing any insulin - thus differentiating whether the set or the insulin is causing the issue.

For myself, I found that switching to metal sets and taking a daily antihistamine (which I have to do anyway) really helps. Also keeping any eczema under control (which I also have). I haven’t found steroid sprays to be any help at all, although I’ve heard of people using them (my theory for this is because I’m not reacting on the skin surface but rather underneath the skin where the cannula sits).

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I met an adult T1 who was tested by a dermatologist / the test lasted 3-4day . All metals and adhesives were part of the test and she tested positive for nickel and zinc… I just contacted a Paediatric allergist…he doesn’t test for those things …

Allergists also sometimes do patch testing. Although in my experience (of looking into it but never having it done) they can only do metal and adhesives, not necessarily things like the plastics that the infusion sets are made out of.

I suspect Lipohypertrophy and an allergy. Total daily varies from 15u to 24u… 15u with uncovered carbs and 24u to try to come back in range with no success . I am suspicious of the issue since June.

There is a place near me that does testing for that, but I do not know what it would take for you to get your young one tested where you live.

If you can get tested, that seems like a better way to rule it out than to swap out pumps. If you swap out pumps and find that it was not an allergy, then are you stuck with a pump you did not want? I think testing for it is the best thing to try. If you find an allergy, then you would certainly look at other pump options.

How close are you to the border? If you can’t find a place to do it near you, could you travel to the U.S. for testing?

My regular disclaimer: My children are not currently T1D and I’ve only ever had to take care of myself as a T1D. I was diagnosed in young adulthood. You have my respect. Feel free to take anything that might be helpful and leave anything that won’t work for a kiddo.

I’ve podded since 2014. I used Humalog for my MDI without problems for 8 years prior to podding…and then a few years into using the Omnipod, Humalog started welting up my sites, bleeding, and not working for bg. FUDders got me to switch to Novolog (it took two tries for it to take bc the first time it worked SO well that it scared the crap out of me) and Knock On Wood, I’m podding with mostly success right now.

Even with Novolog not welting up my skin, I still have to take most of my meal boluses via injection to preserve my pod site. That idea also came from FUD. I was working with Gary Scheiner’s consulting group (Integrated Diabetes Specialists) at the time and ran the idea of injecting for meals past them, and when they double checked my usual meal bolus size, they said, “Oh, yeah…that’s a lot of meal insulin to put into a site over the course of three days…and certainly all at once…so yeah, let’s try injections for meals.” I realize podding PLUS injecting for a kiddo may not work. But even with Novolog, if I bolus everything through my pod it will wear out my site prematurely.

AND, even with injecting most of my bolus insulin, I also see site degradation on Day 2 and Day 3. I personally add 10% more basal per day past Day 1 for each pod (i.e. for Day 2 I add +10%, and on Day 3 I use +20%). And if that feels like too much to me based on what I’m seeing, then I add to my meal insulin instead. YDMV. Some of my sites are really cruddy by Day 3…but Knock On Wood, I’ve had a good run of 3 day long sites lately.

Also, I’m on the skinny side. FUD has taught me that skinny people can have a more challenging time with pumping and with CGM working well. My skinnier sites, or my more active sites, will definitely bleed more easily than my cushier sites.

I do use pod sites on my right side of my body for 30-45 days and then switch to my left side of my body for 30-45 days. I do this to try to add an extra layer of protection against scar tissue on top of careful site rotation within each area. I believe I do have some scar tissue on my right thigh from years of MDI injections. I have limited pod sites so I’m trying to protect them as much as possible.

Do you ever notice leaking insulin soaked into the adhesive patch of the Omnipod? Or do you see leaking in the window?

As for bleeding, is it enough to soak into the adhesive? Or is it just red with blood directly around the cannula? FWIW, 90% of my cannulas have blood directly around them by Day 2.

As for the swelling, how big does it swell? Is it larger than a mosquito bite? When Humalog was reacting badly for me, both the pod site and individual injection sites would swell up to the size of a quarter (half to 3/4 inch across). If you inject Fiasp, does it swell up? I’d be curious if only pod sites are reacting and not injection sites. Not sure if your kiddo will let you check that.

I’m hoping for the best for you! I can relate to some of your struggles and the crushing weight of needing to solve the problem. I think you summed it up perfectly:

Sending all of the good thoughts that I can your way! Keep at it! I believe it will get better one way or another!

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Oh! The feeling when you discover your are not the only one!!!
A few acronyms I don’t know : FWIW and YDMY

Injection for meals is not an option. My DD panics and cries when she sees a needle.

Yes, window is often cloudy and leaky (you are the first ever to ask!!), yes, blood around the canula and adhesive.

In the perfect world, the adhesive would change colour when leaking.

I don’t accept that management should include increasing insulin requirement (day 2 and 3), when the medical device should ensure quality, efficiency and reliability. I know this practice is more than common, as people accept the hyper after day one.

Is OmniPod in the business of R&D and quality improvement (I’m not referring to closed loop).?

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