How much of a pain is it to change infusion sites every three days? Does anyone have issues with scar tissue built up on their stomachs from years of MDI? (I do and am wondering if it will interfere with insulin delivery from a pump.) I continue to contemplate … procuring a pump. Thanks for any thoughts!
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Can’t comment on scar tissue, son has only been diabetic for 6 years, so that isn’t a problem. The infusion site change takes approx. 10 minutes. My son has gone additional days in the beginning because it wasn’t a habit. He now changes every other day due to better absorption of the insulin on day one and two. It isn’t that big of a deal.
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For me, a site change takes about 2 minutes. Disconnect, insert new infusion set, reconnect, remove old infusion set, fill cannula. No bother at all.
One of the nice things about tubed pumps is that there are lots of different places to put the infusion set. So rather than using areas where you have scar tissue, put the infusion sets elsewhere so you’ll get good absorption.
I use spots in rows up my sides and back, saving my abdomen for CGM. I get 3 or 4 rows, each with 3 or 4 spots on my left side and around to my back, and the same on the right, so each site gets a couple months to rest before being I come back to that area. The infusion sets are small enough that it doesn’t bother me to sleep on them or lean on them, and that doesn’t seem to interfere with insulin delivery either, so pretty much anywhere I can reach with my fingertips is fair game.
A reservoir change (which I do completely independently of site changes) takes me about 5 minutes. I fill the reservoir completely full, and use it all up before changing to a new reservoir.
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@bkh not to get too intimate, but what do you mean by your sides and back? Like obliques and rear end? How much padding do you need for the cannula to go into? I can’t use my abdomen for Dexcom; I believe b/c of scar tissue and am wondering if it would be an issue for an infusion set as well, or if the cannula would go deeper than the filament of the Dexcom? I also avoid the center of my abdomen for insulin b/c I think absorption is impaired b/c of scar tissue. I find myself tiptoeing to the edge of wanting a pump and then shying away from it. Feeling like I’m close right now!! I think the technology has taken a great leap forward in recent years.
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More or less over my entire rib cage. Like from the waist up towards the armpit and shoulder blades. Look at the right side of this picture How often/ much to rotate pump sites? - #18 by Aaron but carry the spots up higher on the back too. And on the sides, which are not shown in these photos.
Not much. On my sides it feels like the ribs are right under the skin, but if I pinch there’s at least a half inch in the pinch, and the infusion sets work fine…
I’d say probably it would be a problem. Anyway, why fight with questionable areas when there’s so much more skin surface available where you haven’t been injecting.
I agree. And now that they’re doing software updates to pumps, we can get a pump now and still enjoy any improvements that they release in software upgrades over the next few years.
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It’s a PITA; something I have to do with the Omnipod but I delay it as long as possible - 80 hours - even though it means getting up in the middle of the night to do it.
I have scar tissue on the fronts of my legs (no fat to see no where) and on my stomach (lots of fat, or something, problems if I put the Omnipod there). The only answer I can see is to not inject the insulin subcutaneously; for me all the sites have been used up, permanently. I move the pod between unofficial sites; my upper arms are also pretty much devoid of fat but that’s nothing to do with the pod, or MDI, that’s the way my arms are.
For me before I swapped to the pod MDI was a disaster on wheels, the pod is half a disaster but getting worse. Use it, lose it. I couldn’t find anything documenting the effects of long term subcutaneous injection, but I certainly know there are deleterious effects from personal experience. (Hey! Explain why there is no fat on the front of my legs, anyone?)
I assert the problem is the injection, not what is injected or how it is injected. Pumps might help because they use a single site for an extended period. For sure this causes more damage, but it is more localized. I’d fire my syringe at any obvious and convenient piece of flesh.
Ask your endo, “How do I ensure that after doing this for 50 years my skin won’t be damaged?”
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I alternate my Omnipods from left- to right thigh. I don’t have a problem with a scar and I can’t see the prior injection site after three days. The odds of hitting the same spot sequentially is very remote.
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The back? I don’t have any fat at all on the outside of my thighs (not through MDI, there just isn’t any there) and my endo advised against the inner thigh (though I may try it in the future). I have tried the outside thigh, there are a couple of places where I can get half an inch in a pinch, but I get wardrobe malfunctions there - it’s too exposed.
I thought about my calves, but that strikes me as extreme likelihood of wardrobe malfunction, unless I wear a wet suit.
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I like the wetsuit idea!! Kind of binds the wrong parts while driving and a little cumbersome at parties and during those “intimate” moments though….
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My endo advised that I could put the pod anywhere I would do an insulin injection.
I wouldn’t worry about “no fat” (congratulations). The cannula only goes a few mm into the skin. It doesn’t reach the fat layer
That can’t be true. Insulin pumps aren’t approved for intradermal infusion of insulin, only subcutaneous infusion. I.e., into the fat layer. Skin is thin, the fat layer is close to the surface.
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I just measured the cannula on the pod that I removed this morning. It is 3.5mm deep.
That puts the injection site right in the middle of the subcutaneous tissue:
The fat layer is below the subcutaneous.
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No, I don’t think that’s right. Subcutaneous is the fat layer:
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cutaneous (adj.)
" pertaining to the skin ," 1570s, from Medieval Latin cutaneus, from Latin cutis “the skin” (see cuticle)
Sub is below, subcutaneous is below the skin, but above the muscle. The subcutaneous layer is fat and loose connective tissue.
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Neat, thanks for that ref and the measurement. Modern MDI syringes are 4mm; about the same; the idea with those syringes is that you shoot straight into the skin with no pull-up.
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I can’t find a single fault in anything you say. You have my respect, but more than that, my admiration; I could not have said it any better myself and I didn’t, thank you.
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@psfud123 how are you feeling about using a pump and (I think?) ControlIQ? Do you think you’ll stick with it? How often are you manually finger-sticking? How often ketone testing? How do you feel about letting “the system” deliver your insulin? (That is very scary to me.) I’m also very experienced at being diabetic, and quite a few years into using a CGM, but I have not yet added a pump into the mix. Very interested in your thoughts, if you’re willing. Thanks! Jessica
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