Pinch an inch site rotation to a new place. It worked!

[Irish]

I’ve been rereading scores of posts that I’d missed over the last many months and recently stumbled on one of @eric’s “pinch an inch” suggestions. I decided to give it a try, in part because my belly has started rebelling more lately (mostly allergies, but if I’m being honest, I’ve also gained weight, and I cannot handle the extra 3/4 inch beyond my waistline).

Anywho, I wondered if rotating off that area entirely would be helpful, so this week was the first time I tried up just above my lowest rib on the left side. And, probably no one but me will be surprised by the results. I loved it!

The thing I loved most about it was not seeing the pod multiple times each day. It almost felt like it wasn’t there at all. I may be alone in this, but some times I’d like to Marie Kondo the devices from my body. Just rip them right off and feel totally free.

I still had the allergic reaction on day 3, but the insertion felt wonderful! And while I usually feel like I have a painful iv by day 3 because the pod has been jostled about so much, this time I feel so much more comfortable. Still a little discomfort (mostly of the allergic variety), but also a slight, slight cannula discomfort. Still, overall feeling better than usual on day 3. So, thanks, Eric, for encouraging us to try new things!

Now, I’m trying to find all sorts of new “pinch an inch” places.

[T1Allison]

For some reason my abdomen really hates adhesive. Like HATES it. And my pen injections welt up there worse than other areas.

I love wearing pods on the back and inside of my arms, as well as my upper tush. Those have all worked best and not reacted as badly adhesive-wise for my skin.

Congrats on a new spot!

[Eric]

Now, I’m trying to find all sorts of new “pinch an inch” places.

Hey, that’s cool. I would love to hear what else you find, because I am always looking for a new spot too!

Hope it works well for you.

[Irish]

@Eric, will do!

One question…

I do have a larger than a lima bean-sized knot under my skin after removing the pod. The itching had been really bad, so now I’m wondering what was going on underneath. I don’t necessarily think the knot is any different from my usual sites. I often have a knot. But this one I can feel more than usual, because it has less fat.

About an hour after removal, I squeezed some insulin out of it and hoped I might get rid of it kinda like a pimple pop, but the knot seems to be the same size as before.

[Eric]

I sometimes get small bumps, but nothing that big.

What insulin are you using? It seemed worse for me with Humalog and Fiasp. NovoLog was not too bad.

That might be good to show your endo. (If you ever got a better endo that the last one you had!!!)

[Irish]

And my pen injections welt up there worse than other areas.

Thanks for this response! When you say welt up, do you mean on the surface of the skin or below it?

Sure wish I could do my lower back. I try to keep arm real estate for the CGM (though I’m starting to rethink this a bit), but the back seems to be off limits for me because I sleep on my back.

[Irish]

sometimes get small bumps, but nothing that big.

What insulin are you using? It seemed worse for me with Humalog and Fiasp. NovoLog was not too bad.

Yeah—the bumps are sore to the touch. Always are, but this one feels more extreme.

Humalog. I’ve been thinking of visiting him (same one, but last visit he was so fed up with his patients not having access to more reasonably priced insulin that he wrote down the contact of our favorite canadian pharmacy and seemed more open to things). I read your take on novalog’s stability with pumps and wondered if this wouldn’t be a better fit for me, since my day 3 numbers seem to be so erratic.

[T1Allison]

I try to keep arm real estate for the CGM (though I’m starting to rethink this a bit), but the back seems to be off limits for me because I sleep on my back.

I use my love handle area for CGM and sleep on it without issue. I don’t struggle with lost signal or discomfort. And honestly, I prefer not to see it. There’s nothing wrong with it, but I prefer my robot parts on my backside, lol.

As for my shot welts, they typically get red and grow up for a day or so. Sometimes I can feel a tough rounded spot under the skin for a few days…but that is typically in an area that bruised significantly with the shot.

[T1Allison]

I can attest to better looking sites by a wide margin after switching to Novolog. Just five or six weeks ago with the gentle idea prodding of my buddy @Eric. He was right on the money with that recommendation. My Day 3 performance is far less degraded on Novolog. My sites are less red and less raised upon pod removal currently.

[Eric]

Humalog.

Definitely try out NovoLog and see if it’s better for you.

Maybe your next run to the border?

[Beacher]

but the back seems to be off limits for me because I sleep on my back.

I mostly sleep on my sides, but I do roll onto my back, and I’ve been pleased to discover that being on my back has not interfered with pods on lower back or upper butt.

I wondered if rotating off [my belly] entirely would be helpful

I try to keep arm real estate for the CGM

Because the CGM isn’t infusing anything into the tissue, the tissue isn’t as “harmed” by it. I find my belly area very reliable for the CGM, which frees up arms for pods (plus, of course, anywhere on the belly that’s more than about 2 inches from a pod, which is actually a lot of pod placements if each insertion point is an inch from the last).

I rotate through five areas – thigh, upper butt, belly/side, arm, and pec – which is more than I ever could on a tubed pump. If I get a minimum of two insertions in each area (just reverse the direction of the second pod and put it roughly where the first one was), it’s a month before I return to the first area in the cycle. And that’s just down one side of my body, so I feel that’s pretty good rotation. (Of course, for a kid who injected in the same place over and over again and has reminders of it decades later, ANY rotation is good.)

My Day 3 performance is far less degraded on Novolog.

Digression from the topic, but were you still getting the third-day problem even after limiting the size of a bolus? My issues disappeared once I did that – with the odd exception, Day 3 is just as good as Day 1.

[T1Allison]

Digression from the topic, but were you still getting the third-day problem even after limiting the size of a bolus? My issues disappeared once I did that – with the odd exception, Day 3 is just as good as Day 1.

I can still tell some degradation on Day 3 but not every time. It’s usually most noticeable when Day 1 of the next pod accomplishes much more with the same amount of basal than Day 3 of the last pod. I guess that could also be difference in site location effectiveness, but it happens enough that I notice it and think it is more linked to Day 1 vs Day 3.

Limiting my bolus size definitely helps…but I can’t totally pin it all down. My pod sites tend to either work fine or fail with the scream of pod death. There’s not a ton of in between. So I guess that’s good? I’ve had two pod deaths this month.

[stearner]

Are they gone by the next day? I often have some puffiness when I initially remove a site now, but by the next day, it has gone down probably 95% (presumably inflammation). I think that’s probably ok/normal.

Contrast this with me 10 years ago who would remove sites (back when they said to wear them for 5 days) and the lumps would also have redness and not clear quickly. It took me a while to figure out it was scar tissue and I’ve still got some of those little lumps inside of me to this day

[TiaG]

do we have a link to the “pinch an inch” rotation suggestion? I must have missed this convo!

[ClaudnDaye]

Maybe this?

Ooops ! Forgot to Bolus

12.7mm is only 1/2 an inch. It’s really not that long for many adults. Try this: Tighten your thigh muscle as hard as you can. Now try to pinch it. The part that is easy to pinch in your fingers is your skin and fat layer. The hard part underneath that does not move is your muscle. This can give you an idea of how long the needle needs to be to get into the muscle. Different areas of your body need different lengths to reach muscle. I use the 12.7mm’s when I want to make absolutely sure.

[Irish]

"New" to Omnipod and Pumping: 4 years in and I feel like I'm missing something

Hi @T1Allison! Welcome! My partner EH has T1, and recently switched from Humalog and Lantus/Tujeo/Triseba (we tried them all) to the OmniPod. Lots of stuff to love about it (suspending basal for exercise, for example) but many knobs to fine tune. We are also still trying to figure it out. We’ve found our endo and CDE to be somewhat useless in the struggle to dial it in, honestly. And EH just goes for it when it comes to making basal adjustments on his own. @Eric is super helpful (and probably…

Here was the section from @TravelingOn that made me pause and start to think:
“Also, we’ve asked for a site change every two days. And we second @Eric’s advice to use plenty of body real estate - I hear his voice in my head chanting “if you can pinch an inch!” all the time (well, about every two or three days when I help EH stick a pod somewhere hard to reach).”

[Irish]

Are they gone by the next day?

Hi, @stearner! Unfortunately, not. Today’s more palpable site is about half the size it was last night, but still really hard and a little sensitive. Maybe reduced to pea size?

5 days!!! I can’t imagine! Sorry to read about the persistent scar tissue.

[DexcomMama]

Try applying hydrocortisone to the area before applying the pod. Make sure to wipe it really well before inserting the pod. My son also has some reaction to the adhesive. This seems to help.

[T1Allison]

Today’s more palpable site is about half the size it was last night, but still really hard and a little sensitive. Maybe reduced to pea size?

I’ve had a new experience that brought this thread to mind.

I have a pea-sized hard lump under the skin at the cannula site from a pod that I removed two weeks ago. Doesn’t hurt. Not red. No bg issues with it. It might be starting to soften up but that may be wishful thinking.

I’ve never had a hard lump like this, and not one that persisted. I’m assuming it’s some sort of tissue trauma and not an infection. I rotate sites carefully. I give each side of my body (left side/right side) a 45 day break before restarting my pod rotation on each side.

Hmmmmmm.

[daisymae]

I read your take on novalog’s stability with pumps and wondered if this wouldn’t be a better fit for me, since my day 3 numbers seem to be so erratic.

just to chime in, and sorry in advance for going a little off topic but: i took Eric’s suggestion regarding the pump site change-out, and now i change my pump out every OTHER day. i have gotten major benefits from this: no scar tissue at previous site, better insulin absorbtion/reliability, and, b/c of no scar tissue, it is MUCH easier to rotate and find fresh insertion sites (my insertion needle slides right in without much effort).

but i am not on the POD. i use Medtronic and they are different systems from what i understand; i can change my site without changing my insulin resevoire, as well, i can re-fill my insulin resevoir without having to change out my pump site.