Post-Site Change Highs

[Emck]

Hi all,

I’m a newbie on the forum, but am hoping that someone might be able to help me out.

I started pumping with the Tandem TSlim x2l last summer.

Ever since then I have been having issues with post-site change highs. I find this really stressful and hard to manage.

I have tried multiple types of infusion set (autosoft 30, autosoft 90, trusteel and varisoft) but nothing is helping.

Tandem and my hospital have been no help in trying to figure out a solution. I’m at my wits end!!

Has anyone else had this issue and found a solution that worked for them??

Thanks,
Emer

 

[m1dnc]

I have this too to some extent - not enough to make it stressful though. I think that it might be about absorption only really getting going when a "pool" of insulin has formed at the new cannula site. What I have tried with some success is to immediately dial in a one unit dose when the new set is attached irrespective of any other bolus. This seems to get the absorption process going quicker.

I discussed this with my DSN last year, and her reaction was basically "whatever works for you dear".

 

[Thebearcametoo]

It takes a few hours for the set to settle in with my kid so a high after insertion is common. We tend to do a couple of units when the set goes on which helps or up the basal for a few hours. It depends how high you go and whether you’re using basal or control iq or anything. The other thing to do it do a couple of units with the old set before you take it off if you know you’ll put the new set on immediately.

One thing we were told was to try and avoid a big bolus on a new set as it can be hard to absorb so it depends if you’re eating at the time you change the set or not.

 

[Emck]

Thanks for the replies.

I never really thought about avoiding a bigger bolus through the new site.

I have quite high insulin resistance, so my mealtime blouses are probably larger than most.

The highs do tend to come after a meal bolus.

I wonder if leaving my old site on for boluses and using the new site for basal might let it settle more easily.

 

[nonethewiser]

Ever since starting on pump bg has gone up after infusion change, so always do correction bolus half hour before to prevent it happening.

 

[SB2015]

If you are changing before a meal so then following it with a meal bolus, I am wondering whether you are pre-bolusing for meal, and whether the timing of these boluses needs to be reviewed. This would only make sense if the highs happen on meals where there has been no set change too, but I thought that it was worth mentioning.

 

[Thebearcametoo]

Thanks for the replies.

I never really thought about avoiding a bigger bolus through the new site.

I have quite high insulin resistance, so my mealtime blouses are probably larger than most.

The highs do tend to come after a meal bolus.

I wonder if leaving my old site on for boluses and using the new site for basal might let it settle more easily.

You could try splitting the bolus. It doesn’t need to be for a long time, 15 minutes or so. But yes if you’re changing a set just before you eat it might be worth doing the bolus through the old cannula then switching. Just as long as you don’t forget.

 

[Pumper_Sue]

Can you change the speed of insulin delivery? Also perhaps try a split bolus as well.
Are you also sure your basal is correct?

 

[everydayupsanddowns]

One thing we were told was to try and avoid a big bolus on a new set as it can be hard to absorb so it depends if you’re eating at the time you change the set or not.

Weirdly I was advised to actively try to do a set change before a meal so that I’d need to push a ‘proper’ bolus through it, and give the site a dose to ‘start it off’. And that I should have a carby snack if no meal was imminent.

I have relaxed a bit on the tSlim, and don’t stress too much is a full meal isn’t happening, but I’d have something like 10-20g of carbs partly to push a bolus through, and partly to check it’s working OK.

Sites can be a bit slow to get going (I think I notice this more on tSlim than Medtronic), so sometimes I add an extra unit to the meal bolus and then keep an eye on things

 

[Emck]

If you are changing before a meal so then following it with a meal bolus, I am wondering whether you are pre-bolusing for meal, and whether the timing of these boluses needs to be reviewed. This would only make sense if the highs happen on meals where there has been no set change too, but I thought that it was worth mentioning.

It doesn’t happen at any other time, except on site change days.

 

[Emck]

Weirdly I was advised to actively try to do a set change before a meal so that I’d need to push a ‘proper’ bolus through it, and give the site a dose to ‘start it off’. And that I should have a carby snack if no meal was imminent.

I have relaxed a bit on the tSlim, and don’t stress too much is a full meal isn’t happening, but I’d have something like 10-20g of carbs partly to push a bolus through, and partly to check it’s working OK.

Sites can be a bit slow to get going (I think I notice this more on tSlim than Medtronic), so sometimes I add an extra unit to the meal bolus and then keep an eye on things

Strange how everyone has a different reaction!

I do have quite large boluses. Some meals my ratio can be 1u:4g, so even a sandwich could be 10u! So it would make sense that the site would struggle to absorb it.

I have been diabetic for a long time, so I wonder if I might have some superficial scar tissue that the insulin needs to “push” through.

I’ve been looking into swapping to trusteel, to rule out a reaction to the cannula. I’m also considering longer cannulas but think that could be painful with the trusteel.

 

[RichardS]

Up to 2022 I had been using a Medtronic pump for 12 years and from the 6th year onwards for 12 - 16 hours after I changed the infusion sets I would go high and the insulin I would bolus would only have limited effect (so eating anything resulted in a very high BG). After that first period everything was fine. I got to the point where I would try and avoid food for that period of time because the insulin just didn't seem to work.

Discussing with my DSN and consultant was frustrating because they didnt have anything to offer. I believe it was linked to site over-use (I only used my abdomen as anywhere else was impractical). Hence why I chose a patch pump from 2022 onwards so I could apply the patch elsewhere (which is what I now do). Things have improved although every now and then I get a repeat (and reliability of the patches has been an issue for me - hopefully now resolved).

If it is site re-use that leads to this then I think there will come a time when I may not be able to use any pump and will need to revert to injections/pen. This doesn't worry me like it once would have - I (personally) think a CGM (Dexcom G6 user) is much more useful for me than a pump.