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Re: [IP] Silhouette, Comfort, Tender insertion angle

Maureen Reagan wrote:
> Last night, I was told I was inserting my Silouette set too shallowly
> (about 30 degree angle). 

Who told you that? Actually it's wrong, the angle is set by YOU for your needs.
The instrructions say that it should be inserted at 30 to 45 degrees,so you
are still in the normally recommended range, but many here have found that 
going to as little as 15 degrees works for them. Of course estimating the angle
going into a curved surface is a BIT problematical for most people....

 I had never tried it deeper, and thought maybe I
> had got confused somehow with my thinking that you can insert it shallower

No, you were right. Thing is that people vary, and these sets are designed to
let YOU adjust the depth as needed for your body.

> (I'm on the thin side, one of my reasons for not using the Sof-Set).  So I
> inserted on a 45 degree angle (abdomen is where it is right now).  First,
> the insertion was a lot more painful.  

Yes, and a very painful insertion likely means it went all the way through 
your thin fat layer and into the muscle below where you DON'T want it to go. 
That's what you bought this kind of set to avoid, after all.

But I can get over that.  But since
> then, occassionally when I twist or pick up something with a little wieght,
> I feel something in my side rubbing (it took twice to figure out that it
> was probably my infusion set, it isn't pain, but I definately don't like
> the feeling of something rubbing underneath my skin).  The site looks okay,
> but when I jab at it I can feel it (which I never could before, it isn't
> pain that much, I just can feel it).  So this is what I'm wondering.  Is it
> just the site that is causing this or could it be the angle I inserted?

Sounds like the angle is too steep and the tip is being moved across the 
muscle by the different acting fat layer, which tends to crimp sets faster than
most things would. Why change what worked before because of somebody else's 
impression of what's "right"?????

> Also I inserted it vertically (my pump trainers suggestion), could that be
> another source of the problem?

NO WAY do you insert a Comfort/Silhouette/Tender set vertically. Thing is
regular insulin needles are a set length which is 1/2", though new thinner 
ones are somewhat shorter. There's a reason for this, the insulin MUST be 
delivered into the fat layer, NOT into the muscle below, because the fat 
delays absorption somewhat, which helps smooth things out. Shooting
into muscle gives faster action, but hurts besides. 

Sounds like your pump trainer doesn't understand geometry. MiniMed QR sets
go straight in, and have 1/2" long canulas. Silhouette, Comfort, Tender sets
are a lot longer to get to that depth, or a slightly different one as needed,
NOT straight in, but on an angle. It's a triangle, with the depth of the tip 
as a short side, the canula itself as the hypotenuse (longest leg) and the
distance sideways that the tip is under the skin as the other short side. 
I imagine your pump trainer is used to the QR approach without much idea
WHAT'S going on with what you use now.

Ted Quick
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