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Re: [IP] 2nd time...insulin INJECTED through an infusion site

In a message dated 10/13/2002 9:07:16 PM Mountain Daylight Time, 
email @ redacted writes:

> My 3 year old daughter will be starting a saline trial soon, and I am 
> wondering if anyone has ever done, or heard of being done, injecting her 
> insulin doses through the site. I just think it would be too confusing to 
> her to still get a shot even though she's wearing a pump. We would bolus 
> the 
> insulin through (after hooking back up) with saline, so, I really don't see 
> a problem with it, but then again, what do I know?

It definitely can be done (we did it using Comfort sets -- which are basicaly 
the same as Silhouettes & Tenders) , and I agree that with such a little one 
shots AND a pump could be very confusing.  However, making sure she gets 
accurate dosing could be very tricky, particularly when switching back & 
forth between insulin and saline . . .

When we did it, there was no saline involved so we only had to fill the 
cannula with insulin once and then just inject in the right insulin dose into 
the set each time thereafter.  Basically, we disconnected the set (no tubing 
attached) and inserted the needle from the syringe into the same hole that 
the introducer needle went through at insertion.  Before trying it on my 
daughter, I took apart a set and practiced inserting the syringe needle into. 
 It was very easy to do with this type of set (the angled insertion kind:   
Comfort/Silhouette/Tender), but I don't think it would be very easy to do 
with the Quick-sets my daughter normally uses with her pump (still could 
probably be done, I just don't think it would be very easy).

The potential problem I see when you're switching back and forth is because 
you have to allow for filling up the cannula with insulin (anywhere from 
about .3 units to 1.0 units or more depending on the type of set & cannula 
length you're using) plus the actual dosage amount you want her to get.  This 
would work fine for the first injection because filling the cannula with 
insulin is simply going to push the *saline* that's already in the cannula 
into her body (not a problem).  BUT, when you go to hook the pump with saline 
back up to the set, the saline basals and boluses will then be pushing the 
insulin that's filling the cannula into her (and with a little one that could 
be a pretty significant amount of insulin -- potential BIG problem).  Another 
potential problem I see is the possibility the the mixing of the insulin and 
saline could interfere with the insulin action . . . I hope this is making 
sense to you, and I'm sure that someone will correct me if my thinking is 
wrong, but in any case I'm not sure that this would be something I'd want to 
try out on a 3 year old (JMO).

I do have two suggestions that may be viable alternatives, depending on the 
underlaying goals of doing a saline trial:

If the purpose of ths saline trial is to see how she (the three year old) 
handles being "hooked up" 24/7, you might want to insert one set and reserve 
that set for injecting insulin into (i.e. not hooked up to the pump and with 
no saline solution involved).  Then, take another set, pull out the 
introducer needle and fold the cannula out of the way and stick that to her 
skin (without actually inserting under her skin on this second set) -- hook 
the pump up (with an empty cartridge in it).  

Even before my daughter had her saline trial, they had us use this "just 
stick a set to the skin without inserting the cannula and practice wearing a 
pump" method for several days so that she could experience what it's like 
have a pump attached to you all the time.  With a three year old, you could 
also just do her regular shots and let her wear the stuck on set &  wear the 
pump if you talked with her that about "pretend" pumping (kind of like "dress 
up") -- some three would be able to understand that distinction and some 
would just get confused (like you said) . . .

If, however, the purpose of the saline trial is to get familiar with using 
(operating) the pump, I'd suggest that one or both PARENTS do the saline 
trial for several days instead of your daughter.  Since she's three, even 
though she's going to be wearing the pump it is her parents/caregivers who 
will be responsible for operating the pump.  Even though my daughter was old 
enough at pump start (10) that she needed to do the saline trial so that she 
could get comfortable with operating the pump, we parents also did saline 
trials.  It was an invaluable experience (on several levels) for us and one 
that I would recommend for any parent of a prospective pumper . . .

Anyways, that's my 2 cents on the issue . . . Good luck to you!

Pumpmama to Katie (12) happily pumping with her Animas pump "Elvis" since 
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