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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
> 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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