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Re: [IPk] pump bumps



Pump Bumps

I'll give you a rundown of what I experience.  I use a D pump also and
I used Tenders for quite some time (am now on the bent needles).
After many months of effort I came to the conclusion that I (my
tissue) was allergic to Humalog or some component of it (probably the
buffer).  My total daily basal usage is 28u with bolus usage about 20u
(I eat pretty meagerly on a low-carb regime), so I'm not flooding a
lot of insulin into a small area of subcut tissue.

 24 hours after putting in a new Tender I see a rosy red "blotch" on
the surface of the skin centred directly above where the end of the
teflon cannula would be in my subcut tissue.  The blotch size is about
1cm in diameter and can spread to be slightly larger.  At about this
time this blotchy area starts to become tender to the touch.

 At 48 hours there is some hardening of the tissue centred on the
blotch.  This is much like a little bump, a mounding-up of the tissue.
It is firm to the touch when I run my fingers across the area.  The
red blotch is also still there.  Absorption is still fine.

 At 72 hours I would usually remove the Tender and place a new one
 somewhere else.  On exit of the cannula I make these observations:

 1	The red blotch is still there
 2	The hardening or lump under the skin has progressed
	into a more noticeable lump, and this can be quite red
	and tender to the touch.
 3	There is no infection as such.
 4	Absorption is fine.
 5	The lump/bump takes several days to heal completely.

 CONCLUSION:	Humalog allergic reaction.  I know it's Humalog that's
 causing the site tissue problems as when I pump Regular insulin I
only ever get a much smaller red blotch after 24 hours and this goes
on to fade to nothing from there, no lumps or tenderness, really nice,
and a Tender easily lasts 3-4 days.  If you read the package insert
with the Humalog it talks about allergic reactions and pretty much
describes what I am seeing.

I also note that my insulin absorption from these bumpy sites on
Humalog seems totally fine.  I seldom get site failures or erratic
BGs.  But clearly there are undesirable tissue changes and as time
goes on this will probably leave my tissue in a bad way, but I don't
really know what the long-term effect would be (anyone hazard a guess
at this please?).

 I use excellent field hygenic technique.  I clean the skin with a
spray containing chlorhexidine and cetrimide which I buy in 30ml
ampules.  I use 3M "No Sting" spray to provide a barrier to the skin
as I have skin sensitive to all brands of tape known to man, plus this
makes things nice and sticky so the tape sticky well yet comes off
cleanly.  I wash my hands carefully with 4% chlorhexidine foaming hand
wash under water.  I did once use the Skin Preps but gave them up for
cost reasons, and I noticed the same allergic reaction using them.

I tried switching to Regular insulin as a last resort but in fact if I
had have tried this early on I would have saved myself a lot of trial
and error and a lot of infusion sets!!!  Trying R is well worth a
shot, but talk with your doc about this (and remember, you are in
charge of your diabetes, not your doctor, so be assertive and
confident when dealing with them especially if their is resistance to
your ideas).  You will need to retard your basal timings by 1 hour on
Regular due to it's activity being slower than Humalog's.

A comment on NovoRapid.  I also tried this insulin thinking I may be
able to use this rapid analogue instead of Humalog, hoping that the
tissue allergic reactions would not appear.  Unfortunately, I
experienced the exact same problems on NovoRapid as I did on Humalog.

I now use Humalog with a bent needle infusion set.  This enables me to
re-site my needle each 24 hours and this nips the Humalog tissue
changes in the bud.  If I leave the bent needle or in fact Rapid in
for 2-3 days I notice exactly the same things as with the Tender,
therefore it's not the infusion set causing the problem.

Good luck!  I can empathise strongly with you, been there!

Mike

PS:	If your BGs are unstable there may be other reasons for this.
Have you gone to the effort of rigorously setting your basals by
skipping meals and their bolus and checking to see if the BGs are
stable throughout, for all parts of the day?  If you use Tenders then
your technique may need a look at - Tenders require good technique to
insert them and this takes time to learn.

Regards
- Mike
 __________


>> I've been using a Disotronic pump for 7 months, and am really
>> pleased with the flexibility it allows me. I don't seem to be able
>> to achieve stable blood sugars though- can range from LO to 18/20s.
>> Could this be the pump bumps I've heard about?  I've tried different
>> infusion sets, needle lengths and - obviously -sites, but get hard
>> (often sore) lumps almost every time. I change sites every 2 days
>> now - anybody else experienced this  and  is it normal part of pump
>> therapy?
>>
>
>No, not normal. Based on reports from other pump users with similar
>experiences, the problem usually has one of several possible origins.
>
>1) Sensitivity to a component in a "prep" material or "tape" that
>irritates the infusion wound. This is usually fixed by switching from
>one type of tape to another or from one prep mfg to another, i.e.
>Bards to Smith & Nephew or visa versa. Switching to a non-latex tape
>such as IV3000 -- even that bothers some people and other tapes work
>for them instead. There are some paper based tapes from 3m that work
>in a pinch.
>
>2) Sensitivity to the plastic material used in the cannula. Try
>SofSets vs Sil/Tender/Comfort set -- or use Disetronic Rapids for a
>while.
>
>3) Sensitivity to Humalog -- Try FIRST using straight regular or
>Velosulin insulin to eliminate or confirm Humalog as the culprit. If
>so, then try a mix of 5 parts H and 1 part V (or R).
>
>4) You may be a "Staph" carrier. These little guys live in some
>people's nasal cavities and are benign THERE, but cause serious
>problems when they make their way into a wound. You can easily
>be tested to confirm or refute this. Revised sterile field techniques
>will eliminate this as a source of contamination. I won't review them
>here at this time.
>
>These options should be discussed with your health care provider.
>
>Only ONE thing should be change at a time in your management regimen
>so that you can clearly identify what has been eliminated when the
>problem goes away. Changing two or more things at the same time makes
>this difficult.
>
>Michael
>email @ redacted
>- ----------------------------------------------------------
>for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
>help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml
>
>------------------------------
>
>Date: Fri, 23 Feb 2001 18:00:35 -0000
>From: "Kate Clapham" <email @ redacted>
>Subject: Re: [IPk] pump bumps
>
>Hiya SallyAnne,
>
>I have been using an H-tron for nearly 2 years now, and still get the
>occassional lump - I have to change my infusion site every 2 days too -
>although I know people who seem to get away with much longer...
>I use savlon woundwash to clean my skin before inserting the canula - it
>fits into the case very neatly, and lasts forever! and have had toswitch to
>Tegaderm from Opsite as I seem to be allergic to it (Tegaderm seems much
>better as it doesn't leave as much mucky residue either!)
>I wouldn't recommend changing insulin without discussing it with your
>consultant first - have you tried talking to Rita at Disetronic? She might
>be able to suggest something you haven't tried yet...
>The number for the office is 02476 531338 (although I think Estelle is away
>at the moment, and I doubt anyone will be there before Monday!)
>If you are having problems with swinging blood sugars, it might be worth
>having a chat with them anyway...
>
>Good Luck,
>
>Kate
>- ----- Original Message -----
>From: "James Baldwin" <email @ redacted>
>To: <email @ redacted>
>Sent: Friday, February 23, 2001 5:43 PM
>Subject: [IPk] pump bumps
>
>
>> Hi,
>>
>> I've been using a Disotronic pump for 7 months, and am really pleased with
>> the flexibility it allows me. I don't seem to be able to achieve stable
>> blood sugars though- can range from LO to 18/20s. Could this be the pump
>> bumps I've heard about?  I've tried different infusion sets, needle
>lengths
>> and - obviously -sites, but get hard (often sore) lumps almost every time.
>I
>> change sites every 2 days now - anybody else experienced this  and  is it
>> normal part of pump therapy?
>>
>> tia,  SallyAnne
>> ----------------------------------------------------------
>> for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
>> help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml
>>
>- ----------------------------------------------------------
>for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
>help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml
>
>------------------------------
>
>Date: Sun, 25 Feb 2001 21:47:34 -0000
>From: "Abigail King" <email @ redacted>
>Subject: [IPk] new site
>
>I've just put a tender in my chest wall ( 2 to 3 inches below breast) as
>I've become fed up of using my abdomen. Have already had sucess with sites
>over my lower ribs (last 2 sets) despite not having a vast amount of fat (I
>just insert at a more oblique angle). I thought it might be worth rotating
>sites a bit rather than "wearing out " my abdomen . Thighs aren't bad but I
>seem to catch when pulling trousers on and off. I'm sure the area I'm using
>now isn't in an "acceptable " place according to the diagram. I can't think
>of any reason why it should be a problem other than the risk of
>inadvertantly infusing into muscle???
>- ----------------------------------------------------------
>for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
>help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml
>
>------------------------------
>
>End of ip-uk-digest V1 #433
>***************************
>
----------------------------------------------------------
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