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Re: [IPk] Re: Question for Teresa



Hi Teresa

As Nanette says, you do need to prime the cannula with every new
insertion. If you think about a cannula as if it's a garden hose,
remember that each time you turn on the hose, there's a delay in the
water coming out the end. That's because of the air that sits in the
garden hose when the water is not flowing through it. Likewise, the
air in the empty (new) cannula means no insulin will reach the body's
tissue until the space in the cannula has been filled with insulin. If
your son is on a basal rate of (say) 0.4 u per hour at the time of day
you do a set change and his cannula requires 1.0 u to be filled, he's
missing over 2 hours of his basal insulin every time you do a cannula
change.

Just to check, when you change the cannula you are selecting a
different infusion site on the other side of Mackenzie's body, right?
i.e., if he had a cannula put in on his right side on a Monday, you're
putting the new cannula in on the left side of his body on a
Wednesday. Site rotation like this is very important for making sure
Mackenzie has sites for his infusion sets for years to come.

Recent clinical research has shown that keeping insulin in the
cartridge and tubing for more than 3 days can in some cases cause
problems with diabetes control. Plenty of adults will say they don't
notice a difference when the insulin has been in the cartridge for 6
days or more, and that they use the same length of tubing more than 2
times, but it seems that some quite insulin-sensitive people
(particularly small children) may need to have a complete change of
the set every 3 days. You may find that when you try the Rapid D Links
Mackenzie can get 3 days rather than 2 out of a set. If that's the
case, you can plan to do a complete set and cannula change once every
three days and see how that goes. If you still need to do cannula
changes every 2 days, you may get into a groove where you do a cannula
change on day 1, a cartridge change on day 2, then a cannula change on
day 3, then leave it all alone on day 4, then a complete cannula and
set change on day 5.

You do not have to waste a lot of insulin if you change the cartridge
every 3 days. Instead of filling the cartridge up all the way, you can
fill the cartridge with just the amount of insulin that Mackenzie
usually needs for 3 days. To get an idea of how much insulin Mackenzie
usually needs in 1 day, you can review (say) a week's worth of the
total daily dose history on his pump and take the average. Multiply 1
day's average insulin use by 3, then add 10% more insulin than he
usually needs (in case he needs extra one day), then add 12 units to
prime the tubing and the cannula (if he's using 23-inch tubing, which
I would guess he is).

Does that make sense?

All best

Melissa

>
 > Got on to my DSN this morning who is letting me sample some Rapid D sets as
we
 > have had a few problems with the teflon ones bending especially in his tummy.
I
> will try leaving old one in situ as advised
>
> Thank you so much
>
>> ----- Original Message -----
>> From: Melissa Ford
>> Sent: 06/29/11 08:40 AM
>> To: email @ redacted
>> Subject: [IPk] Re: Question for Teresa
>>
>> Hi Teresa
>>
>> Can you clarify what you mean by "new insertion" versus "set change"?
>> Do FlexLink sets come packaged so that you're meant to use each length
>> of tubing twice, ie one length of tubing per 2 cannula changes?
>>
>> Re the highs after a new cannula, that's pretty common. A lot of
>> people (myself included) find that leaving the old set in place on the
>> body for a few hours (no tubing attached to it) after changing the
>> cannula seems to help. The insulin sitting in the old cannula seems to
>> help smoothe the transition to the new cannula.
>>
>> Of course if the reason for the set change is irritation or bleeding
>> (etc) at the old site, it's best to remove the old set rather than let
>> it sit. If the blood glucose is very high at the time of the set
>> change, you may wish to deliver the correction bolus by injection,
>> then change the set right after the bolus to get the glucose down
>> quickly. If you give a bolus by injection in this way, it's a good
>> idea to deliver the same amount by pump whilst the pump is NOT
>> connected to the infusion set so you have a record of the bolus in the
>> pump history.
>>
>> Does that make sense?
>>
>> Melissa
>>
>>
>> On Wednesday, June 29, 2011,  <email @ redacted> wrote:
>>  > Thank you so much for the advice. Can you tell me if you fill the cannula
>> after
 > > > each new insertion or just set change as agter a new cannula is fitted we
> get
 >> > high numbers for a few hors with the correction not working the first
time.
>> >
>> > Cheers
>> >
>> > Teresa
>> >
>> >> ----- Original Message -----
>> >> From: Melissa Ford
>> >> Sent: 29/06/11 06:51 AM
>> >> To: email @ redacted
>> >> Subject: [IPk] Re: Question for Teresa
>> >>
>> >> Hi Iain
>> >>
>> >> It depends on the person - people have different thresholds for pain
>> >> and some people will feel the withdrawal of the needle more than
>> >> others. It can be more painful for children because they tend to
>> >> squirm around, which creates vibration and thus stimulates nerve
>> >> endings in the subcutaneous tissue as the needle is being pulled out.
>> >> Even if the child is very still, another person doing the set change
>> >> may unconsciously introduce vibration whilst withdrawing the needle.
>> >>
>> >> If you're happy with your sets, keep doing what you're doing. Just
>> >> ensure you're rotating your sets around enough so you're not
>> >> developing scar tissue. If you feel nothing at all (i.e. it's as if
>> >> the tissue below the skin is numb) when you insert a set, you may have
>> >> hit on an area of damaged/scarred tissue. Continually putting sets
>> >> into damaged tissue can lead to trouble with absorption and,
>> >> therefore, unpredictable blood glucose levels (just what we try to
>> >> avoid with a pump).
>> >>
>> >> Melissa
>> >> Type 1 18+ years; MiniMed pumper 7.5 years; Animas pumper 6.5 years;
>> >> currently writing up a paper on infusion site management for diabetes
>> >> care professionals (freelance gig)
>> >>
>> >> On Wednesday, June 29, 2011, Iain Jenkins <email @ redacted> wrote:
>> >> > Hi Melissa,
>> >> >
>>  >> > What are the problems regarding introducer withdrawal - I don't have
>> issues
 >> >> > with medtronic quicksets and silhouettes, maybe some other types that I
>> >> should
>> >> > be wary of?
>> >> >
>> >> > With every good wish,
>> >> >
>> >> > Iain.
>> >> > T1 Essex, UK.
>> >> > minimed 515 pump
>> >> > Current A1C February 2011 5.7.
>> >> >
>  > >> > Help diabetics to reach their full potential through athletic
> endeavours:
>> >> > http://www.insulindependence.org
>> >> >
>> >> > --- On Tue, 28/6/11, Melissa Ford <email @ redacted> wrote:
>> >> > The big benefit, they say, is
>> >> > set changes are a lot easier without having to withdraw the introducer
>> >> > needle (the worst part of a set change for many of us, even adults).
>> >> >
>> >> > All best
>> >> >
>> >> > Melissa
>> >> > .
>> >> .
>> > .
>> .
> .
.
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