Child Pump Infusion Site not lasting

[mkh2]

My 6 year old's infusion sites now only last about 1 day before poor absorption results in high glucose numbers.  When we started on the pump 4 months ago, they lasted just over 2 days.  Sites become red and a small hard spot appears.  We have tried needle and cannula sets.  He also has a primary immune deficiency. I am wondering if anyone else has to change sites so often, and whether it could be the insulin (humalog)?  We love the flexibility and precision of the pump, but this has been difficult.

[JDRF-Team-LRS]

Hello MKH2,
As you may know, we're all volunteers here and none of us is a medical professional.  We all have learned about diabetes in the same ways you are.

I happen to be a pumper also and have a few suggestions for you to discuss with your son's endo.  I'm sure you know how important it is for a physician who knows the details of your son's condition to evaluate the ideas that work for someone else.  So, with all those disclaimers, here's what I've found ...

I used Humalog for a number of years and found that I had skin reactions & absorption issues more quickly than in the "old days" when only Regular was available to me.  I was about to switch to Regular (there is/was a formulation called Velosulin designed specifically for use in pumps), when my pump rep (also a pumper) told me about Novolog, which *has* been approved for use in pumps.

Its action is similar to, but not exactly the same as, Humalog.  Some folks find it starts/stops working more quickly, so if your son's endo thinks it's safe to try it, be sure to monitor closely.  In a 6-year old munchkin, it's tough to find "new" sites for pumping rotations, but do try to give a reactive site some rest.

This slide show was very useful to me a few years ago.  I revisit it from time to time to refresh my knowledge.  This isn't directly related to your question, but if you are able to continue pumping, you might find this helpful, too:
http://www.diabetesnet.com/diabetes_technology/insulin-pumps-advanced.html

Finally, if you'd like to have more direct support from knowledgeable volunteers in your area, please contact our sister group, JDRF's Online Diabetes Support Team and let them know we sent you!  (Visit www.jdrf.org and then click on their link to Online Diabetes Support Team ... it's NOT just for newly diagnosed folks :-) ).

Good luck and let us know how things work out, okay?

[JDRF-Team-LRS]

It might have been implied in my answer, but I have had excellent results using Novolog in my pump.  Normally, I change my site twice a week, with good absorption and no more bumps & redness.  I've been using Novolog for 3-4 years at least.

[TonyAlmeida]

You didn't mention where you were putting the sites.

Novolog and Humalog are what we call *designer insulins* - not quite the same as Regular Insulin, but derived from it.  Which is obvious since they act within 15 minutes or less.  The main difference I've found between the two is in the preservative used .... some people have an allergic reaction to to the Humalog preservative and Novolog works better (and vice versa).  As far as speed - I really couldn't tell a difference between the two, I guess it just varies from person to person like everything else.  You'll know it's a preservative issue if your child complains the site "really itches" even after a day.

Poor absorbtion comes from a variety of things.  Using an area too much is the main culprit ... but putting the site into muscle tissue is another, putting the site in an extremely fatty area, and just plain Insulin Resistance (Like Type 2 Diabetics suffer from) is yet another cause.  Some people have put infusion sets into their thighs and had no absorbtion at all.

If the red bumps you are talking about are those tiny little needle sized red dots that appear where the cannula was put through the skin ... that's normal for a lot of people.  It's a wound and the skin is healing itself.  Some people with very sensitive skin get these all the time, other people never get them.  You'll see it more common on leaner diabetics than heavier ones.  Some people still insist this is a teflon cannula allergy, but it's not likely.

If the skin around the cannula is red where the tape was a day after you pull the set (it will be red right after the site removal and air hits the area, combination of suction from pulling off adhesive and the fact skin hates anything taped to it) - then it's a tape allergy and you need to get a wipe on barrier film like Bard Barrier or IVPrep or Tegaderm to act as a buffer between the skin and the tape.

If Humalog isn't doing the job, then IMHO you should ask your endo to switch your child to Novolog on a trial basis.  If the sites still are not working - you may have to just go back to MDI and try the pump again at a later age when there aren't so many body chemistry changes happening.

[mkh2]

The diabetes nurse agreed to a Novolog trial, and we have not had a problem with his site since (4 weeks and counting).  I am still changing every 2 days, to be on the safe side.  The new insulin seems to work faster, so he doesn't go as high after meals either.  We couldn't be more pleased, nor more grateful for the suggestion.  Thank you!

[goofybrandon]

i where an minimed insulin pump and i get infections in the insertion site. humalog is not very stabe so maby try novolog or apidra.  one reson for this is humalog has a active insulin time of more of 3 but novlog and apidra is 4. also you might want to try a tape kit it is where you put a tegaderm on your stomach and then insert the infusion set over that. usual that will help for some one like your child. i am not advised in the medical feild but i am a user of a pump.