# Canula Blockages



## Tony R (May 9, 2013)

My son has been on the pump for just over 3 months. I'm pretty sure his basal and bolus rates are about right. However we seem to have had quite a few occurrences when his levels have jumped in the night and I have ended up having to replace the set, probably due to the cannula being pulled or a blockage there. 

We do a nightly check for bubbles and have started to use Micropore tape to stick the tube to his body as he moves a lot during the night.

My question is how often do pump users tend to find they have to replace their tube sets due to readings jumping up. And are there any other users who had had a similar problem (mainly at night) and do they have tips which may help.

At the moment he's on the standard 90 degrees Teflon cannula which comes as a starter with the pump and a 23 inch tube. He also uses an auto set inserter.

Thanks in advance.


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## HOBIE (May 9, 2013)

Hi Toney. I havent had any blocked cannulas in more than 4 years of pumping.  I allways do set changes after being in shower/bath when skin is softer. Like your son i dont sleep still. I regularly work in & out of lofts & have court the canula on ladders etc getting out. & have only broke it from once & nacked   I think your son would be making a noise if it came apart. I use the same cannulas   Good luck finding out


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## Riri (May 9, 2013)

Hia I've been pumping since November 2011 and use the Medtronic pump with silhouette teflon cannulas and the sil serter. To date I've not had a single blockage or any high readings that are due to the site or a bad insertion. I would suggest that you may need to do night time basal tests for a few days running in case it is a change in basal rates that's required. It's a nuisance I know. I find that I have to adjust my basal rates regularly which I didn't expect to be honest. DSN suggests it might be an age thing. I only say this as I speak to a few people new to pumps in my clinic and, like me initially, they don't expect to have to regularly change their rates. Hope you get it sorted soon.


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## everydayupsanddowns (May 9, 2013)

Tony R said:


> My son has been on the pump for just over 3 months. I'm pretty sure his basal and bolus rates are about right. However we seem to have had quite a few occurrences when his levels have jumped in the night and I have ended up having to replace the set, probably due to the cannula being pulled or a blockage there.
> 
> We do a nightly check for bubbles and have started to use Micropore tape to stick the tube to his body as he moves a lot during the night.
> 
> ...



Hi Tony

I had a bit of a recurring issue with sets that either 'kinked' (so that the cannula was bent at 90 degrees when you removed it), gave a 'no delivery' alarm, or just seemed to 'go off' and result in high BGs which quickly resolved after a set change (even though there was nothing apparently 'wrong' when I removed the set).

The problem was - the more it happened, the less I trusted them, and I would often panic and change 'just to be on the safe side. It was happening about every 2-6 weeks at one point.

Following forum comments from other pumpers I decided to try out alternative sets (I too was using 90-degree teflon at the time) at as short a length as was available as it seemed that the cannula was hitting _something_ inside that was messing with absorption.

I can't remember how old your son is, but perhaps he doesn't have a lot of 'spare' and might be better with an angled cannula? I also gather that across the top of the buttocks is a pretty good spot as there is always a decent amount of flesh to go at.

It never seems to matter whether the set is in a position where I might lie on it (I tend to use sides/lovehandles) - but it might be different for a littl'un?

After so few months I'd certainly say it sounds like you are having too many failures. I changed to different sets last September and have only had one dodgy one since!


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## everydayupsanddowns (May 9, 2013)

Riri said:


> DSN suggests it might be an age thing. I only say this as I speak to a few people new to pumps in my clinic and, like me initially, they don't expect to have to regularly change their rates. Hope you get it sorted soon.



I need to tweak basals every few months at least - I did on MDI too. Maybe we're just 'lucky'


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## Redkite (May 10, 2013)

Hi Tony,

If when you remove the cannula you can see a kink in it, it would be well worth trying a different type of cannula.  My son was 7 when he started on the pump and very skinny - the 90 degree cannulas (Quicksets and Mios on the Medtronic) didn't suit him at all, but he's had very good results with angled sets (silhouettes).

The other thing you should consider if the rises in BG are happening overnight is the effect of growth hormones.  Children secrete growth hormones during their sleep (often during the first part of sleep), and this causes insulin resistance and a need for higher basals at that time.  It isn't a steady predictable phenomenon (nothing ever is!), and if your son is having a growth spurt he could need quite an increase in his night basal, then when the growth spurt finishes you will need to swiftly decrease the basal again to prevent a night hypo.  I test my son's BG during the night to try and keep on top of this.


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## Pumper_Sue (May 10, 2013)

Tony R said:


> My son has been on the pump for just over 3 months. I'm pretty sure his basal and bolus rates are about right. However we seem to have had quite a few occurrences when his levels have jumped in the night and I have ended up having to replace the set, probably due to the cannula being pulled or a blockage there.
> Do you actually correct the high and then check an hour later? If not I suggest you do this, that way you will soon see if a cannula problem exists or just a wrong type of meal bolus. High fat and or protein meals tend to wallop the blood sugars late into the night and early morning so an increased basal or extended bolus is needed to counteract this.
> We do a nightly check for bubbles and have started to use Micropore tape to stick the tube to his body as he moves a lot during the night.
> Tape is always a good idea saves a lot of hassel in the long run.
> ...



As to the standard cannulas, the pump supplier has different sorts for each customer to try. So ask for a sample of each one to try if not happy with the ones you are using.


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## Hanmillmum (May 10, 2013)

Hi, we had a spate of problems with the quicksets from medtronic and kinking (6mm tephlon), I really lost confidence in them and so moved to the sure T steel cannulas which we now use predominantly. I have the reasurrance these don't kink so if we find a high reading now we will do a correction and then find it must have been something else, as it works. Downside is more frequent changing but the insertion is easier (manual) and we mostly use the buttocks as my little one is very lean elsewhere.

It would be worthwhile trialling some different cannulas to see what works best


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## Tony R (May 13, 2013)

*Pasta*

I think I've twigged what the majority of the problem is. It's occurred to me that all the recent instances where his readings have shot up, come down a bit with a correction then gone up again, have coincided with him having *pasta*. 

I occurred to me last week it may be a problem. The last couple of nights his readings have been perfect. Then yesterday he had pasta for supper. By 10pm his reading was up 12.3. At midnight it had gone a bit to 9.3BG but by morning it had gone up again to 12.4BG

I know how to use the dual wave bolus feature but I think it's easier just to take pasta off the menu.

I may post this as a general thread to see do many other people have the same problem.


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## everydayupsanddowns (May 13, 2013)

Posts relating to pasta have been split off to join the new thread here: www.diabetessupport.co.uk/boards/showthread.php?p=433815


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## HOBIE (May 13, 2013)

Hi again Toney, i am pleased you may have found prob.  Other people have said they get probs with teflon.  Try & snap/ kink a used 1.  They are really tough.


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## everydayupsanddowns (May 13, 2013)

HOBIE said:


> Hi again Toney, i am pleased you may have found prob.  Other people have said they get probs with teflon.  Try & snap/ kink a used 1.  They are really tough.



Yes I know! It's mad isn't it...  I can't get a kink to stay in just by bending one either - but when I was on Quicksets this is the sort of thing I would occasionally find when I took the set out (hope Anna at 'insulin independent' doesn't mind me using the image!)


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## HOBIE (May 13, 2013)

Soft skin needed ??? On insertion. Try it works for me


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## everydayupsanddowns (May 15, 2013)

Not sure what you mean by soft skin? Is that a product or just the place where the cannula goes?

In any case I was always pretty confident that the cannula went in 'straight' because it has the metal introducer needle running through it... whatever was happening always seemed to be occurring sometime later when the cannula was 'in use'.


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