# Quicksets? Silhouettes?



## Patricia (Apr 23, 2010)

First off all -- apologies for not being here for just too long. Glad to meet you everyone I haven't met yet, and howdy to all I do know...

Just a quick question this time: anyone else running into problems with the bog standard quicksets? I know Mand has had some difficulties...anyone else?

Saying this because it looks like we will have to switch to the more fiddly silhouettes... My son keeps having No Delivery messages, and we are at risk of losing confidence in the pump etc... Medtronic think that he is always running into muscle now, esp as he tries to vary his sites...and the cannula is either bending (happened three times in quick succession) or not delivering properly and 'backing up' as a result. They are being EXTREMELY helpful, and think this shift may be due to growth, and everything 'stretching' out, eg less subcutaneous fat.

Anyone else encountered problems?

More to the point, anyone else using silhouettes? How do you find them? We tried to do one at home two days ago and it was a real mess. There is clearly much more of a 'knack' to them? Off to clinic we go asap.

Bye!


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## bev (Apr 23, 2010)

Hi Patricia,

So far we havent had a problem with quick sets - but Adrienne said there is a problem with the adhesive causing rashes I think (?).
I think its Adrienne that uses sils - I am sure she will be able to advise on how best to use them.
Have you tried the quicksets on the bottom? I used to do this with A as there was enough fat etc. The only problem we found was that it was difficult reaching to take off for rugby. You could also try the top of the thigh if you dont want to change to sils.Bev


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## Patricia (Apr 23, 2010)

Thanks Bev. He's totally against the bottom thing -- no way! And he doesn't have enough fat on the thigh either. I think part of what's happening is he is just like a bean pole at the moment, really growing -- 6 cms or so in last few months. His body make-up seems to be completely changing.

Okay, I'll see if Adrienne picks this up... I seem to remember she tried quicksets but went back to sils?

Thanking you...


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## Cate (Apr 23, 2010)

When I first got my pump I tried the silhouette first as I thought it would suit me better - I preferred the angled insertion rather than straight down.  But I only tried a couple and switched to the quickset instead.  I know there is an insertion device for the silhouettes, are you using one?  IME that cuts out some of the potential problems.

Having said that, I've sadly got lots of S/C fat so don't normally have problems with them.  In nearly 6 years I think I've had set failures on about 3 occasions.  I have had a couple of No Delivery messages, and after getting one while out with no spares, re-delivered the bolus and kept an eye on BS results - which were normal.  So I'm slightly less worried about that now, though obviously always try and keep spares in my handbag!


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## Freddie99 (Apr 23, 2010)

Hi Patricia,

I use the quick sets from Medtronic. Perhaps trying the silhouette sets would be worth it if they quick sets are getting caught up against the muscles?

Tom


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## Mand (Apr 23, 2010)

Yes, we are having same problems as Patricia. Three 'no delivery' in the past couple of weeks and one bent cannula. Also have experienced high bloods for several hours after doing a set change which has prompted us to do another change (even when there is not a 'no delivery' and the removed cannula has not been bent).

My son is slim but does have a little extra fat around the tummy area and so not completely convinced that in his case he is hitting muscle. The hitting muscle theory certainly makes sense though.

We have swapped to a new batch of quicksets that Medtronic (who have been very supportive) sent us and so far so good. Just coicidence? We will have to wait and see. 

The pump is fantastic and i am so grateful that he has one. We just need to get over this current problem with the sets.


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## purpleshadez (Apr 23, 2010)

I tried the silhouettes on the advice of my DSN as I'm quite slim. Initially I thought they were good as with the quick set i had re-site almost every time I changed the canula due to high readings. However, despite not having to re-site with the silhouettes I have found that it REALLY hurts when you get it wrong. This made me get a bit nervous when it was time to change so this week I've decided to try the quick sets again and so far so good. I'm not sure what I'm going to do about it to be honest. I will probably see how I get on with the quick sets until my next appointment at the end of may and discuss it with my nurse. I wasn't using the inserter though so I may try them again with that.

Sorry, not the most helpful post as the jury is still out on them for me.


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## Sugarbum (Apr 23, 2010)

Hi all,

I am using the quicksets and always have done, but I am finding this thread very interesting because I am scaring very badly, having some bad reactions and a belly that looks like Ive got chicken pox I know!). I was thinking of trying the siloutte....

I was going to ask my DSN next time I went in but that isnt for a while, see if she had some as a sample of something...

Its interesting to read what has been said about the siloutte....but perhaps it might be case of 'better the devil you know'? I havent had any no delivery messages. Sounds like you guys are getting a few?

Given the past experiences of pumpung on the other versions, this must make you feel a little aprehensive? It would me.


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## tracey w (Apr 24, 2010)

Hi,

I use roche tenderlink, which i believe are the same as silhouettes.

You insert by hand at a 45 degree angle, they lie flatter on your body and i have never encountered any problems with delivery or bending or even pulling out. Even when ,as we do in a rush to get changed, the pump ends up hanging off the body. Yes there is the ouch factor there but never ever had i had one come out or need changing beccause of this (yet).

They are apparently designed for leaner, muscular people, hence 45 degrees, however im definately not in that category.!

Personally i find inserting them myself much easier and calmer than the ones with the inserter, tried it once, never again!

Pain factor, sometimes nothing, sometimes little sore but nothing terrible.


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## Patricia (Apr 25, 2010)

Wow incredibly useful stuff, thank you all. Like everyone is saying, in some ways jury still out...

We are off Wednesday to clinic to try the silhouettes and also talk in general about the quicksets. Since starting this thread we have had ANOTHER no delivery message. Feeling a bit like jumping off a cliff, and poor E -- he gets over it, but it literally makes him tear his hair out, and no wonder. When we took this one out: no bent cannula, and insulin actually coming out the end (was in the middle of a bolus).

Medtronic say that insulin 'builds up' in the tubing if the site is not right. But I confess I am now wondering about whether the actual pump could be malfunctioning? Medtronic say no, and actually nothing else has caused us the slightest worry...

Oh lord! It's such a huge pain!

E is not particularly muscular (sorry E!), but he IS very slim, and more slim even than a few months ago it's true, because he is just shooting up. I took a good look today at set change and did think he actually had considerably less of ANY kind of fat on his tummy, anywhere, than a few months ago. And he has nothing anywhere else. It's just his build at the minute. At this age, until about 30, to be honest, his father was exactly the same.

I'm really interested in the hand insertion Tracey, as some of what is troubling us just from the outset with the sils is the inserter, which is like some kind of shot gun. It's very hard so far for him to manage with one hand, while holding a shirt up for instance, and the silly button to push down is right at the end, and requires a push virtually *past* the end of the pen, concave like, if that makes sense. It's fairly daft, and a little scary looking.

Purpleshadez, I'm interested too in your switching around... So you have found that they hurt more when wrong? Some of what we've found with quicksets is actually quite a lot of pain, almost every time...and this too, say Medtronic, is a sign it's going into muscle?

We had No Delivery messages about 6-8 weeks ago -- every other one or so for a week or two. Then, like Mand, Medtronic sent out a new few boxes to try. Seemed okay for a while. But now, last two weeks, nightmare. Two bent cannulas and four No Delivery messages. Up until 8 weeks ago, we'd had two bent cannulas ONLY, since last June. Even then, now that I think about it, it's quite a few?

Tracey et al: do you think 45 degrees scars less? What does attract me about them is that you can actually *see* what's happening with the cannula. With quicksets it's all out of sight, and you never know what the heck is going on...


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## Patricia (Apr 25, 2010)

And yes, Lou, the risk in this house is that E is losing confidence in the pump. Not quite yet, but he's fading a bit, and feels fragile about it. Which is why we have RUSHED off to clinic with this. Needs sorting. The pump IS the way to go. This is a blip. But it's feeling difficult to manage.

xxoo


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## Sugarbum (Apr 25, 2010)

Gosh that sounds quite a run of 'bad luck' should I call it? It sounds particually stressful. I hope the clinic visit puts things in a new direction. Fingers crossed.

When I read you post Patricia, my instincts as I was going through were "the pump is faulty" over and over! I mustnt jump to those conclusions, or lead you to think that either. But I felt that straight away, it must be so hard to keep the air in the right temperament so that E doesnt loose that vital confidence- and you and your OH too. Maybe it struck me as that because I have been lucky enough not to experience any 'no delivery' messages...although I am regretably not so lean!

I really hope things pick up a little- as ever I admire your tackle on this situation!

xx


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## Mand (Apr 26, 2010)

We had another 'no delivery' yesterday! After it, my son was finally prepared to try a new site area. Bless him. So brave. We put a quickset around the back of his body (above bottom but below waist). Will this help? Time will tell!

Right with you, Patricia!


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## purpleshadez (Apr 26, 2010)

Patricia said:


> Purpleshadez, I'm interested too in your switching around... So you have found that they hurt more when wrong? Some of what we've found with quicksets is actually quite a lot of pain, almost every time...and this too, say Medtronic, is a sign it's going into muscle?



Hi Patricia, 

I'm sure that the painful changes are due to my build and me simply getting it wrong/hitting muscle. I am also extremely challenged in the fat department so I struggled to find injection sites on MDI especially with the addition of lumps in my tummy . This was one of the reasons I wanted a pump as I was drasticly running out of places to inject. Fortunately the lumps have all but gone since I started on the pump. 

I have the 6mm quicksets which seem fine if I use them on my left side but on my right side I never seem to get it right and usually have to change it again. I only noticed the side thing when I changed over the weekend. After trying a quickset and found it to be quite uncomfortable, I stuck a sil in again this time and it is absolutely fine!

I long to put more weight on (11st not so good when your 6ft 4) so I can try an alterative site. I think for the moment at least, I'll keep trying the sils until I gain some weight. I have found as my control improves so does my weight. However, this could be down to my age too !

EDIT: I can also relate to getting disheartened about the pump with the issues I had to start with. I guess I was lucky in that my DSN predicted that my build may be an issue and advised me that I could try the sils when ever I wanted. She initially wanted me to start me on them but I wanted to try the quick sets first.


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## Patricia (Apr 26, 2010)

Thanks for all this everyone. Lou, I'm withholding judgement until clinic on Wed. If they think there's ANY possibility of the pump mis-firing: I'm sending it away!

Mand: man alive! We are in this together! Brave boy for switching sites. I'll be interested to know how it goes. E just won't even entertain that, darn it.

Purpleshadez: This makes so much sense. I was gutted today on the way home from school when E said that people on MDI don't seem to 'worry' as much about it all. This may be true? Or is it maybe just that at the moment we are in a bit of a worry phase?

It's all so hard. But better to  be able to come here. I take heart in what you say about using sils Purple -- do you use the inserter, or by hand?

Til later!


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## Heidi (Apr 26, 2010)

Patricia and everyone else on a pump,
this is not putting us off pumps. Even with blips like this (and I do truly believe this is just a blip) going with a pump *has* to be better than the unpleasantness of MDI. 
And we're only a few weeks in! 

You're definitely doing the right thing. 
Keeping my fingers crossed for you on Wednesday. 

H
x


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## Mand (Apr 26, 2010)

Heidi - I glad we not putting you off pumps!  Certainly would not want to do that. We are very happy with the pump and feel lucky to have one.  My son's blood sugars are so much better and it has given him more freedom. His last hba1c on mdi was 8.5. His latest hba1c, after several months on a pump, is 7.4. A great improvement we think. Good luck with your application. Pumps are not without their disadvantages but, as i have said before, the pluses outweigh the minuses so far for us. 

Just not sure what is going on re sets but hope to get back on track soon.

Patricia, my son also would not entertain idea of different site either but he suddenly changed his mind and we were sooooooo pleased. (It is sited where Manky's is!    So far so good but only 1 day into it so need to see how next few day and nights go. Fingers crossed! If no luck then going to have to give silouettes (cant spell it!) a go. Good luck for Wed!


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## Patricia (Apr 27, 2010)

Thanks all. Like Mand, I'm SO relieved all this gufuffle (how the heck do you spell that?) hasn't put you off Heidi. Phew. The pump for our money really is worth the hassle. The control is better (good results Mand!) and perhaps even more important to us, the quality of life stuff for a teen is hugely improved.

We are off to clinic tomorrow am. Sigh. Fingers crossed that it's a blip in the road and soon gone over!

xxoo


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## bev (Apr 27, 2010)

Good luck tomorrow Patricia - let us know the outcome as I am thinking of using another type of canula as its possible A is allergic to the teflon in the quicksets.Bev


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## Patricia (Apr 27, 2010)

Okay Bev will certainly do. What a DRAG for you all if A allergic. Damn.

xxoo


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## purpleshadez (Apr 28, 2010)

I have to agree with Mand, just by the unbelievable improvement in my control in such a short space of time is enough for me to not lose faith in the pump. My average blood sugar has come down from ~11 to 8.0 in six weeks! I am really looking forward to my next hba1c which I'm getting done in a few weeks!

Patricia: I do the sils manually and the quicksets i use the inserter. I think the only reason I use it is because I have it to be honest.


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## Sugarbum (Apr 28, 2010)

Good luck Purleshadz!

I am having dreadful trouble with marking still. Perhaps I shouldnt whinge- the quickset is soooo sticky, it really doses the job (I guess if it were anythign less I would complain about that!) but it makes my skin sore after peeling off. The onle I have removed this morning is itchy on the hole where it was sited- anyone find this? I used the lifter spray recommended by Adrienne this time though to lift it off as my skin is falling apart!

I am glad none of this is putting anyone off pumps, Heidi!  The insulin pump has been the best thing to happen to me since I was diagnosed- you would have to prize ot off my dead body I love it so much!


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## Patricia (Apr 28, 2010)

Hello all!

Have zero minutes in which to try to record our clinic visit -- just home -- but I'll try!

Generally very successful. We have a great clinic. And a certain DSN -- T1 herself -- is just absolutely straight-talking, understanding, and full of ideas. We are SO lucky to have her. 

It *does* seem clear that the quicksets are troubling E because of his build. This is common and esp more so at growth or puberty. We looked quite closely (poor thing) and all came to the conclusion that there ain't much fat there. She agreed with Medtronic that a) painful insertion b) bent cannulas and c) no delivery messages were all clear signs that what is probably happening is that the sets are either running into muscle (eg bending the cannula or making it less efficient by swinging it off to the side) or nicking muscle (causing considerable pain and being less efficient). 

She had two options ready for us. First, silhouettes: we did everything right EXCEPT pinch up whatever fat is there. Psychologically this makes a HUGE difference -- it's going into *something* then rather than feeling like it's going to skim across the top! -- and it guarantees going into the slim layer of fat. After watching it all happen on a cushion, E gathered his considerable nerve and did it to himself right off the bat. I cannot stress the difference that pinching made. Everything seemed much more stable (the inserter is sort of 'held' in by the pinch too). He was immediately impressed that it didn't hurt. At all. Except for the expected pinprick of the needle at first. So he is now on a sil for a couple of days.

She also had another option, which I think also may work: adding a little 'donut' (as she called it) to the cannula of the quickset, a little 'cushion', to make the cannula not go in as deeply. It's hard to explain, and it's wonderfully heath robinson/blue peter, but basically it involves scissors and a hole punch: you take high quality dressing (only available from GP), punch hole, cut to size, repeat another time or two to build up the thickness of the cushion, then remove the adhesive on the back to connect it to the cannula set, and insert as usual, with the added cushion just keeping the cannula from going in as deeply.

I need to say though that this method is simply one tried and tested by this hospital, and they particularly use it for babies, who are exclusively on quicksets -- because the needle for the sils is much longer and sites are harder to locate in little ones (). This is not a method you will find anywhere official, I reckon! BUT -- they use it. If anyone is thinking of doing it, this is one I'd discuss with your DSN before trying, just to make sure you have the right materials, and think it through.

In any case, we will try this too in time and see what happens. Finally, there is another set which is only doable by hand and involves a little needle under the skin. Off-putting, BUT works well as a last resort. The great thing here is she has tried EVERY SINGLE ONE OF THESE, with inserters and by hand, at some length.

We left feeling that we will get there. She was so positive about the pump that I think E felt rallied up too. He *is* positive about it, just a bit tired of the hassles, understandably. There was *no* discussion of the pump being faulty. She congratulated him over and over, complimented his growth and successes, and acknowledged his feelings completely: _sometimes you want to throw it against the wall_, she said. _I do_.  Hear hear!

Anyway, must run. Feeling positive. We have more options than we thought, and E was open to them all.

As for the traffic -- pah! Don't get me started.

Will add more later!

xxoo


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## Mand (Apr 28, 2010)

Great news, Patricia!!! Look forward to hearing how he gets on over the coming days. Sounds like you have a great dsn and clinic! I like the sound of the extra padding so needle doesnt go in so far. I will run that by my sons dsn if we continue to have problems.

My son getting on ok with new site so far. We have to insert it for him but he says it doesnt really hurt and so far we have not had a 'no delivery'. But his levels are a bit up and down at moment. Probably we just need to do some basal or bolus tweaks but we need to have the insulin going in properly before we can make these tweaks. 

It has been a difficult couple of months, especially due to the night testing. 
We have been totally exhausted so we really hope we can have a smooth run soon. 

Good luck for your next hba1c, Purpleshadez!


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## purpleshadez (Apr 28, 2010)

Wow, I love the padding idea! Genius! Glad you had such a positive outcome  Thanks for the luck, I have to say its the first time I've actually looked forward to finding out 

Mand: Fingers crossed that things settle down for you and your lil man now. 

All the best, Martin.


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## tracey w (Apr 28, 2010)

Patricia said:


> Wow incredibly useful stuff, thank you all. Like everyone is saying, in some ways jury still out...
> 
> We are off Wednesday to clinic to try the silhouettes and also talk in general about the quicksets. Since starting this thread we have had ANOTHER no delivery message. Feeling a bit like jumping off a cliff, and poor E -- he gets over it, but it literally makes him tear his hair out, and no wonder. When we took this one out: no bent cannula, and insulin actually coming out the end (was in the middle of a bolus).
> 
> ...



Sorry if its been answered, just catching up. I dont know if they scar less as I only tried the other type the once and yowser too much pain for me.
I do have scarring but nothing that i worry too much about and they do seem to disappear after a while. 

I too like the fact that i can see what is happening with the canula. I always check to see for example no blood in it (so far not), and i definately like the fact i can insert by hand at 45 degrees. Its not too painful apart from the occasional one like on injections you do get the odd one that makes your toes curl for a second. But mostly no problem. 

I hope you have resolved the problem now, I do think the sils are definately worth a try.


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## Mand (Apr 30, 2010)

Just a quick update to say that now my son using a new site, the quicksets are working fine again. Phew! (though I hope i have not spoken too soon )

It has been a difficult couple of months but, fingers crossed, problem solved. 

So we are now making some tweaks here and there to get his levels steady again. So far so good!


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