# Confused



## Lauren (Oct 21, 2012)

For over 6 months now I have been having problems with my cannulas.

Firstly I was on the Medtronic Quiksets and I used them in my stomach.
I then decided to change my cannula site to my thighs as I noticed I had lipo on my stomach. Since changing to my thighs one in three of my cannulas fail. What I mean is they go in ok but four or five hours afterwards my BG will be really high (in the teens or twenties) and I'd have to change them. Then it would often happen again and I would end up going through 2 or 3 cannulas in one day. I thought I must be putting them in wrong and my DSN agreed. But when I pulled them out the cannula was still perfectly straight and I could see insulin coming out of the hole in my leg. So I was very confused.

Then my DSN decided to put me on Sure-T sets (the steel ones) because they were much more likely to go in properly and be successful. I found that one in four or five of these would be having the same problem and I'd end up re-inserting cannulas all day and my BG would be high. I was getting pretty fed up with this and I also didn't like inserting them by hand, it would take me ages to do so I decided to go back to Quiksets.

This was a few weeks ago and I have the same problem again. However I decided to experiment. Instead of pulling them out and changing them straight away I decided to correct the high BG and wait. Obviously I did this anyway before but I'd only wait up to an hour before changing it because I felt unwell. Now I decided to correct and wait, correct and wait, and I find that after an astonishing amount of time my BG will come down. One day last week I waited six hours for it to come down. I have no idea why this happens but when I last changed my set I had to wait EIGHT HOURS before my levels came down, and I ended up doing about seven extra units without eating! And this was after doing two extra units when I changed my set that morning because I realised I must need extra insulin after changing my set.

I am so so confused. This has gone on a long time. Some of the time I don't need to do any extra insulin because the cannula started working straight away. I have no idea why sometimes it works and sometimes it doesn't, and why it takes such a long time for my BG levels to drop. My DSN doesn't know why either.

Has anyone else had any experience like this?


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## Pumper_Sue (Oct 21, 2012)

Hi Lauren,
             You might find that you need extra basal for thighs and bums.
Have you tried leaving your old cannula in and also running a temp basal once new one is inserted?
I have given up on thighs as can't get a good number from there. 
Another thought is a different length of cannula or type. Not sure what the ones you have used are made of but if tethlon try steel.


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## Lauren (Oct 21, 2012)

Thanks Sue I never thought of that. I will definitely be doing a temp basal from now on. It would make sense to use a longer cannula but I'm a bit scared it might be too long and hurt! Worth a try though


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## Pumper_Sue (Oct 21, 2012)

Lauren said:


> Thanks Sue I never thought of that. I will definitely be doing a temp basal from now on. It would make sense to use a longer cannula but I'm a bit scared it might be too long and hurt! Worth a try though



I started off with 9mm went down to 6mm and now settled on 8mm steel cannula and thats on year 5 I think of pumping. I did read somewhere that people use different types and lengths for different body locations. but good ol temp basal works wonders.


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## everydayupsanddowns (Oct 21, 2012)

Sounds like a more extreme version of what I have experienced (though I had no problems when trialling Sure-Ts). Do you get 'no delivery' errors at all? Sometimes I did, other times not. And I was having an issue perhaps every 4 weeks or so. 

Have you tried the Silhouette angled sets? I have just switched to them, and because you can slightly adjust the angle I seem to be able to get better results in more places.

Also... Are you always changing before a meal? I was recommended to do this so that the meal bolus 'flushes' through the cannula from the start.


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## Lauren (Oct 21, 2012)

No I only got a 'no delivery' once and that was when it had gone in at a funny angle.

In regard to changing the cannula before a meal, that makes so much sense! It does seem to be the ones I change and then go several hours without a meal, I just never realised before! I am glad you said that, I will definitely be aiming to change them before my evening meal from now on 

As to the Silhouette sets, I was given some and an inserter but I chickened out and never tried them! One day I will have to give them a go.


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## HOBIE (Oct 21, 2012)

Hi , i always change after a shower or bath. Skin is soft after a soak & have always used 6mm quicksets & nothing else with no probs. Good luck


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## Pumper_Sue (Oct 22, 2012)

Lauren said:


> No I only got a 'no delivery' once and that was when it had gone in at a funny angle.
> 
> In regard to changing the cannula before a meal, that makes so much sense! It does seem to be the ones I change and then go several hours without a meal, I just never realised before! I am glad you said that, I will definitely be aiming to change them before my evening meal from now on



Hi should have checked that you were changing before a meal, my bad sorry.
If this is the case then do not do the temp basal as will run into problems.

Perhaps not change before the evening meal incase you run into problems and end up correcting all night long!

I found this the other day http://www.accu-chekinsulinpumps.com/documents/ProfessionalsPocketGuidetoInfusionSiteManagement.pdf
Even though it's not medtronic same rules apply, so hope it's of some help to you.


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## AlisonF (Oct 22, 2012)

Hi Lauren

Here are a few thoughts:

I know some people find they always rise when they do a set change, and take an extra bit of insulin immediately after the change to deal with that. I wonder if that would help? 

I'd second what people say about always changing a set before a meal - I try to always to that, it means you've got a good amount of insulin going through the set early on. 

Finally, I try to leave my old set in for an hour or so after inserting a new one, so any insulin left around the site of the old set gets properly absorbed -I have no idea how effective this is, but seems to work for me. 

Ali


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## Lauren (Oct 22, 2012)

Thank you for all your advice  I will leave off trying a temp basal, but will try changing my set after a shower and before a meal, and will have a go at leaving the old cannula in for an hour after  Hopefully there will be a drastic improvement!


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## Phil65 (Oct 22, 2012)

Hi Lauren,

Cannulas have always been my bug bear with the pump, I'm still not entirely satisfied with their consistency. I have found the steel rapid d 8mm to be the best for me, but I still get regular bleeds at the site and sometimes leaking insulin at the site....feel the patch! I have swapped from my tummy to my thighs also. One thing that might help you.....do you make a loop and tape the tubing down?


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## Lauren (Oct 22, 2012)

Hi Phil

I tried the Sure-T sets which are the Medtronic steel cannulas. I tried them for a few months but I found them difficult to insert as I have a bit of a needle phobia (silly I know!). So I went back to the plasticy ones. I have not tried making a loop and taping it down, might this help do you think?


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## Phil65 (Oct 22, 2012)

Lauren said:


> Hi Phil
> 
> I tried the Sure-T sets which are the Medtronic steel cannulas. I tried them for a few months but I found them difficult to insert as I have a bit of a needle phobia (silly I know!). So I went back to the plasticy ones. I have not tried making a loop and taping it down, might this help do you think?



.....yes a loop can definitely help, particularly if you are very active. The loop will stop your cannula being pulled from the cannula site. Shame about your needle phobia, I couldn't get on with the teflon ones at all ....hence the steel 8mm that I use...but I have to change them nearly every day.


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