# Issues with infusions



## martynal (Jul 17, 2018)

Hi all.
*Sorry that this post is so late but I’ve currently done my infusion twice with both times failing and a sugar level rapidly increasing from 6,3 to 10,6 in a matter of 30 minutes*
I have had the pump for most of the 13 years I have been type 1 diabetic (I am currently 16). However, over the past several months I’ve been having issues with my infusions and it’s starting to become a big, disheartening issue. For some reason, my infusions always fail if they are injected into my belly or butt. After half an hour of having the infusion, my pump always displays the now familiar message that the insulin flow is blocked. I am forced to always inject the infusion either into my arms or thighs now and I’m worried that scar tissue may eventually build up (my mum constantly lectures me about this and how insulin won’t work in the affected areas). I have brought up my problem with my diabetic consultant and nurse, however they only suggested a different type of infusion (meo) rather than my current one, but they have not worked either. I am really concerned and I’m hoping that maybe I can find some answers here; any input will be greatly appreciated.
Thank you so much for reading.


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## SB2015 (Jul 17, 2018)

Hi Martyn and welcome to the forum

One thing I have found helpful when sorting out a problem, is to use my pen for any correction when I spot a problem with my pump.  It kind of buys me some time to sort out what has gone wrong.  It is a bit scary how quickly things rise when there is a blockage, but that is why they tell us to carry our pens with us if more than an hour away from home.

With infusion sites, I am no expert on build up of scar tissue.  I use tum and sides so far, and carefully swap side to side and also to work along one of three lines on each side. On my bum I use as far round as possible when I have had a few skanky sites.  Are you able to use further round by getting some help with putting them in.  Not ideal I know but would it give your usual areas some rest.  Do you find it a problem using your thighs?  Wherever you use I know it is important to move on each time and give areas a rest.

Another thought is about what size cannulas you are using.  I started with quite long ones but have gone as short as possible.  I also switched from 45 degree ones to straight in and abandoned the metal ones which seemed to cause me problems.

I hope that someone else comes along with other ideas soon.


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## everydayupsanddowns (Jul 17, 2018)

Hello @martynal 

Welcome to the forum. 

Sorry you are having such a tough time with infusion sites at the moment - I completely get how frustrating this is for you.

During my first year on a pump I was using Quicksets (90 degree) and I had all sorts of bother with them. Sometimes they were fine, but then other times it took 2-3 goes to get a set to work. And I wasn’t necessarily getting ‘blocked’ warnings - sometimes the first I knew was a BG in the high teens / low 20s 

Different people suit different sets, and while @SB2015 found 90-degree better than angled, I found exactly the opposite. And there’s no reason for me to think that at some point my trusty Silhouetes might need swapping for another alternative. Diabetes is like that - is constantly fixing the issues, only for the goalposts to suddenly move and we need to start all over again and find the new ‘right thing to do’ / ‘stuff to use’. 

You don’t say which sets you are currently using and whether they are 90 degree or angled, but you may find that swapping to another type, or a shorter or longer length might help. In all likelihood your body is changing rapidly at the moment and with a new physique comes the possibility that a different cannula might suit you better. 

If there is any build up if fat or scar tissue in your favourite sites you can try just completely testing them for 3-6 months. I’m not sure if you have a system for rotation or go more ‘freestyle’ but it might be helpful to try to notice if there are any particular spots in your general areas that give you problems more often (as an example there are a few places on my sides low down towards my hip that I’ve spotted are sometimes a bit iffy for me so I try to skip over those areas or at least be prepared if I’m inserting a set there). 

Hope you manage to find solution that works for you. Let us know how you get on.


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## martynal (Jul 17, 2018)

Thank you for the welcome and advice.
I have never thought about using pens whilst having issues; thank you for that, I’ll definitely be able to control my levels a bit more during these issues  
I have no problem with injecting an infusion in my thighs and arms, however when I was a little younger I developed a little scar tissue in the tops of my arms, so I usually either have it in my lower arm but primarily alternating on my thighs (I never inject into the same leg/arm twice and always move places so that I don’t hit the same infusion site). After c. 15 failed infusions on my belly and butt over several months, I’ve asked for help doing them from my parents however when they did it, it failed too. When I was younger they also did my infusions for me in those areas as well as my arms and they hardly ever failed, so I don’t think they fail due to incorrect insertion. I’ve also tried injecting into different sections of my belly and butt to no avail. 
Currently, I have the 90 degree plastic canula quick-set paradigm infusions. I’ve never tried any others apart from when my nurse suggested testing out the meo infusions (I don’t think they were angled) which also did not help. I have also switched from the quickserter (apologies not sure what they are more commonly known as but I’m talking about the thing that actually injects the infusion) to a more powerful one which eventually allowed me to successfully inject into my thighs. 
I shall speak to my nurse about testing out angular or longer canulas; I’ve never really been told that the length of them could make a difference so thank you again for that information. It is really frustrating, so I hope that I end up finding something that works. The metal canulas sound a little daunting but I definitely will try them out too as they seem more durable... when I removed the canula it has been bent which obviously prevented flow but most of the time there was a bubble in the end of it despite my 5-minute checking and removing bubbles from the tube . 
Thank you both again.


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## everydayupsanddowns (Jul 17, 2018)

There are angled Mio sets (Mio30) and also Silhouettes which insert at an angle. 

If you are getting cannulas bent at a 90 degree angle it could be that the cannulas you are using are inserting OK, but then bending during wear where the cannula comes up against muscle underneath. 

The sure-T (metal ones) are super easy and pain-free to insert and are very resistant to those bent cannula fails, but they do need to be changed every 2 days rather than every 3. 

Would be worth asking your DSN/clinic for a few samples to try out of different types so that you can see what suits you better. 

Hope you find a fix soon.


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## HOBIE (Jul 17, 2018)

Good luck & Welcome Martynal.


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## Pumper_Sue (Jul 17, 2018)

Hello @martynal and welcome to the forum.
Have you tried different sets for different body locations?
The fact you have no delivery alarms would indicate a blocked canula or tubing or even a faulty pump.
When you have removed what you have thought was a faulty set have you actually primed the old set once it's out to see if delivery is the cause of the problem?
I had a problem the other day and it was the first time in 12 years of pumping bloods would not come down no matter what I bloused then...………. my nose twitched I could smell insulin so felt the canula to find the insulin had leaked out for some reason. Changed the set and no problem since.

The sets you are having problems with are they from the same batch?
Edited to add just seen your other post, what length of canula are you using?
I found using an angled set and I refuse to use the self serter things they give me a heart attack each time so just use a manual insertion each time. For me this works fine others might not like the idea, so use what ever is most comfortable for you.


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## martynal (Jul 17, 2018)

Thank you, I shall ask them to try out some new infusion sets ASAP. I think I’m also gonna ask them about pumps and such because in all fairness I’ve never had any PROPER training, I’ve just been taught how to inject and use my pump.
I am not sure of the length of my canula however I’ve had the same quick set infusions for the entire time I’ve had the pump.. I shall check my boxes and find the length. I haven’t really been talked through the effect of different lengths and angles and materials of the canula on the success of an infusion so I am sorry but I have no clue haha... does the canula have to reach inside the muscle for it to work? I have tried a variety of batches as well as I’ve had the issue for quite a while. I haven’t primed the set after removal, so maybe I’ll try doing so. There’s usually a long bubble at the end of the canula and on a rare occasion it bends. I monitor sugar levels after attempting to do the infusion in my belly or butt and if it’s rising, I type in the sugar into my pump and give a correction bolus which then brings up the ‘insulin flow is blocked’ message and then I go through the hassle of removing and reeinjecting etc. 
I’ve been through 4 pumps (2 minimed, not sure the type but they were landscape and one failed after several years which led to the 640g twice as the first ones battery failed and I had to have a replacement 640g) so I cannot be sure if the pump fails. The infusion works in my arms and thighs though. 
I also agree about the inserters, sometimes they just randomly pop in and scare me haha.. I admire that you can insert them manually, I doubt I’d ever have the heart to do that 
Thank you all for the advice and information, I feel a little better that I have options to try sort this out


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## everydayupsanddowns (Jul 18, 2018)

Great that you are feeling better and have options. 

The infusion sets should reach into subcutaneous tissue, but not go as deep as the muscle layer. Most sets are available in different cannula and tubing lengths - you select the ones you need when you re-order them. 

Hope you get some good support from your clinic.


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## Pumper_Sue (Jul 18, 2018)

martynal said:


> I’ve had the issue for quite a while. I haven’t primed the set after removal, so maybe I’ll try doing so. There’s usually a long bubble at the end of the canula and on a rare occasion it bends.


Another suggestion for you, if you have the blockage alarm again just disconnect your tubing from the cannula and prim it to see if that's where the problem lies.

I seem to remember quite a few years ago there being a major problem with the quicksets, so perhaps there's another issue.
On the box of quicksets it will say 6mm or 9mm so you can then tell what length you have.

So you can move on with your pumping, perhaps ask your parents to invest in the book called Pumping insulin by John Walsh. This can be found on amazon and would probably be the best investment that life can bring you.


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## trophywench (Jul 18, 2018)

My husband has just made the comment that if insulin leaks inside the pump on to the winding mechanism for the reservoir (which was not uncommon when people including me, inserted the reservoir incorrectly by not attaching the tubing before I inserted the res) it caused the mechanism to stick - eventually it glued itself up completely and you couldn't get any insulin delivered.

You don't think that could be it?  Have you actually asked either the Helpline or your clinic?


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## martynal (Jul 18, 2018)

I have checked and my canula length is 6mm. Thank you, I shall ask my nurse about it today. 
I re-prime the tubing each time but the same thing happens over and over again, I just cannot think of a reason why bubbles form in the canula inside the body after multiple times checking and removing bubbles from both the tubing and the insulin container... hopefully switching to longer canulas for those areas or different angles will help. Is the book like a help guide? I might take a look at that but I don’t think that we’re doing anything wrong, it’s just something happens to the canula once injected. 
When changing my set I always connect the tubing outside of the pump and after removing the tube is always dry, so I don’t know if this could be the issue, but then again whenever I inject into my arms/thighs everything is fine. 
Thank you all.


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## everydayupsanddowns (Jul 18, 2018)

martynal said:


> I have checked and my canula length is 6mm. Thank you, I shall ask my nurse about it today.
> I re-prime the tubing each time but the same thing happens over and over again, I just cannot think of a reason why bubbles form in the canula inside the body after multiple times checking and removing bubbles from both the tubing and the insulin container... hopefully switching to longer canulas for those areas or different angles will help. Is the book like a help guide? I might take a look at that but I don’t think that we’re doing anything wrong, it’s just something happens to the canula once injected.
> When changing my set I always connect the tubing outside of the pump and after removing the tube is always dry, so I don’t know if this could be the issue, but then again whenever I inject into my arms/thighs everything is fine.
> Thank you all.



I've a few ideas about this (if I'm understanding you correctly)...

1. Bubbles that appear in the reservoir after a change where you KNOW you have very carefully tried to get rid of them all *can* be the result of temperature variation. Warmer liquids can hold less dissolved oxygen than cooler liquids, so any dissolved oxygen in the insulin itself can appear as new bubbles in a bubble-free reservoir as the liquid warms next to your body and/or overnight under the duvet.

2. Any bubbles that are in the reservoir can find their way into the tubing where they will be pushed along by the insulin until they reach the cannula end. You can have bubbles that just stay harmlessly in the reservoir all the time, but unless you are checking every couple of hours all the time there is at least a theoretical chance that a bubble hidden near the 'neck' of the reservoir has dislodged during wear and then got into the tubing as insulin is being delivered.

3. Bubbles in the reservoir can be *really* hard to spot! Even if you've tried your hardest and cant see any with the top of the reservoir pointing upwards you will sometimes find a little sucker lurking if you angle the top of the reservoir down and tap it so that bibbles can rise towards the rubber 'o' rings.

4. To give the best chance of bubbles harmlessly staying in the reservoir some people angle their pump so that the tubing is towards the bottom. This may not be practical depending on how you wear yours, but if the tubing connection is lower any bubbles will rise away from it and can't find their way into the tubing.

5. My understanding is that the reservoir/tube/cannula/body forms more or less a closed system until the point of delivery. The piston presses against the base of the reservoir and pushes insulin (and potentially bubbles!) along the tube and out the end. When I've spotted bubbles in tubing before I've set an alarm on my phone to wait until the bubble (which appears as a longish gap in the insulin through the tube) has made its way to near the end before I primed it out. I could have primed out at any point, but that would have wasted a whole tube's worth of insulin, so I just waited until the bubble was in a more convenient place. BUT it's important to remember that the pressure in the tube/reservoir combo has its own balance with the weight of the fluid and gravity acting and an open end allowing flow. When you disconnect eg for the shower and hold the tubing end up high, the pressure changes and you can sometimes see a small empty gap with no insulin at the end of the tube.

This might be the bubbles in the cannula that you are seeing - that's a smaller tube, which most likely is open-ended at the time that you take it out so insulin can flow out and air (bubble) can flow in to take its place.

Not sure if that helps?


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## everydayupsanddowns (Jul 18, 2018)

trophywench said:


> My husband has just made the comment that if insulin leaks inside the pump on to the winding mechanism for the reservoir (which was not uncommon when people including me, inserted the reservoir incorrectly by not attaching the tubing before I inserted the res) it caused the mechanism to stick - eventually it glued itself up completely and you couldn't get any insulin delivered.
> 
> You don't think that could be it?  Have you actually asked either the Helpline or your clinic?



I think that would be difficult with a Medtronic pump TW. We did have an alert about reservoir connection best practice, because of some tiny vents at the top - but on a MM640G you wouldn't be able to drop the reservoir into the pump without conecting to the tubing first I don't think, because it'd be very tricky to get the two together (you fix one to the other with a quarter turn before twisting the tube/reservoir combo into the pump)


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## martynal (Jul 18, 2018)

everydayupsanddowns said:


> I've a few ideas about this (if I'm understanding you correctly)...
> 
> 1. Bubbles that appear in the reservoir after a change where you KNOW you have very carefully tried to get rid of them all *can* be the result of temperature variation. Warmer liquids can hold less dissolved oxygen than cooler liquids, so any dissolved oxygen in the insulin itself can appear as new bubbles in a bubble-free reservoir as the liquid warms next to your body and/or overnight under the duvet.
> 
> ...


Do you suggest that I angle the pump downwards? I clip it into my pocket or top of jeans. Also possibly it could be due to the temp change; I store my insulin in the fridge, remove it approx an hour prior to a set change but on the day of my post I used the same insulin in two infusions and only had it out for like 25 mins


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## everydayupsanddowns (Jul 18, 2018)

martynal said:


> Do you suggest that I angle the pump downwards? I clip it into my pocket or top of jeans. Also possibly it could be due to the temp change; I store my insulin in the fridge, remove it approx an hour prior to a set change but on the day of my post I used the same insulin in two infusions and only had it out for like 25 mins



I tend to leave my 'in use' insulin out of the fridge (it's fine for 28 days at room temp), but even then I see bubbles after wear that I KNOW weren't there when I filled the reservoir. Keeping out of the fridge might help though? Some people pop the insulin vial somewhere warmer (pocket?) just before the change too so that the insulin is at 'near the body' tempeature rather than just ambient temp.

Top of jeans might be tricky, but you could hang upside down (tube downwards) if you had a belt? It'd keep that annoying sticky-up bit from digging you in the ribs at least!


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## trophywench (Jul 18, 2018)

What insulin are you using @martynal ? I use Novorapid and 20mins out of the fridge has always been more than enough for me to avoid bubbles whereas a friend uses Apidra and has always been plagued with them.

I've never kept insulin out of the fridge for longer than that except by accident (other than in-use pens when I was on MDI) - for starters I'd have to find an alternative site to keep it - in both our house and in our motorhome which we also spend a lot of time in - and why bother anyway when I've proved it isn't necessary?


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## Pumper_Sue (Jul 19, 2018)

martynal said:


> I re-prime the tubing each time but the same thing happens over and over again, I just cannot think of a reason why bubbles form in the canula inside the body after multiple times checking and removing bubbles from both the tubing and the insulin container..



Am I right in thinking the bubbles are in the canula and not the tubing? If this is the case then there's a problem of interrupted insulin flow at the canula section ie., u have a kink in the set. If this is the case then disregard what you have been told re the room temp of your insulin. Obviously how you store and use your insulin hasn't been an issue before.


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## martynal (Jul 19, 2018)

trophywench said:


> What insulin are you using @martynal ? I use Novorapid and 20mins out of the fridge has always been more than enough for me to avoid bubbles whereas a friend uses Apidra and has always been plagued with them.
> 
> I've never kept insulin out of the fridge for longer than that except by accident (other than in-use pens when I was on MDI) - for starters I'd have to find an alternative site to keep it - in both our house and in our motorhome which we also spend a lot of time in - and why bother anyway when I've proved it isn't necessary?


I also use novorapid, and my nurse told me to keep insulin and stuff like glucogel and injections of it in the fridge so I’ve been doing that, also when I used pens for a while when my pump broke abroad, I kept the insulin out of the fridge most of the time as we were very active and it was fine too, so I’m not sure as to why they told me to keep it there


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## martynal (Jul 19, 2018)

Pumper_Sue said:


> Am I right in thinking the bubbles are in the canula and not the tubing? If this is the case then there's a problem of interrupted insulin flow at the canula section ie., u have a kink in the set. If this is the case then disregard what you have been told re the room temp of your insulin. Obviously how you store and use your insulin hasn't been an issue before.


Yes, they happen in the canula. Sorry but what is a kink in the set?


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## Pumper_Sue (Jul 19, 2018)

martynal said:


> Yes, they happen in the canula. Sorry but what is a kink in the set?


It means the canula has bent thus fluid (insulin) can not flow through it, think of a hosepipe being squeezed and the water flow restricted. That's what has happened so nothing you are doing wrong yourself 
Do you sit or stand when you insert the canula in your tum? Either way you do it try the other and see if that helps.


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## martynal (Jul 20, 2018)

Pumper_Sue said:


> It means the canula has bent thus fluid (insulin) can not flow through it, think of a hosepipe being squeezed and the water flow restricted. That's what has happened so nothing you are doing wrong yourself
> Do you sit or stand when you insert the canula in your tum? Either way you do it try the other and see if that helps.


I’ve just injected a set into my belly, will update if it worked or not. I had it done standing up, the other night when I posted this post I tried once standing and once laying down for the set in my butt


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## HOBIE (Jul 20, 2018)

Good Luck Martynal. I have used Medtronic pumps for years now & never had probs with bubbles.


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## martynal (Jul 21, 2018)

So, my nurse gave me some new angled infusions and the one in my belly has been working! Thank you all for advice. Hopefully the next infusions work too.


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## Pumper_Sue (Jul 21, 2018)

martynal said:


> So, my nurse gave me some new angled infusions and the one in my belly has been working! Thank you all for advice. Hopefully the next infusions work too.


Fantastic hope things continue to work for you. I have found the angled sets work best in my tum.


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## martynal (Aug 1, 2018)

Hi all. The infusion in the belly worked three times but had it changed a few hours ago and didn’t work. This time the site really hurt and it worked at one point and I use a libre and my sugar level dropped a little after correcting, however then it stopped working again so I am now changing it into the thigh (high sugar levels + heat abroad= bad idea!). Maybe I hit a bad spot?


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