# Medtronic Silhouette Users



## bigpurpleduck (Jan 28, 2011)

How much does it take to fill a sil cannula?

My DSN gave me a couple to try but I don't have any instructions. I think (!) I can remember how to do it, but forgot to ask her this.

Gonna try one tonight. Bit nervous, as it looks scary


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## shiv (Jan 28, 2011)

I do 1.3u - I think Tom told me this? 1.3 works fine for me!

Are you inserting it manually or with an inserter? I insert mine by hand and find it fine - the needle does look big but it doesn't bother me much to be honest. I unpeel the small bit at the front, and hold it back whilst pushing the needle in - I hold the Sil itself (the plasticy bit) between my thumb and middle finger, and hold the sticky bit back with my forefinger. When the needle is in as far as it will go I stick down the small bit, then peel off the rest and stick that down.

Hope that helps!?


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## Freddie99 (Jan 28, 2011)

I go on the rule of 0.1 units per milimetre of cannula. I use the thirteen milimetre cannulas so that's 1.3 units. As for inserting it, well, I just hold it between middle finger and thumb and stab. I've also got a Sil serter but I hate it.


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## bigpurpleduck (Jan 28, 2011)

Many thanks to both!

I just put one in, with the inserter. Manual doesn't appeal to me at all! The inserter seemed quicker & didn't stick like the Quick-serter does.

I just bolused 5 units for dinner and it was fine. So far fairly comfortable. This is the first time in months I've had a set in my stomach without it failing immediately, so I'm chuffed 

So far so good. Will see how it goes the next couple of days, but I think I may be ordering sils from now on!

Thanks again guys - it wouldn't be in if you hadn't got back to me so quickly!


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## Ellie Jones (Jan 28, 2011)

Why don't you give metronic pump support line and ask them to be on the safe said!

Tom not sure about your 0.3 to 1mm theory, as I use a 13mm canular all be it a tenderlink, but my prime is 0.7!  And there can't be that much different from one manufactuers to the next can there?


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## Freddie99 (Jan 28, 2011)

Ellie, 

I use 0.1 units per milimetre. So for a thirteen mil cannula I use a 1.3 unit prime. I find that the prime that Medtronic reccomends I end up going rather high after the change. I need to have more in the prime than alot of people I find. I first discovered that with Mios.

Tom


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## Ellie Jones (Jan 28, 2011)

I very much suspect that you are including a correction to compensate the post BG raise, nothing wrong with that at all...

I know some pumpers who leave their old infusion set in for several hours after a change as this stablises their post BG and prevents it from rising..

Others find trying to keep to a certain time a day helps with avoiding the post bg rise...  And if forced to change at a different time, will use a correction bolus to prevent it..

It's one of those things that works for you, but for me using your theory would cause me problems it's probably safer to give the information given in the inserts of the particular infusion sets from the manufacturer to be on the safe side, as this will be the actual amount to fill the canular, then the individual needs to work out the best plan if the experience a BG rise after a change


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## shiv (Jan 28, 2011)

Ellie Jones said:


> I very much suspect that you are including a correction to compensate the post BG raise, nothing wrong with that all



Nope, Tom uses an increased temp basal after changing sites. Sorry to step in and speak for him, but I know that he does.


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## bigpurpleduck (Jan 29, 2011)

Just wanted to say that 1.3 caused me no problems, and this morning I'm still loving the sil


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## Ergates (Jan 29, 2011)

Changing sites can cause a raise in bG?


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## shiv (Jan 29, 2011)

Yes, lots of people have to use an increased temporary basal (although not all - as with everything diabetes related, everyone is different). I've been told it's due to the trauma of inserting a new cannula, but that's only what I've heard.

Personally I use 180% for 2 hours after changing set.


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## Sugarbum (Jan 29, 2011)

TomH said:


> I go on the rule of 0.1 units per milimetre of cannula. I use the thirteen milimetre cannulas so that's 1.3 units. As for inserting it, well, I just hold it between middle finger and thumb and stab. I've also got a Sil serter but I hate it.



I was taught the same as Tom.

For a cannula 9mm I prime 0.9 units. I have some Mios that are 6mm and the prime is 0.6mm.


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## Pumper_Sue (Jan 29, 2011)

Sugarbum said:


> I was taught the same as Tom.
> 
> For a cannula 9mm I prime 0.9 units. I have some Mios that are 6mm and the prime is 0.6mm.



 wow I use 6mm and the prime is 0.2u and the 9mm is 0.3u I use Cleo90

This link http://www.diabetessupport.co.uk/boards/showthread.php?t=11952&highlight=cannula+prime&page=6 also show at the bottom of the page that going on what other people say/do instead of reading the instructions does not always pay.


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## shiv (Jan 29, 2011)

Pumper_Sue said:


> wow I use 6mm and the prime is 0.2u and the 9mm is 0.3u I use Cleo90
> 
> This link http://www.diabetessupport.co.uk/boards/showthread.php?t=11952&highlight=cannula+prime&page=6 also show at the bottom of the page that going on what other people say/do instead of reading the instructions does not always pay.



Yes but Emma asked how much to use. We all told her how much we use, and why - we didn't suggest amounts to her. Medtronic say 0.7u.


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## Pumper_Sue (Jan 29, 2011)

bigpurpleduck said:


> How much does it take to fill a sil cannula?My DSN gave me a couple to try but I don't have any instructions. I think (!) I can remember how to do it, but forgot to ask her this.
> 
> Gonna try one tonight. Bit nervous, as it looks scary



Emma asked how much does it take to fill the cannula


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## shiv (Jan 29, 2011)

Fair point, but as I said, we only told her how much we use. Not 'you should use this amount'.


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## Ellie Jones (Jan 29, 2011)

There is one problem that's been overlooked is that Emma didn't say what size canular she was given and nobody has actually asked!

In all the years I've been around pumps (a fair few now) I have many many times seen the same question asked by fellow pumpers how much to prime...

I have never seen any mention of any 'theory' to work out the prime for different sized canulars! as I know I would have remembered this, so I checked the 'bible' well pumping insulin to be exact if there was a theory then it would be located in this book but alas nope..

As we can see the 'theory' suggested actually works out quite different from what the manufacturer suggests...  Which is 0.7 for the stills 13mm (which just happens to be the same prime for my tenderlinks made by rouche) 

Now if I followed toms advice, then I would be over priming my canular by 0.5 units of insulin, for a lot of pumpers probably not going to make a huge difference by for me personally it would have quite an effect and very likely to cause a nasty hypo...  

This is always the problem when answering questions in forums, sometimes we need to think, what the question is actually asking and how we may reply, do we give advice from what is recommneded or from our own experience!

In this case it should have been what the manufacturer says...


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## Adrienne (Jan 30, 2011)

Just to butt in here with the Mios.   The 6 mm Mios are definitely 0.3 fixed prime.   The book says so as does the web.   

The 13 mm silhouettes (the shortest in the sils) is either 0.7 or 0.6 fixed prime (definitely).

However what works for one person doesn't always work for another.  Some have found that they need more in a 13 mm sil (ie Tom) but when they change to a different set ie a Mio or quickset they only need the actual amount which will fill it.  

Some people find their levels go sky high after a set change due to the trauma on the skin and for kids occasionally it is just a trauma.  However some people find they go down a lot.   These people use temp basals up or down to sort this out.

We used to use the 13 mm sils and needed the recommended fixed prime only but levels shot up so we put on a 150% temp for 1 1/2 hours.   We moved to Mios and we do not need the temp basal at all and we use the recommended 0.3 to fill the canula (of a 6 mm Mio).


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## bev (Jan 30, 2011)

Adrienne said:


> Just to butt in here with the Mios.   The 6 mm Mios are definitely 0.3 fixed prime.   The book says so as does the web.
> 
> The 13 mm silhouettes (the shortest in the sils) is either 0.7 or 0.6 fixed prime (definitely).
> 
> ...



Hi Adrienne,
Well said.Alex uses the mio's 6mm and we use a 0.5 for the fixed prime. I was told recently that if you leave the old set in for a few hours then this can help to stop any later rises and also to have fixed days for the set change so as to build up a pattern and routine. However, we change every other day anyway so cant really do much to change it. I understand the problem with advising people on a forum and how mistakes can be made, but the OP really had no idea what sort of number to go with - so it is difficult to not answer a post, and the various replies were not saying that the OP should do x,y, or z - they were just advising what they did for themselves so it is up to the OP whether she chooses to take that advice or not.Bev


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