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Glucose Goblins.

Remove the old infusion set after my workout at the gym (most often).  My blood sugar is usually excellent at this point - in the low 100's. 

Okay, that's easy.  It pulls right out and I give the area a once-over for any signs of infection or irritation.  Then I take a look at the old cannula and check for any curious kinks or bends.

Then I shower.  (I love "free shower," without any infusion sets to catch on my shower pouf or carefully avoid while I shave my legs.) 

Ready the new set - prime the thing, and shunk into my other thigh, away from any recent sites.  Test again, see something very similar to the result I saw before the shower.  No problems.  The site feels fine - devoid of any sharp pains or aches - and the first bolus doesn't feel like slices of lemon being pushed into my nerves.  Everything appears to be aces. 

Commence evening activities, either going out with Chris, doing a little writing, (gasp) housework, watching a movie, or piddling around on the Internet.  About an hour and a half passes.  I run my tongue over my teeth and notice the fibrous sweaters.  Test (another shunk, but this one in my finger) and see a result hovering near the 300 mg/dl range.

What.

The.

Hell.

This happens all too often.  I don't know if there is a delayed absorption after placing a new site or if I'm just waiting too long to "reinstall" after pulling the old one out, but I feel like I'm being followed around by these blasted glucose goblins.  It's like they're lacing the air with sugar, sending my numbers into orbit.  It's veryHoly sugar jar that is apparently attached to my face after a site change. frustrating to spend so much time monitoring and carefully calculating, only to have a site change send my averages over the moon. 

I almost always change my sites in the evening, barring any unforseen circumstances like scraping the site off by accident with the grocery bags (last month) or bonking against my desk drawer at work and knocking it loose (last year).  This timing is intentional because I can go longer without eating in the evening hours.  But regardless of whether or not I'm snacking, it seems to take HOURS for the infusion set to settle in.  And the highs every three or four days are making me go bananas.

Damn glucose goblins.  I need to find their kryptonite.

Comments

I am so glad to read your post. I was just ranting about this yesterday. I have the same problem every time I change my infusion set no matter when the site is changed! I chased my sugars for a good 4 hours yesterday after my am change! I don't have any answers for you, but misery loves company.

Hi,

I usually change my site & follow it with a large bolus - normally in the morining, right before breakfast - that way I give myself a fairly large bolus for the meal and that gives a good 'kick start' to the infusion set & lets me know right away if there's trouble. I find that doing it this way has really helped with 'post infusion set change highs'.
Here's hoping you'll be able to figure something that works for you!

Randee

Sorry to hear your having issues. I just thought it was nice to hear that someone else has "free showers."

Yeah, I struggle with this too - except it doesn't "hit me" until my first meal.

I often wonder "where does the insulin GO?" I mean, if it's not keeping my BG where I want it - where the hell is it going?!

I agree - very, very frustrating.

is this common?
i (usually) have the opposite reaction. 2 hrs later, i get a low.

Maybe I'm stating the obvious but two things come to mind: maybe your fixed prime is too small, or another thing people do sometimes is leave the old set in for another hour after putting in the new one.

"fibrous sweaters" I always call it furry teeth.

I have the same problem. I usually change sets in the morning. It's so irritating to see the high a few hours later. I'm never sure if the sets not in right or if it's just "adjusting". Now I leave the old set in until I'm sure the new one works just in case. It's all a mystery.

I have the exact opposite reaction. I find that I am very insulin sensitive whenever I change my site for at least half of the day. I figured this happens because the insulin is "fresh" and the new site is more "absorbant" right after a change. By the end of day two my numbers start trending upward and it's time to change the site & insulin again.

One solution that has been suggested to me is to leave the old cannula in for a couple of hours after you've inserted the new set. (I know, you won't get your free shower this way). However, the problem in some cases is that when you remove the cannula some of the insulin "leaks" out (I'm not sure the mechanics of this process), so immediately after you change your set, you may have lost some of the basal insulin.

I have tried to do this as often as I can. I do see some improved results (but it isn't always consistant).

Since this happens to you so regularly, why don't you try giving yourself a small bolus right when you insert the new set (I wouldn't do it before the shower because the warm water speeds up the insulin absorption). I know I'm always nervous giving myself what could be "extra" insulin, but when the pattern is so regular, there shouldn't be much danger (I got into a pattern of giving myself an extra bolus before an exam during finals week because the stress would make my BS skyrocket...)

I'm with Lili and Aaron. When I change my site, if I remove the old cannula right away, I get a leakback. I can visibly see insulin leaking out. And I know I'm going to have a high within a few hours. To address this, I leave the old cannula in for several hours (bummer, I know; no free shower), and I place the little plastic cap on it. When I do this, I generally don't have any issues.

For a Quick Set, I prime 0.3. Is that what you're priming?

Regarding the lows after set changes, it could be that the prime amount is too much.

I'm no MiniMed expert so someone is going to have to translate this(I don't get what fixed prime and all that jazz mean). But I'm thinking that perhaps when you are doing th disconnect for the shower with a possible bolus to cover the missed time, pulling the site is causing a loss of insulin.
I leave old sites in if I've just bolused within say the past 2 hours. I also never do "free showers", but that's because I'm extremely afraid of like a moisturizing bead finding it's way into the old site spot.

I've actually talked to Insulet reps (from OmniPod) about this very same problem, having my sugars go up into the 300's (often higher!) after changing sites. They told me that this happens to some people, especially people with lower basals, because the insulin in the cannula needs a little "push" to get out. (Capillary action? I dunno...) Without taking a bolus, the insulin will stay stuck in the cannula for awhile. The rep told me that the only way to fix this is to always take a bolus (I take about a unit) when you change the site.

More often than not, this will send me low, so now I always change sites around meal time. I'll test after a half hour to see if it's working, and then eat. A pain in the behind, but it always works for me.

Either someone from a CGM company or insulin pump company told me that your body is responding to the new site like it's the wound that it is and sending in all the troops to help it heal/reduce the inflammation. As a result, it's going to call for more insulin. What I do is increase the basal for the next hour and a half to 'teach' my body that this is the new place to find insulin. I think it also depends on how recently you were using that specific area of the new site change. Even if it is on the other leg and therefore at least a couple days site-free, I think your body is still recovering from that annoying little tube that keeps protruding under your skin. 'fresh' sites becomes a relative term after so many years of pumping and now more sites from the CGMs.

Today is my first day on the pump so this couldn't be timelier. Now I'll try not to have a freak out if my BS skyrockets after my first site change.

I love the 'free shower' also! And I love learning that there are other people out there that love it too! (Yay internet!). Interestingly, I've never noticed a pattern of numbers one way or another after a site change, but have heard lots of people talking about keeping their previous site in for awhile. Either I've never paid enough attention to the numbers coinciding or I'm just lucky?

Have you considered a temporary basal for 1-3 hours post site change? Maybe bump it up to 125-150% your normal basal...that's what I would try. I've never had this problem though...

I have this problem with O. I give her an extra unit of insulin in her new site and that seems to do the trick.

Are you bolusing before your shower for the insulin you're missing during the "free" shower?

My basals used to be just under ~2.0/hour, and I would unhook for the shower without any trouble. Now, due to a combination of things, they're all under 0.7/hour, so unhooking for 30 minutes puts me near that threshold where there's not enough insulin for "housekeeping" and I shoot sky-high. A bolus before showering has eliminated this problem, although others make really good points about leaking insulin when you pull the old cannula, too.

My honey has the opposite reaction as well- I know I have to keep an eye on him every time he changes his infusion set, because he has had some seriously low lows (in the 30-35 range) many times after changing it. They are less frequent now because I am on his case to test more often after a set change- but it's horribly scary to have to wait and see what happens with each set change.

Ugh, I have this problem also.
I change in the morning so I can deal with the highs as they come.
As a matter of fact I had this issue yesterday...Hit 441 and then I ended up with a low in the afternoon. Very typical for me.
One thing that I try to do, that does seem to help, is after my "free shower" when I hook up the new site I do a fixed prime of 0.5 (quick set) and then push though, with the fixed prime, whatever basal I missed while enjoying my "free shower" that turns into a "free getting ready" :) because in the morning I cant go without any basal for any amount of time.
Most days that works for me but yesterday the world was working against me…right after the site change I drove through Chick Fil A for a tasty Diet Dr. Pepper which I immediately sucked down 4 of 5 gulps of before realizing that it was NOT diet.

We do like a few others have suggested. We make sure that Ian leaves his old site in for a bit after inserting the new one.

I've been reading your blogs for a long time, but this is my first posted comment :) So glad to know I'm not alone, in loving "free showers", and experiencing high BGs immediately following installation of a new infustion set. Those high BGs actually didn't start until a few years after I went on the insulin pump (I've been on it for about 8 years)- but since they did, it's always been a consistent thing. So this is what I now do, having figured out what works through trial and error for my body: When placing a new set into my leg, rather than the recommended 0.3 units for the short cannula, I'll "prime" a whole 2 units (used to be 4 units a couple years ago! I don't know what changed); for my stomach, I'll prime 1 unit. Somehow the crazy math works out! And since I always replace right before a meal, and check my BG 2 hours after I eat, I can track the post-prandial reading to see if my BG's heading low before it actually gets there... usually it's spot on. Play around with it little-by-little and see what works for you. Good luck :)

Oh those goblins!

I have the same issue, the waiting after a site was changed. It has happened half a day later sometimes then I have to go through each and every step I took to rule out the site (I just put it in, change it Again and waste and inset?!?! No!!) But I can usually tell when it is due to my site (lack of insulin absorption). My symptoms of going high via a bad site is much different than any other high, more dramatic if you ask me. I usually get nauseous and thirsty with a vengeance.

Either way, love your blog. Keep it up (I was diagnosed at 6 too, almost 24 years with this darn disease).

Those damn goblins! I got hit hard by them the other day at work and was pretty much out of comission for the rest of the day - I usually change my site after breakfast, was a nice happy 95 when I got to work, 2 and 1/2 hours and a yougurt later I was climbing to 190, then 220, then 280 - yeah not fun!

Maybe Bill Murray could take care of these ghosts for us.

Glad to know we're all in the same boat and paddling like mad. I've experienced this too with the pod. The tricks I've learned which help most of the time are depending on where my new pod is put on to watch my numbers closely, legs, arms and butt get good absorption, stomach and back are more iffy. I used to change after dinner, then ran high by bedtime, so I switched to about 2:30pm which is cumbersome at work but do-able, now I'm doing about 9pm at night so I have a little bit of time to tell if it's working and shower first to help loosen the old pod's adhesive. I've also learned that showering just after or before a change is good, the warm tissue makes the absorption better, or to exercise after a pod change, the increased blood flow seems to help the lag phase. If it's not down after the workout something maybe wrong. The one thing I hate about the pod is that if there is a problem and I have to change it, I lose all the Humalog that's been loaded into it, something the other pumps don't experience. Oh well, my numbers are still better and less dramatic on a pump than not.

I don't take free showers because if I do, the place where the old site was turns bright red! (Sensitive skin). My fixed prime is 2.0. I upped it when I saw a similar pattern to what you are seeing. If I change the set midday, I only do .5 because otherwise I will go low. But I also do 2.0 if I do it in in the evening.

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