Insertion site troubles

My insertion site has ripped off twice in the middle of the night - any advice?

Yikes! ! just wondering, are you a new pumper?
A couple of thoughts come to mind:

  1. You might need a longer cannula. Length is usually determined or recommended based on weight or BMI but there may be other factors, so you could try a longer one.
  2. There are sets that insert at different angles, and a steel cannula option (some people say it’s not as bad as it sounds while others find them uncomfortable).
    Your pump rep might have recommendations and samples of either of the above for you.
  3. If you toss and turn in your sleep try clipping your pump to your pajamas. It’ll move when you do so may not pull out as easily.
  4. Have you tried different locations? The abdomen is the most frequently used, but you could hip, upper thigh, buttock or even upper arm could work. There may be logistics involved in inserting, and caution involved when getting undressed, but I thought I would mention them anyway. The longer tubing (42"?) may be better.
  5. Do you wipe the area with alcohol before inserting? In addition to sanitizing it can help if your skin is oily. And on a related note…
  6. You could try a skin prep/skin tac product - they help with adhesion but you might need a product to help remove the glue.

I hope you find a workable solution - keep us posted.

I am a fairly new pumper! I try to wipe my skin before inserting it but I usually forget :man_facepalming: last night I did clip my pump to my pjs, which worked and alerted me better to the five lows I had :cry: lol I will definitely ask my friend at Tandem for advice

Hi Grant @Grant567 , I can hear your frustration, especially since you are new with this pump thing. I might be the exception, but with sleeping with a pump for the last 6,000 consecutive nights I’ve not yet had an infusion set pulled out - a few times I suspect that it may have been pinched and disturbed. I have found the “best” place for my pump is clipping it to the neck of my sleepshirt; or if the T-shirt has a pocket, in the pocket facing away from my body. The waistband is my second choice. I always choose the shortest tubing available by thinking that excess tubing [especially with someone else in the bed] only provides “lots more” to get entangled.

For my next comment, keep in mind that I AM NOT a licensed medical advisor. Your “FIVE LOWS” during the night are very disconcerting, unless you were involved in extraordinary activity the previous day or if meal timing or dosing was off. Not knowing your pump settings [time periods, I:C Ratios, basal rates] and, before bed BGL readings, I venture a guess that you are “guilty of overbasalization” especially if these “lows” regularly occur. I suggest that you look closely at your BGL and bolus charts to see if a pattern exists.

I would like to follow up on @Dennis’s suggestion about looking into those lows. If you’re new to diabetes and/or pumping speak with your medical team for guidance about how to prevent and treat them. If it is your basal rate, work with them to adjust as necessary. In time you will learn to adjust on your own, but for now work closely with them.

I actually had a very long tennis tournament yesterday, so that makes sense. Thank you for the help!

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Try skintac skin glue on the infusion site, I usually apply the glue from a bottle to the fabric in the inserted device when the hard needle is cover. Or apply directly to skin.

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I also have not pulled out a site at night after pumping for over 16yrs. I use skin tac adhesive. I don’t always have a shirt on so I always use my waistband but I also always tuck my tubing inside my waistband so nothing is left to get pulled on. When I first started pumping I had many sleepless nights where I would wake up and worry about something going wrong or insulin flow stopping. After 16yrs I now find that I just naturally avoid laying on the side my pump and site are on. I also struggle with night lows induced by evening activities so I definitely sympathize with you there. The best piece of advice I can offer is to always clean and prep your site. I have been forced to replace pulled, leaking, and damaged tubing at work and when I start a new site in less than ideal conditions then premature failure is a constant battle. Clean and.preped skin is the secret to site success. Good luck and hang in there.

@Grant567 , all have give good ideas. I have two:
[1] when you skin prep, are you using an alcohol where you can rub your skin until pink? I was trained to do this by my endo’s pump training RN CDE. The rationale is to de-fat the skin as well as assure it is clean.

Image of skin rubbed until pink.

[2] how are you taping the site set? I was trained to use all of the tape pieces in an IV3000 dressing.
Image of taping the adhesive ring securely.

Wow. I’m thinking you had WAY more thorough training than we did. That taping job looks professional!

My training for first time pumping 20+ years ago on Animas & a Dexcom 7 was about 8 hours including 4 each on the pump & CGM. The CGM included curve analysis by the Dexcom nurse CDE pump trainer.

When CIQ came along, it was in person with three CDEs from endo, Tandem, & Dexcom. More than the one hour video of this is a pump stuff of today.

You are correct. I was thoroughly educated about the ins & outs, not trained as many are today.

@Grant567 , are there any other thoughts you have about securing site sets?

Wow you’ve got a great memory for the details. I had training with two other patients in my doctor’s office but don’t recall how long it lasted. I wore mine for maybe a couple of weeks using sterile saline, so I could practice “dosing” and inserting; then spent a couple of nights in the hospital with the other female patient while the doctor made sure our initial basal and meal settings wouldn’t send us there😊.
I got the CGM some years later and trained with a rep who came to my home. I think the initial CGM training was pretty substantive but the online I did for BIQ and then CIQ (my doctor had me do both although it’s not a requirement) was not as good - at least for me.

See private message.

wadawabbit Dorie Member with T1D
June 14

Wow you’ve got a great memory for the details. I had training with two other patients in my doctor’s office but don’t recall how long it lasted. I wore mine for maybe a couple of weeks using sterile saline, so I could practice “dosing” and inserting; then spent a couple of nights in the hospital with the other female patient while the doctor made sure our initial basal and meal settings wouldn’t send us there😊.
I got the CGM some years later and trained with a rep who came to my home. I think the initial CGM training was pretty substantive but the online I did for BIQ and then CIQ (my doctor had me do both although it’s not a requirement) was not as good - at least for me.

Nope! I actually have been clipping my pump on my pants at night which has been working - also I was never told to tape over my insertion site, which is quite smart so thank you for that!

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I was never advised to tape over an infusion site either…but, even with occasional snags, I’ve only pulled one loose once in 4 years.

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