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Reviewed by Bruce W. Bode, MD
Reader Joan Stout from Durham, North Carolina wishes she had these tips, tricks, and suggestions when she started using a pump for her diabetes. Through the years, she has received contributions from Betsy, Polly, Maryle Ashley, Chris A. Bates, James Canning, Karen Gundy-Burlet, Peter McCracken, Larry Murphy, Brian J. Rodriguez, Laurie Schatzberg, Ed Stanford, and Ayaz Usman.
Stout has had type I diabetes for 24 years. She got her first pump in May 1990 after losing two-thirds of her kidney function and having an A1C over 13%. Today, she claims she is a successful pump user with her most recent A1C at 6.1%.
In her collection, which she's compiled from friends via the internet, Stout has included individual tips for both Disetronic and MiniMed pumps as well as general tips that apply to both brands.
Tricks to Minimize the Pain With Infusion Sets (Both Pumps)
I'm thin, about 6 feet and 135 pounds, and I've had problems with the Sof-Set introducer needle hitting the muscle wall during insertion. This is quite painful. My technique is to pinch up the skin, insert the set all the way, and pull up the introducer needle about 1/8 of an inch. This makes the needle just about flush with the cannula. Then release the pinch, continue pressing the set flat, and tape it down. After taping it down, I remove the needle entirely. If I don't pull the needle, it hits the muscles when I release the pinch and try to tape it down.
I used to get a little sore at the spot on my skin that came into contact with the spot on the bent needle set where the needle is plastick-ed into the butterfly. That little plastic piece always seemed to give me a sore that took longer to heal than the place the needle penetrated. My solution is to cut a very small length of Hypafix tape and place it over the general area on my abdomen where the bent needle was to be inserted. Insert and fasten as usual, but insert the needle through the tape.
Skin Preparation and Tape Tricks (Both Pumps)
I have also had quite a time finding the right combination of infusion set type, site, and additional tape when necessary. I've found that I'm very sensitive to just plain alcohol, so I use baby oil to remove adhesive and even swab it over a stubborn piece of tape before peeling it off. If redness is particularly bad, I also use some over-the-counter hydrocortisone cream, avoiding the actual insertion site that I've just finished using.
Perhaps you would benefit from something to protect your skin. I use Skin Prep which comes in a box of 50 swabs for about $11. There are many other skin barriers like this available. They are swabbed on the new insertion site area and allowed to dry for about a minute before doing anything at all to the skin. I use them all the time, no matter what type of infusion set or tape I am using. (It also makes the tape easier to remove.)
I notice that the more hair under the tape causes more adhesive to stick when I try to remove it. I shave the areas about once a week so whenever I'm going to move to a new site, it's relatively hairless!
Another possible remedy for dealing with skin irritation is applying a little vitamin E oil to the old site. Just puncture one of the vitamin capsules and gently apply some to the skin. I do this for a day or so after I remove an infusion set and find that the little red dots heal rather quickly.
How to Make the Pump Easier to Wear (Both Pumps)
To make wearing the pump easier in a dress, cut slits in the dress pockets from the inside and then hem the slits. You can place the pump in the pocket from the inside with no exposed tubing.
If you don't have a convenient place to put the pump, try a baby sock. Drop the pump into the sock and pin the sock somewhere underneath your clothes. If you're wearing a shirt and a jumper, pin it to the shirt so it doesn't pull on your outer layer of clothing. If you don't want to carry a purse, you can also add a few rolls of emergency candy to the sock!
Tips for Better Absorption (Both Pumps)
The biggest problems with absorption come from the angle of insertion, not from the type of infusion set being used. Some people who have been on an insulin pump for a while are going in too deep and thus causing all sorts of problems.
There can be erratic absorption and scar tissue build-up. As a side issue, the comfort level at the site is never good when you are in too deep. So, what is the correct angle of insertion?
There is no one pre-determined angle for the infusion set for all people. It depends upon the site selected and body build. Look at the site you are selecting and try to picture where the tip of the needle is going to end up. You want the tip to be between the muscle and the skin. For example, under the rib cage you want to go in at less of an angle than next to the belly button. In the legs you usually want close to a 10 degree angle.
I use the straight sets because I feel I have better control over the angle, and thus have more sites available for me to use. The new Disetronic Tender set with a Teflon cannula allows you more flexibility with the angle of insertion.
Different types of insulin will make a difference in absorption also. The pump does not care if you are using Humulin, buffered, or beef/pork mixed. As long as it is regular insulin, it will work. Sometimes switching to another type is an effective thing to do. Check with your doctor.
If all else fails, try changing to other sites for a while. I have found that the inner thigh was a good place, but I had to go in at about 10 degrees on my insertion angle. I have a friend who uses a place about an inch from and beside the backbone. A lot of the time, runners will use their inner arm, again going shallow on the angle. Maybe giving your normal site a rest would be beneficial.
[Remember to always check with a doctor before changing regions of infusion since switching sites could have serious medical consequences.]
Sleeping With Your Pump (Both Pumps)
When taking your pump to bed with you, there are many tips for making the night more pleasant.
You could wear a Unique Sleep T. They are very nice, but I only have two, and sometimes I'm so tired that I just can't find it.
I like to have a shirt pocket to fit it into, like in a pajama top. I run the tubing under the shirt and button over it. This way it is not left loose to catch on things, and the pump stays in the pocket.
Sometimes I also use a soft leather belt with one of those belt cases on it and just let the pump stay there overnight.
I find I don't notice the pump much unless there's more than me in the bed. It doesn't catch on anything, and it ends up sleeping beside me. I use the 80 cm length so there's not enough to get all wrapped up in tubing.
I like to wear my Disetronic pump in the soft elastic belt that came with the pump. I've also sewn a pocket out of stretch lace on the inside of pajamas and stuck the pump in there. I have sticky Velcro on the back of my pump case which doesn't allow the pump to slide out of the pocket because it adheres to the lace. This pocket would work on nightgowns, T-shirts, whatever your imagination leads to. You can also improvise a pouch out of a baby sock and pin it on.
Before You Stock up on Supplies
When you buy a pump, you will probably be encouraged to immediately order a large amount of supplies from the company or the distributor.
Think twice before you do this because preferences for tape and infusion sets are highly individual. One tape may break you out in hives while another has no effect at all. Remember, all infusion sets and tapes are interchangeable with both brands of pumps.
The No-Air Solution (Disetronic Pump)
I fill as many cartridges as the vial will fill so I only handle the vial at one setting. A vial can fill three cartridges plus a little bit of another. I use only one cartridge-filling needle at each setting and save the unopened ones for "change-cartridge-but-not-infusion-set" days. I re-cap and then store each of the filled cartridges in an empty One Touch 2 vial of test strips. I tear out the desiccant from the vial's cap, so the capped cartridge fits in there quite nicely. I cap the partly-filled cartridge and store it the same way, but I label it. The next time I need to fill cartridges, I top off that one and use it first. I store all of this in the refrigerator.
Fill each cartridge as you've been instructed, except be sure to skip the step the says to inject air into the vial of insulin. You'll need stronger hands to fill the cartridge while drawing a bit of a vacuum, but it works just fine and results in much less air being introduced into the cartridge.
Changing the Cartridge Without Changing the Infusion Set (Disetronic Pump)
To change a Disetronic pump cartridge without changing the bent-needle infusion set you will need the following things close at hand: a filled cartridge, screw cap for end of infusion set, plastic clamp, and a cartridge-filling needle (one of the ones you use to fill a cartridge from the insulin vial).
First, turn the pump off. Fasten the plastic clamp to the end of the infusion set, as close as possible to the screw top. Disconnect the infusion set from the pump and screw the little screw cap on to the exposed end of the infusion set. Now you're connected to a plugged-up infusion set and the pump is separate from you.
Then, remove the empty cartridge and insert a fresh cartridge as usual. Now you're ready to top off the infusion set and reconnect.
Attach the cartridge-filling needle to the pump and begin to prime. Then unscrew the cap from the end of the infusion set. As drops of insulin begin to appear at the tip of the needle, allow these drops to drip into the now-exposed end of the infusion set to fill up any air gap that was created when you disconnected it. The needle is useful to pop any air bubbles that are in that spot, too. When the air gap is filled, unscrew the cartridge-filling needle from the pump and re-attach the infusion set to the pump as usual. Finally, remove the plastic clamp from the end of the infusion set, and turn the pump back on.
(The manufacturer states that it is vitally important that the clamp is on tightly while the cartridge is changed. Without the clamp, dangerous amounts of insulin could drain into the body.)