Sarah Howard
Sarah Howard has worked in the diabetes research field ever since she was diagnosed with T1D while in college in May 2013. Since then, she has worked for various diabetes organizations, focusing on research, advocacy, and community-building efforts for people with T1D and their loved ones. Sarah is currently the Senior Marketing Manager at T1D Exchange.
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For current or past insulin pump users: Have you ever changed your insulin delivery routine because of insulin absorption issues? Cancel reply
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For 16+ years I pretty much used my lower abdomen, manually inserting Silhouettes. In 2020-2021 I started having many alarms about insulin flow being blocked, no delivery. Last year I switched to Mio Advanced sets and I am able to reach all new areas I couldn’t before. I plan on giving my lower abdomen a good, long rest.
Insulin absorption issues can also happen to those of us doing the syringes and vials (MDI) too. It is important to change body spots and for me the best absorption is into the CORE.
I answered that I changed to tru steel but a few more of the answers would have been correct. I wish there has been multiple choices. I have stopped using sites then went back to them and years ago I had to stop using a pump and used Afrezza because of poor absorption. Now using pump! 60 years TD2
Unless I am misinterpreting your answer, there were multiple choices. I clicked on two of the choices.
I took a two year pump vacation mainly due to infusion set site problems. I returned to pumping in June and am using TruSteel sets and that seems to make a big difference. It’s actually harder to vary sites as much as I’d like because your need extra space for the needle and for the second adhesive pad.
Last June, I began having insulin absorption issues on Day 3 of my infusion site. (46 years w/Type 1 and pumping since 2011). I should have changed out my site early on Day 3 but, because I have been unable to obtain Medicare-approval for more frequent site changes, I am making my sites last the full 3 days and “supplementing” my insulin delivery on Day 3 with insulin injections via syringe. I have maintained good control by doing this with my A1c’s in the low 6’s. If I changed the sites early, I would run out of infusion sets and cartridges for my pump and have to resort back to MDI. Medicare allows 30 of each for a 90-day period. I did purchase out-of-pocket an extra box of each to prevent my running out. Even though I provided data about my glucose values on Day 3 and my syringe-delivered insulin on Day 3, my endo’s case notes of my office visits haven’t provided the info Medicare requires to approve site changes every 2.5 days vs every 3 days. I am in the process of changing endocrinologist and am more confident my new one will be able to navigate the Medicare requirements and get me what I need. So frustrating…all I’m trying to do is stay healthy.
The manufacturer recommends changing the Trusteel every 3 days, so Medicare has to approve that one for 2-day frequency of set changes. That solved my problems with high sugars on day 3. I am getting 45 sets every 90 days on Medicare.
Beyond the choices that were provided, I have also changed infusion sets from a longer cannula (9mm) to (6mm) and visa versa.
In addition to my previous response, I have started to use the fatty area on my back (2-3 inches above belt line. I get really get good absorption from these areas since they have not been used prior. Little trickier to insert it but good spots for me
Good reminder! Especially for those who have less padding or are noticing that they’re soft cannulas are bent at withdrawal.
I do switch the site when absorption seems to be impaired, and that usually works. But it’s never a permanent change.
I’ve been a Type 1 for over 50 years. I’m currently on a 1 year pump vacation which will end in May. I’ll then resume use of my MiniMed 640G and the Quick-Set infusion sets. I’ve found that the biggest advantages of the pump are the ability to program different basal doses and use a square-wave bolus. FWIW, my A1C and time in range has not changed significantly since I went back to MDI (two shots per day of Levemir and Humalog before meals or snacks).
After years of rotating sites around the abdomen and butt, there are certain areas of my abdomen that just don’t allow insulin absorption. I’m also using my legs now. I cannot reach my arms to insert cannulas. I find that anywhere around the rib cage does not work, lower abdomen does not work, high up on my thigh does not work. I have lots of absorption issues on my legs. It seems that I’m running out of places to place my cannulas where I get decent absorption. I change sites early often.
I am always willing to tell people to give Tru-steel a try if they have issues with the soft cannulas. So many of my soft cannulas became bent with insertion which caused so many high blood glucose readings. Since starting the Tru-steel infusion sets a few months after starting to pump, I haven’t had those issues.
If I notice poor absorption, I will give a little more time for that spot in my Omnipod rotation.
T1D ~ 45 years and have pumped for about 25 years. I use the steel needle canulas and find insulin absorption to be more consistent with them. I rotate all over my body and use different basal rates for different areas. I’m thin so to use some spots I gently bend the needle to ~ a 45 degree angle before insertion, this has worked well for me.
23 yr Pumper started on Humalog then Mixed with Velosulin the Novolog and changed to Apidra. On Tandem so now with Novolog
I answered “other” – I often need to change my site after only 2 days rather than 3. This was particularly true while pregnant/TTC – by day 3 I had much more frequency hyperglycemia (>200), which negatively impacted my A1c.
I am getting better time in range and consistent glucose readings by changing injection areas. With Tandem AutoSoft 90 I had trouble disconnecting and reconnecting the tubing for a shower. So I had infusion sets only in my abdomen for well over a decade. The Tandem rep made me aware of AutoSoft XC infusion sets. I can disconnect the XC with one hand and this has allowed me to move to fresh real estate around my back and upper butt with significant absorption improvement.
I had to change sites every 2 days when I was using Fiasp or increase my insulin by >30% on the 3rd day. When I switched to generic Humalog, that problem went away and I can now use the same site for 3 days. I speculate that the same ingredient that make Fiasp faster acting (niacinamide) also wore out my sites more quickly.
I would also like to try inhaled insulin but my insurance won’t cover it.
Have you contacted Mannkind directly? They have some options for cases like this.
As said before, I have gained much better control through the use of the insulin pump, however, I am running out of viable body ‘real estate’ due to scarring and hardening of the tissues under the skin. When this happens, absorption of the insulin gets more challenging, and uncomfortable. I would hate it, but it may come to the point where I will have to give up the use of the pump. (Solutions are welcome!)
I’m with you, M C!
I don’t know that there is a solution involving injections or pumps. No educated individual that I have asked has come up with a working solution. The most common answer is “move your site.” But, that’s not workable for me. Also, I’ve not used my abdomen in _years_, yet the lipoatrophy is still there and quite visible. So, it’s a big bummer that I can’t use the abdomen anymore.
Carol Meares’ answer may be the only one that comes close to working: inhaled insulin.
I need a lot more education on inhaled insulins before I could say for sure, though.
I hope we both find a solution!!!! 🙂
Try the tubeless OmniPod it can go in at least 10 different sanctioned areas which gives you twenty or thirty spots and I get great absorption. I use much less insulin than I used to just because my absorption has improved with so many areas where you can put it.
I had reactions to all insulin types and processes for a while. It went away after many trials to get my insulin into me. (This includes injections)
I had to give my abdomen a several years vacation after MDI there for almost 30 years. Now using the Tslim pump and rotating sites every 3 days using a chart I made showing rotation order to ensure I leave sites alone for as long as possible, so far so good.
No, not in over 30 years. Now that I think of it, I did change to metal needles but hadn’t had a huge amount of trouble first, just the educator’s hunch it might help.
A couple of years into using the Tandem t:slim 2x i was having bad problems with absorption. I asked both Tandem and my NP to meet with me and go over the training. After some back and forth they agreed. I found that I was not holding the cap containing the infusion set correctly and consequently when I pull it back it didn’t catch well enough. They also suggested the metal needle which I tried and didn’t like at all. I also changed to the AutoSoft XC.
Anyway, to make the story shorter, the training helped me do things correctly. Eventually I decided to tape the back end of the incision set and also the tube right where it begins. I only need to retape the tube after I shower. Now I get a better absorption and they last 4 days and even 5 without problems.
Still Tandem infusion sets are not that easy to connect and disconnect unless I can see it and because I’m a side sleeper I”m only able to use the front of my abdomen.
I still at times have absorption problems but now I know that when my BGs are not working correctly is not my fault. So, i just found a new place and replace it with a new one.
Taping my sound like another hassle, but it really helps.
I found absorption from my abdomen didn’t work as well after my two pregnancies. I’ve had good luck with the area at the top back of my hip just above our below the beltline. I have more padding there.
I always had trouble with the infusion sets that get inserted straight in (e.g. Quickset). They would frequently kink/bend and fail within a day or 2. I’ve had much better luck with infusion sites that are inserted at an angle (Medtronic Silhouette, Tandem Vari-Soft).
I was having absorption issues so I switched from a tubed pump which only worked in my stomach to the Omnipod which I can put in 10 different locations.
After 67 years of injected/pumped insulin, I’ve many times given the lower abdomen a rest, once for about 3 years. Being pretty thin, I began, years ago, using the silhouette/varisoft type set in order to use the area in front of my lower rib cage just below the skin, and I guess it would also work on the lower back. This was uncomfortable sometimes at first, but it seemed the insulin built up more fat, there, pretty quickly, and it’s been years since I had any discomfort with it. But the scars from heart surgery have limited that area. A steel set might be easier to put in the back above the waist, though I used to do fine with varisoft below waist — maybe work harder on that stretch first before I try putting in a set.
I stopped my meditronic after someone hacked my pump but years later I am back on the omnipod
Wow!! Do you know who/why??
Other was my answer as I changed my sites, but….
My BG is quite variable. Who knows why. Bodily stress comes in infinite forms. In the early years of pump use I would try new sites to see if this was the cause.