Insulin Infusion Set First Day Blues?

I’m curious if anyone else is having trouble with high blood sugars on the first day of a new infusion set. I have noticed an issue with this, despite gradually increasing my fixed prime over time. I notice that on the first day of an infusion set it appears to take some time for the site to really begin to absorb the insulin.

What ends up happening quite frequently is that I change my site at my usual time in the morning, take insulin for breakfast, timing it as usual and eat. Then I go high, often quite high. I take more insulin, of course. At some time later, the insulin finally starts to kick in and I go low.

This was becoming a frequent enough pattern that I discussed it with my doctor, who had not heard of this before, but was not incredibly surprised.

I’ve been pumping for about 11 years now, using humalog since the beginning, so should not be getting such a delayed reaction. As I discussed this with my doctor, it suddenly occurred to me that this has been happening for somewhere about a year. Coincidentally, I also started to use the sil-serter to insert my infusion sets about a year ago.

When I started pumping, the sil-serter did not exist, so I was used to doing it manually. I have always preferred the silhouette infusion sets. I noticed the existence of the sil-serter some time ago and decided to finally give it a try. It’s so much easier! I was really impressed.

I have very sensitive skin. To insert manually, I lightly poke myself sometimes just a few times, sometimes a dozen or so times, until I find a spot that is painless and then slowly but steadily insert the set. Yes, I know how painful that sounds, but it works for me. The sil-serter finally saved me from this both in time and in the poking and prodding to find a painless spot.

Unfortunately, I am now coming to the conclusion that the sil-serter may be my problem. Despite the fact that the insertion is generally painless, the needle is inserted with such force that it actually comes out bent. I am now coming to the conclusion that this force may be bruising the infusion site and affecting the ability to absorb insulin for some time.

Or, perhaps it is just that when I insert slowly and carefully, I end up with the catheter somehow in a better spot or at a better depth. Either way, I have gone back to the manual insertion and am having far less trouble on the first day.

So far, this is just a preliminary result. I have not kept perfect records of this. However, now that I am inserting manually again, I’m even beginning to consider the possibility of reducing my fixed prime amount. I had been using 1.6 units for years. Recently, I had increased to 3.0 units as the prime. The infusion set is documented as requiring 0.6 units. That has never been enough for me to get the usual result from my usual bolus on the first day, so I increase it a bit.

Has anyone else consistently experienced this type of problem on the day of the site change? If so, what do you do for it? Have you noticed any difference between manual insertion of the infusion set or automatic insertion? Which infusion sets do you use?

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15 Responses to Insulin Infusion Set First Day Blues?

  1. Kim says:

    I have been pumping for nine years – about a year-and-a-half with the Minimed pump. I’ve always inserted infusion sets manually (the Tender II from before, and the Silhouette now), but when I switched to the Minimed pump, they sold me the Sil-Serter. I used it once or twice, but I just didn’t feel like I had the same level of control with the automatic “thwump” insertion that I do with my carefully controlled manual insertion. I can understand if you’re new to pumping and the thought of sliding that long needle under your skin is scary, that maybe you would want to automate it, but I don’t.

    Also, when I put the infusion sets in areas other than my abdomen (hip area), I have to increase the fixed prime a bit as well. Right now I do 1.0 units in the hip and stick with the 0.6 in the abdomen. In the past, I have had erratic blood sugars after changing the infusion set due to inconsistent absorption I assume, but I haven’t had too many issues lately.

  2. Kim,

    Thanks for the input. I had never considered different prime values for different areas. This probably won’t be very useful to me as I always use my thighs. I can’t use my abdomen due to both sensitivity there and frequent use of backpacks with waist straps.

    I used to use my buttocks, but now reserve them for the continuous glucose monitor sensors.

    With regard to the sil-serter, I didn’t mind the lack of control, until I noticed the correlation between bad blood glucose on the first day of insertion. It actually does hurt less and is a lot faster for me than hunting around for a less sensitive location. Given my results though with better control associated with manual insertion, I’m staying with manual.

  3. Update: A few more weeks of hand insertion only has convinced me, though still mostly by gut feel rather than real scientific measurements, that my first day blues are mostly gone with hand insertions. I’ve even gone back down to my old 1.6 unit prime from a prime of 3.0 units.

  4. mark webb says:

    Well that is interesting..I’ve just switched to silouettes after my firt couple of years with the quicksets. (always installed with the thwacker..Quik-sert?)

    I’d read on insulin pumpers website repeated praise for the silouettes, and thought I’d try them out. Peaple often nagged about the Quiksets..though I had little problems ..I thoughtI might be missing something better ..so lets give them a try..!

    Also mentions on IP website quite oftens about highs after changing sets…not really infusion type specific but I always thought…never really noticed this myself before.??

    Until yesterday..must be my third/fourth silouette after using the Sil-serter they sent me..

    I first got a couple of samples of silouettes in the mail to try afew weeks back. I inserted these manually, and thought Yep I like these (to wear) and ordered a bulk supply, which came with the Sil-serter.

    As I usually insert the quickset in with the tool I tohught why not use..I do think it easier, if a little abrupt…and the very similar to the CGM sensor inserter I occasionally use from them too.

    But yesterday I did get a very surprising high after my new Silouette went …about 2 hours after I think up at 21 mmols late afternoon which waas probably 10 over expectations at that point.

    I was very confused by this and went manual correction by needle while I investigated and inserted a new set…though on close investigation of the set nothing looked at all untoward??

    The suggestion of the bruising effect is quite plausible….I will do a few manuals and autos and carefully compare my results…

    Thanks for the insight..

  5. Good luck Mark. Let me know how it goes.

  6. Cathye says:

    I use the Silhouette and insert manually. I have been very upset because I usually am high for a day after a new insertion. My fixed prime is only .5 and was not aware that it could be changed.
    I also insert very cautiously as some areas are too painful to put the needle. I was glad to hear that some people (like me) have to prick several times to find a comfortable spot.

  7. Hi Cathye,

    Yes. It seems we’re two of a kind with our infusion sets. When giving a fixed prime, you can adjust up or down the same way as for bolusing, just use the up and down arrows to get the number that works for you. I have been using 1.6 for a long time, though I don’t remember why I started with that particular number. I’d suggest giving that a try. Though, you can definitely go higher if need be. The pump remembers your last fixed prime value and will default to whatever you used last.

  8. Mel Halbert says:

    I have no experience with Silhouettes, but I did have bad experiences (no insulin delivery) several times with SofSets when I first started pumping in July ’07. After reading many recommendations at insulinpumpforums.com for Sure-T sets, I tried them and have never felt the need for any others. The ones I use have a 6-mm long stainless-steel needle that goes in at 90 degrees to my body surface. There is no mechanical inserter; I simply press the needle straight in. They almost never cause me any pain, and I have not had any delivery failures since I started changing them at 3- or 4-day intervals. (For me, insulin delivery becomes erratic after 4 days, presumably because my body is growing scar tissue around the needle.)

    I developed a simple way of priming the tubing with insulin before insertion. It easily eliminates air bubbles and requires minimal Fixed Prime (I use 0.2 units). This method is described in post #14 at Insulin Pump Forums

  9. Hi Mel,

    That’s an interesting idea to do the manual prime of the tubing while connected to the infusion set. I’ll give that a try. I’ve been pumping since 1998 and never thought of that.

    Unfortunately, given that I’m currently priming much more than the documented amount to fill the silhouette infusion set, I suspect my problem has to do with priming my own subcutaneous tissue in some way rather than the tubing itself.

    Unlike the continuous glucose sensors, infusion sites really are meant to be changed every 3 days to avoid infection. Once in a while, I’ll see that my site is not infected, the reservoir still has plenty of insulin, and will decide that for some reason changing the site on that day is particularly inconvenient and I will push it to 3.5 or 4 days. I do this fairly rarely though.

    My doctor is surprised I can still go 3 days consistently. He says many of his patients who have been pumping as long as I have have had to switch to changing every 2 days to avoid infection.

  10. Mel,

    One question about this. I don’t see a way to prime the infusion set without taking the needle out. Once the needle is out I can’t put the catheter in. Am I missing something?

    Thanks.

  11. Matthew Fellows says:

    Hi, I know this is an old post and I didn’t read through all the responses but this is quite common with me as well. My doctor said he has 2 patients this happens with, me being one of them. What he explained is that your body creates a hormone in response to the “foreign” matter in your body. The foreign matter being the infusion set. For me, it lasts about 4.5 hours. What I do is to give a prime of 1.5 units (rather than 0.5), give myself a little extra bolus manually, maybe 3-5 units, then turn up my temporary basil rate to 200% for the 4.5 hours. This usually works pretty good but after the 4.5 hours, I need to watch closely because sometimes I get really low and sometimes my BS stabilizes just fine. Hope this helps in some way shape or form…

    • cat says:

      Yes, I have this problem, but my doctors do not understand that this is a real problem. The problem is…it does not happen every time but only on certain infusion sites. If I try to prevent it, sometimes I go too low during the night.

  12. Thanks Matthew! That just might be the explanation I was looking for.

    I still have this issue. I have gone back to the sil-serter, which helps me with opening more areas for better site rotation. In my case, just going farther around on my legs to places that are too painful for manual insertion. I generally prime 1.6.

    However, one thing that really has helped me to not need such a large bolus for the first meal is to simply switch my morning routine. I now generally bolus with my old site and eat breakfast. Then, I shower and do my site change. That way, it is several hours, at least, before my next meal.

    Voila!

    Waiting those hours while the basal is flowing, but no bolus is needed, seems to really help.

    I don’t know whether this would work for everyone. In my case, my basal from post-breakfast until midnight is just 0.1 unit per hour, barely enough to matter. Perhaps those who require a higher basal would still have issues on site change day and need to do your trick of doubling the basal rate. But, at least this reduces the impact by making it unnecessary to bolus immediately after a site change.

  13. cat says:

    I forgot to mention that I am now on OmniPod and this is still a problem.

  14. eric says:

    I’ve been having this problem, big time, for about four years now. Glad to know I’m not the only one. My sugars always go way high the day I change my infusion set. my doctor has never heard of this happening to anyone else before…

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