Dear Dr. Edelman,
I’ve noticed on occasion it seems like my infusion line fails the longer I have it in. How often should I be changing it?
Dr. Edelman: There seems to be some confusion and/or controversy on how often one should change the infusion on their insulin pump. The standard teaching is three days, but the answer is more complicated than that. Several studies using continuous glucose monitoring data have shown that glucose levels start to rise after two and a half to three days when all other factors have been kept the same as much as possible. If you read the PI (package insert) for the different insulins, they say to change out the insulin infusion line after 2 to 3 days, and the thought is that the insulin itself starts to denature from light, heat and agitation.
Additional issues are that there may be reduced absorption at the catheter or needle infusion site and the risk of a local skin infection is higher the longer one keeps it in without changing. Some PWD are prone to abscess infections that need to be incised and drained by a local ED doctor as well.
Lastly and very importantly…PLEASE CHANGE YOUR LANCET FOR YOUR GLUCOSE METER AT LEAST ONCE EVERY 6 MONTHS!
Once every six months. You must be joking. Also you should add that insulin can “denature” — or change it’s molecular geometry by flipping one end of the molecule over the other— from its surface contact with the plastic
pouch reservoir used by Tandem Tslim, for example. Cheers! 🍸
Wow, you must be a rocket scientist! “Molecular geometry” – wow, that is cool and beyond my knowledge base. Totally agree with you!
Over my 40+ years as a a T1 I’ve also noticed that in general three days is about when my insulin stops working as well, however there are ways to extend the useful life my infusion sets and reservoirs up to a week or a little more.
1> Limiting the rate at which my pump feeds insulin to no more than 3 units in any 15 minute period. Usually this means using the square or dual bolus setting on my pump, and planning ahead for what I’ll probably be eating for meals. Occasionally if I find I need more insulin, and can’t use the pump w/o exceeding this rule, I’ll just take a shot.
2> Keep my pump (and thus the reservoir) in a portable cooler I can wear on my belt or chest. I’ve been using two small Frio Coolers for over a decade to keep my insulin between 60-75 F.
3> Be careful to avoid bumping or dropping the pump.
As I thought about my previous post I realized that there more to when to change infusion sets. I actually change my sets every 4-5 days, not because the insulin becomes less effective, but because the infusion site becomes irritated, red, and sore if I go longer. Also that is about when the adhesive on the infusion set becomes ineffective and I’d need to add Mastic to re-glue it down before it falls off.
Grant, thank you so much for sharing your secrets! Sounds like you go to great lengths to preserve insulin action in your pump. Appreciate your comments for what works for you.
Dr E. All due respect but all PWD are underemployed or under insured or in some cases flat out poor. ive had problems over the past trying to break the “A1C glass ceiling of 8.0” for nearly 25 years of IDDM, type 1.5 (Dx at 33yo and 155lbs). I have the scars from previous injection site infections but also pay out of pocket of over $325 per sensor (3 needed each month, and monitor battery sometime concks out beore end of mont)WITH great insurance.
Getting and keeping insulin, inside my body, is paramount and any lowering of Bg is a success in my view.
Gosh…sorry to hear and I know lots of folks are in the same situation.
Reginald,
I once asked at the Costco pharmacy the price of G6 sensors (without insurance), and it was a fraction of the cost you are paying. You might want to look into that.
Thanks Rich!
Hummmm, you can get G6 sensors via Costco? I thought you could only get them from Dexcom. Where else can you get them?? Also, I keep my infusion set on as long as I can, but it is usually 3 days. I can tell by the higher blood sugars when I need to change. Rarely, I can go 5 days if I am in a good location. I have lots of scar tissue from past shots, before pump, and infusion set sites. It’s getting harder and harder to get a good clean location to put a new infusion set on.
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