The Not-So-Gory Details

To become a "pumper", you need several things:

You will probably start with the pump syringes, tape and infusion sets from the same company as your pump. Apparently most things are interchangeable, so experiment to find out what works for you.


This is how I do things:
  1. I have a shower or just clean the site I have decided on, which is generally on my abdomen. To prepare for insertion, I use an alcohol swab only. It is sort of out of vogue now, but I rarely have problems with site infections. I have tried using site preparation solution, which is supposed to make the tape stick better, but for me it seems to make no difference (and I got infections). Others swear by it.

    I decide where to put the set in based on where I used last (keeping it away from that site), how the area looks and how it feels. I mainly use above my waist because it seems the most comfortable and most stable to me. Below the waist seems to be more sensitive and prone to lasting a shorter period of time (discomfort and problems with absorption). I have no idea why and others do not seem to find this. I pick a spot that won't get rubbed, that I won't lie on, and that I can see. Sometimes I put it somewhere I can't see, with help from my husband. Using the same area all the time is hard on your skin and can make it harder to absorb insulin, so variety is important.



  2. I fill my pump syringe, get out all the pesky bubbles (using room temperature insulin helps keep it bubble-less) and then fill the infusion set from the syringe.


  3. I "prime" the pump, which means that I ensure that the pump will deliver insulin right away by programming a bolus until insulin appears at the end of the needle in the infusion set


  4. I apply a piece of Tegaderm tape down over the site. I have recently started doing this because I was finding that while I was not having irritation at the insertion point, I was having problems with the plastic housing of the set effecting my skin. The extra piece of tape has solved this problem


  5. I use Sof-sets infusion sets from MiniMed, which I find to be much more comfortable than sets with needles in them (Sof-sets have a needle that is removed, leaving a flexible cannula, like an IV). MiniMed has something called a Sofserter, which is a device that automatically inserts the Sof-set relatively painlessly. I use that to insert the Sof-set, through the piece of tape already on my skin.



  6. To secure the set, I use the Sof-set tape or Tegaderm. Sometimes I have allergic reactions to the Sof-set tape, so I have been interspersing it with Tegaderm, which I really like. Since I have been using the extra piece of tape on my skin prior to insertion, I have not had this problem


  7. I remove the needle from the Sof-set and try really hard to put it somewhere safe. I have sat on it a hour later, after forgetting I stuck it in a couch cushion!


  8. I make sure that everything is well attached and then program a bolus. This is supposed to ensure that insulin is really going in when expected and to make up for any loss of insulin from the previous site when removed. For a Sof-set, 0.5 of a unit is recommended. Some people also recommend that you leave in the old set for 2 hours after the new set has been attached in order to keep from losing insulin from the old insertion point when you change sets.


  9. I check my blood sugar over the next several hours to make sure that the site is working and all is well. It is best to not change the pump site before bed, because if something goes wrong (you forgot to prime, the canula crimps inside), you will wake up with a high blood sugar or you could go into DKA. If you repeatedly get high, unexplained blood sugars after changing your site, unfortunately you better change it again just to be sure.


I change my infusion sets every 6 days or more, unless it is sore or looks like it could be/become infected. The recommended time between changing needle-less sets is 72 hours. I am trying to get used to changing things more, but since it seems to work well for me, I am not very motivated. When I do change the set, I sometimes put a button band-aid with some Polysporin over the old insertion spot. It helps things heal much faster, although most of the time it heals quickly on its own.

And after all these years, I still have a hard time making myself change my sites. Someone sent me an e-mail saying "what is wrong with me, I hate doing this!" and well, if something is wrong with you, it is also wrong with me. I don't think this is something any of us will ever enjoy, so if you don't look forward to it, don't be surprised. I try to approach it matter-of-factly, and not let my tendency to remember the extremely rare hard/painful insertions (almost all from back when I had to bend and insert the metal needle very carefully to get the right angle and then hope that the crappy tape would stick for more than 6 hours...) get in the way of making the most of having a pump.


After much thought, I finally tried Humalog. It was added to the drug coverage by local insurance, which helped. I was worried about it for several reasons: reports of early site loss, insulin degradation and a need to mix it with Regular insulin. I tried it straight for a week and did not feel very well, which is normal when changing things like this. I returned to Regular and felt fine, but could really feel the insulin working more slowly. I decided to try Humalog again and found that after the initial adjustment, I felt better and had better bloodsugar control. I am using it un-diluted and have found no loss of insulin effectiveness over time, and am still leaving sites in for 6 days plus. It is very nice to be able to bolus right before the meal, instead of trying to figure out the extra half hour!

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