The Sweet Spot

One of my on-going diabetes management struggles is remembering to change my infusion set on a regular basis.  Many people who've lived with diabetes for any length of time will likely admit to changing their lancet in their finger-pricking device about as often as we change the battery in our smoke detectors!  There are some aspects of diabetes care that can be neglected without a serious affect on blood sugar control.  However, infusion sites do not fall under that category.

Refilling the insulin reservoir and pump tubing are easy to remember.  My handy little pump beeps to remind me that it needs to be changed once the reservoir drops below 20 units of insulin.  I usually wait until the pump tells me that only basal insulin delivery is allowed and no bolus insulin will be delivered before I fill a new reservoir and tubing set. 

Perhaps one approach is to change my sites whenever I refill the reservoir.  However, there are a couple reasons why this isn't my standard practice.  First, I tend to refill the insulin set at work or somewhere else away from home.  Whereas, I prefer to insert a new infusion set from the comfort of my home.  Also, during my pregnancy, I had this epiphany that separating my infusion set changes from the insulin reservoir refills would allow me to more simply pinpoint if a site wasn't working well or the pump somehow malfunctioned.  Basically, by not changing both components at once, I eliminate variables in the event of suddenly having my blood sugar run high.

I've successfully kept to an infusion set changing schedule for a couple weeks at a time.  I use our family calendar in the kitchen and write "change site" on every third day.  However, I inevitably fall back into an unpredictable routine by missing a day on the calendar and thus messing up my schedule for the rest of the month! 

The reason it's so important for me to get a handle on this infusion site routine is that I've noticed how much better my blood sugar control is when my site is fresh.  I've identified what I'm calling the "sweet spot" of my insulin pump management.  Basically, the first 12 hours after a new infusion site, my insulin absorption is kind of spotty.  Sometimes the new site kicks into gear right away; while other times I notice that the insulin takes longer to affect my blood sugar.

Typically, after that first half day or so, my blood sugar control improves significantly.  Suddenly all of my insulin-to-carb ratios and basal rates are precise and predictable.  This level of control usually lasts for about two-three days (the "sweet spot") before I notice a decreased absorbency and effectiveness of my insulin and higher blood sugars.   The key, I suppose, is to change my site before the marked decline in blood sugar control occurs. 

If I can change my site reliably every third day, I should maximize the amount of time I spend in the infusion set sweet spot, thus my blood sugars would be more tightly controlled.