We constantly talk about to pump or to stay on MDI, which pump is the best and continual glucose monitoring. Don't get me wrong we need to have these decisions and conversations but we also need to keep in mind some of the day to day decisions that come up. After being T1 for over 28 years now I am seeing some effects that cause me to think about things that didn't even consider 15 to 20 years ago.
When on MDI I rotated my injection sites from my abdomen, arms and legs and for the past 12 years I have been rotating my pump infusion sites on my abdomen and sides. All in all everything is good with my site locations however one thing that I have done is to make sure that I have limited the possibility of having infected sites. It is recommended that the plastic cannula sites are only used for 3 days and the metal cannuals are used for 2 days. Why is that? this is because you have a foreign item in your body and it is only time before your white blood cells start to react to it. Also no matter how natural the insulin is that you are putting into your body you are still injecting / infusing a substance into the body in an area that is unnatural so there can be a limit to the amount of insulin that can be held before the cells become over-saturated and absorption becomes a problem.
So first I have always used plastic cannula's. One because it was firstly recommended and secondly because I have never had a problem with them so they suit me. I use the minimed quickset sites. These are recommended for the 3 day wear. Does this mean I have always made sure they were always changed at the exact time..... no because life sometimes takes priority and the site is pushed out a little. However it is always at the forethought as when the day 3 comes around the effect on your bgl's is right there. My daughter uses a combination of the short metal cannula's of the sure T's and the short plastic cannula's of the Mio sites. Because of her age, diagnosed at 2 and now 7 the metal canula's that won't bend and stop the flow was necessary even though it meant and site change every 2 days. Being used to the plastic early on with the metal canula's we allowed it to spill late into the 3rd day and wondered why her bgl numbers started to climb even though she wasn't eating. We triple checked that she hadn't eaten something we didn't know about and then went about changing the site. After drawing everything up we removed the site and were shocked as to what had happened. We were left with a hard lump under the skin and a yellow puss coming from where the needle had been sitting. Knowing that this wasn't something we wanted to happen again we made sure we paid attention to the days and effects of what can happen.
Absorption can also become a problem the longer the site stays in. The cells around the area where the cannula sits is accepting a substance that it doesn't normally do. So the longer you saturate these cells the more they have to adapt to what you are doing. If you ask them to do more than they are able then the ability to push the required insulin to the body becomes difficult.
Another problem that we have come across is the damage that can be done to the largest organ in your body - your skin. Every now and again, I do find it more with my daughter, the area around the site becomes itchy. Obviously as the irritation is under the tape scratching it is near impossible but leaving the tape in place will become a problem. Luckily my daughter and I are not allergic to the tape which would be difficult however maintaining clean and regularly changed sites limits the possibility of infections on the skin. There have been a few times where treating damaged skin is another thing that is added to the list of things to think about in a already busy day with T1D.
Obviously one of the main reasons to push things out is the cost of supplies and not wanting to waste insulin which is something I completely agree with. The cost of essential supplies that allow us to live is ridiculous and we all hope that one day governments across the world will understand and take at least one burden off our plate. One thing that you can do to minimize wastage of insulin at least is to only put the estimated amount for a 3 day period in the reservoir. I know this can't solve all problems but maybe alleviate one.... just a little.
Knowing that T1D is for life keeping your mind on the big picture is a must. You can focus on today and tomorrow however you run the risk of possible difficulties later in the future. Looking after your body now is a must. I constantly think about my daughter and how when she is a strong adult I want her to be as fit and healthy and to be able to not have resentment towards decisions that we were in charge of making while she was young. To me it is even more setting her up for a happy and healthy life.
For myself I do have some minor under skin scaring however this is inevitable and honestly is a very minor problem. I am still yet to have an infected site which I believe is a strong reason around achieving this. My biggest advice if asked is to know that everything has an effect and everything needs consideration for the long term.
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