Diabetes Forecast - July 2013

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Where Can I Find New Insertion Sites?

I’ve had type 1 diabetes for 28 years and have used a pump for 14 years. I have trouble ;nding enough good infusion set insertion sites. I primarily stick to my stomach. What other sites could I use?

Wes Barnes, Cary, N.C

Christy L. Parkin, MSN, RN, CDE, responds: A;er years of pump therapy and/or injections, it can be a challenge to ;nd choice “real estate” that o;ers good insulin absorption.

when the thighs rub against each other, the site can become irritated and at risk for infection. ; Back of the arms. You may have some extra tissue under the skin here, but the area is hard to reach, especially if two hands are required for insertion. Physical activity can increase the absorption from this location.

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What to Know: The abdomen is the preferred
site for infusion set sites and injections. It is
easy to see and reach, and o;ers the quickest
absorption. Alternate sites tend to absorb
insulin more slowly than the abdomen. Here
are alternate sites:
; Hips and upper buttocks. Even lean people
tend to have some extra padding in these
spots. Although there is slower absorption
here, these areas are good sites for people
with low body fat.
; Outer thighs. Absorption may be increased
with activity, such as walking or running. The
inner thighs aren’t recommended because
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Possible Solutions: Inserting too many infusion sets in the same spot over many years can lead to scarring and/or overgrowth of fatty tissue (known as lipohypertrophy), which can cause poor absorption of insulin. Poor absorption may delay the e;ect of the insulin or require you to use more. If you can feel or suspect damaged tissue under your skin, avoid using the area; it can take several months for the tissue to heal.

Make a plan to regularly use di;erent sites to maintain good skin integrity. Site rotation is a systematic method of selecting various sites so that each one has a chance to fully heal before it is used again. There are several methods of site rotation (right). Choose the method that works best for you.

New sites should be at least 2;inches away from a previous site (as well as 2;inches away from the belly button). Change your site every two or three days, depending on the type of cannula you use.

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INJEC TION AND INSERTION SITES

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Recommended Alternate

Takeaways: Experiment with some alternate locations to open up your options and keep your sites healthy. And change the infusion set at the ;rst sign of pain, swelling, or redness to avoid tissue damage. Remember, the rule of thumb to live by to preserve your sites is: “When in doubt, change it out.”