Tuesday 27 March 2012

Uncharted territory - update

A couple of weeks ago I posted about how I was trying to use new areas of my body for my cannula sites, because I am always concerned that one day my poor little sites will have had about all they can take and will become unusable. When I was on MDI (multiple daily injections) I used to use an area on my stomach to inject so often that it ended with lipohypertrophy (say that after 3 glasses of red!). Lipohypertrophy is a thickening of the skin under an injection site which can turn into scar tissue. It does this because the cells response to extended insulin exposure is to grow in mass. Unfortunately for type 1 diabetics or type 2s who use insulin, it means insulin injected into this site also often doesn't disperse properly causing lots of problems with blood sugar control. My problem was that it was totally painless to inject there, so I liked it.

Well, after two weeks of using my stomach for cannula sites I think I must have finally cracked it; apparently the lower stomach (underneath the belly button) causes no problems at all for me. I did have one kinked cannula when I was using a site too close to my hip, meaning when I sat down the insulin was being blocked somehow from getting into my body. But this hasn't happened since I've been using the 'fleshier' part of the stomach. Not that I normally value having 'fleshier' parts, but at least they come in handy.

I guess I have too much - ahem - 'muscle' in other areas; so I will tell my gym instructor, anyway.

Anyway, my advice to anyone who has been using sites as high as the ones often shown in pictures (as below), try using sites a little lower on the stomach. Not that the dude below has any fleshy bits (poser!) but if like me you have an extra inch or 20, why not have a go.  Do it on a day when you can keep a close eye on your bloods, when you are pretty stable (because then you can spot a kinked cannula early) and when you feel like the other sites you use need a break.

Good luck!

Sunday 11 March 2012

Uncharted territory

Site rotation, or moving the cannula around to a new area which has not been used for a while, is a really important part of diabetic management, particularly on an insulin pump.  Why?  Because every time we insert a cannula into the skin for three days to allow for insulin to enter our bodies, we are literally inserting a foreign body into our skin that our immune system will attempt to get rid of.  And it does that through the means of infection and scar tissue.  So kind of my body's immune system to get rid of foreign bodies, which I only have to put there because that very same immune system destroyed all my insulin producing cells.  Thanks for that, body!

Anyway, an infected site looks a little like this:

This photo was swiped from someone else's blog because unlike this rather svelte waistline, I would rather steal than get my wobbles out. But back to the point, it shows what the body can do in just a few short days.  If it were just for some short-lived discomfort, infected cannula sites really wouldn't be that big of a deal.  The problem is in the short term, infected cannula sites cause blood sugar swings, thanks to the body being insulin resistant when an infection is on board.  In the long term, and this is the more worrying for me, the sites become scarred and eventually all but useless for insulin infusion, causing massive problems with management.

Most pancreatically pants people have rules about how long we will use each site; some people go below the maximum of three days while other observe strict rotations, making sure they don't go back to a site for at least two weeks.

In general I only use my arms and 'love handles' (there is a benefit to NOT having a svelte waistline, you know!) because I find these sites the most reliable, the least painful and I have never had a kinked cannula using those sites.  But site rotation is something that does worry me because I want to be able to reap the benefits of insulin pump therapy for years to come.  Unfortunately though, I have never had much luck using my stomach with 6 millimetre, 90 degree insertion (some cannulas come with 45 degree insertion) and when I have used them 9 times out of 10 the cannula kinks at the very beginning, resulting in no insulin getting in and inevitable high sugars.  But I realised yesterday that I have never tried to use the lower part of my stomach.

Why?  No idea.

Challenge?  Count on it!

Today was cannula change day and in true stubborn form, I decided to go into uncharted waters and have a go.

So far things are good; no kinks, no pain and my other sites are grateful of the site rotation.  It is a strange feeling getting used to a new site; almost like the first time I ever wore a cannula.  But other than being acutely aware of where it is, my body seems to have no objection to it, yet.

I will be sure to keep you informed!