Where do you put your site?

This post is half "whine" and half "what do y'all do?" :)

I'm on the skinny side and whenever i put anything in my stomach I am *very* uncomfortable. I'm pretty active (weights and swimming) and if my CGM or site is on my stomach I don't feel comfortable "piking" (folding in half) while exercise. And a lot of stuff requires that!

SO I put my sites on my lower back "love handles" and my butt. I know both these spots (especially butt) have lower absorption... but my stomach can't take it. I end up trying to cycle more using these 4 spots, so I'm hoping for lower skin damage by having so much variety.

I use 90 degree (6mm) canulas, angled insertions make me really really uncomfortable, especially since I'm not dying to put a big complicated needle in by hand or with one of those awful "angled inserters".

People keep talking about using their arms or legs.... any tips or tricks? I'm worried about hitting muscle, *maybe* my inner thighs could work but I'm a little nervous to try.

Where do y'all put your sites?

John,

Sounds like we follow the same pattern.  I occasionally will try my thigh, but it has to be in the perfect spot or it leaves a huge bruise (like the one I have right now).  I read on a similar post to this one that the upper, outside part of the thigh can work.  I'll follow your post to see what others have to say.

Jason in Orlando

 

 

I'm really skinny too but I find that my stomach is the only place I can put it and be comfortable. I use the inset 30s from Animas and love them! I'm surprised that you use the 90 degree ones being skinny!

What I do is sit down and put my inset in, and then stand up when I'm taping it down that way there is less pinching. I'm very active as well working with a little boy who has autism and running around after him all the time and I've never really had a problem.

I guess to each his/her own!

I put my sites mainly on my butt but occasionally I use my stomach.  The issue with my stomach is that I have to use Mastisol to keep the set from falling out, and that's a hassle.  Also, I've noticed that I develop slightly (occasionally very) bloody and bruised sites on my stomach.  I haven't found the placement of my sites to noticeably affect insulin absorption rates, except that I have a lot of scar tissue that initially messes up absorption. 

Could you try using some sort of adhesive on your stomach sites if you don't already?  Maybe that will help your sites feel less vulnerable and awkward when bending over.

I have plenty of "real estate" for my sites and favor the stomach, but I wanted to mention that your inner thigh is VERY vascular.  You'd be likely to bruise, pop a bleeder, or damage the tissue.  Stick to the outside.

I love my inset 30 (angled) inserter, by the way.  Cock it, place it against your skin, and POP!  Super simple, nothing done "by hand."  Why do you think they're "awful?"  They're supposed to be better for lean people, by the way.  (I'm not lean, but I do think it gives me more options to put the site on leaner portions of my body.)

Ahaha!  I typed c-o-c-k (as in, pull back and make ready to trigger) and the forum totally censored me! 

i don't know why i always find these posts so funny. i'm by no means making light of your situation, john. that's not my intention - i just happen to have plenty of squish and find it entertaining when people are too thin to comfortably find a place to use their pump.

anywhere you have fatty tissue is a good place to put a site. is there anywhere on your body you have a "little extra" hanging around? i have some in abundance, if you'd like to share. i could probably stick one in my cheek as i look like i'm storing nuts for the winter...

hey, i just remembered! "pat" on here exercises a lot and also wears a pump. you should talk to him about where he puts his site and how he exercises with it. i've never met him, but he seems pretty muscley. it sounds like he works out quite often too.

PAAAAAAAAAAAAAAAAT. where are you? he doesn't get on here all that often anymore... i'll go facebook stalk him for you and tell him he has a new friend to talk to. interesting fact about pat: he doesn't wear shirts... except in the photo below - one of those rare moments when he's almost fully clothed.

here's his profile: http://juvenation.org/members/Woo-Its-Pat/default.aspx i'm sure he'll appreciate me posting pictures of him.... :D:D

Hi John -

It's always helpful to talk to a Diabetes Educator about finding a good site. Whenever I meet with mine, we always go over that stuff and she checks the places that I use frequently for hypertrophies and whatnot. Over the years, I've gone through trials and tribulations with many infusion sets and sites. I currently use a Minimed Paradigm Revel, and I've used the QuickSet, Silhouette, Mio, and now the Sure-T.

I like the 90 degree canulas better than the angled one - I found the angled ones pinch when I bend at the waist and whatnot. The 90 degree sets are much better, and I can put them more places than just my stomach. Surprisingly, I really like the Sure-T sets even though they have a metal needle opposed to a plastic cannula. Also, the disconnect on the Sure-T is not at the infusion site, which minimizes jarring it.

Mostly, I keep the sites on my stomach. I've tried my lower back, but found that I jar it around too much (i.e., while sleeping, putting on my backpack, etc.). I find that using medical tape to keep the set in place better. I have placed sites on the back of my arm in the past, which I'll probably try with the Sure-T sometime soon. I've thought of using my thigh, though I do have some padding there and I'm not sure if it will work well.

Good luck with the sites!

 

[quote user="C"]

hey, i just remembered! "pat" on here exercises a lot and also wears a pump. you should talk to him about where he puts his site and how he exercises with it. i've never met him, but he seems pretty muscley. it sounds like he works out quite often too.

 

[/quote]

Last time I saw Pat he was wearing his site on his lower back, love handles I guess you would call them. lol I remember because he made fun of my for wearing mine on my stomach! :)

You guys pick on poor Pattykins alot. I mean, he does have a life and job and such. So in defense of Pat he will get here eventually.

As for the original question about insertion sites. I have had so many random issues with using my abdomen and sometimes love handles I have been favoring my upper arms for both my CGM and Infusion Site. I am relatively thin, but there is some padding that needs to go away. The upper arm works great for me and there are times when I first moved up there I felt like the absorption was really good.

I do use the angled insertion set from Animas, not the 90 degree because those and I never got along due to my thinness.

Back to the arm though. A few things to think about when and if you do this. The first is the length of your tubing. If you are using the shorter length of tubing and you are a taller person, I am about 6 foot or so chances are the shorter tubing might make it hard to put the pump in your pocket. For a while until I was able to order longer tubing I had my pump climbed to the belt. There will come a time when you accidentally hit muscle, it does smart a little but I normally was fine with the where the site was. Usually, once the initial shock goes away its fine although sometimes you will "feel" your Bolus' as they enter.

Also if you go with the arms whether you use a serter or not I would start with going to the side in which your strong hand would do the placement of the site. So if you are right handed, I would put the site on the left hand side. This way you get used to what you need to do before having to use your "weak" hand for inserting.

Also, the last thing to think about is the tubing angle. Depending on which infusion set you use you want to make sure the tubing is pointing up your arm so it can drop off to the side of your body, again this gives you a little more tube length if you use the shorter tubing. Also, it will limit the amount of time you might accidentally pull the site out when you are taking off shirts. The first few months I would accidentally rip a site out because the t-shirt got caught on the top of the infusion site. Granted it was a rarity. The site I use is usually somewhere about an inch from the shoulder to avoid the bone and such. It really is great, and I am glad I manned up and did it. Also, one other thing to think about is hair. If you do have some hair on the upper arm, I might suggest removing it, this way things stick better.

I am glad I moved to my arms, since moving to the arms, I have had little to no infections or irritated sites. It seems when I wander back to the abdomen and love handles to give my arms rest, that is when I have issues. Any other questions please ask.

[quote user="Brian Q."]

You guys pick on poor Pattykins alot. I mean, he does have a life and job and such. So in defense of Pat he will get here eventually.

[/quote]

i like making fun of pattycakes. he makes fun of me. i have a life, too! ...just not a job. but i'm working on that. be nice, bpq, or i'll ask god to smite thee. :D

If my arms weren't 100%, grade-a, manly-man man-muscle devoid of all fat I'd be tempted... but i'm suspicious that putting a site there would be like trying to hammer a nail into a knot of wood. I'll pester my endo about it, maybe ask to talk to another minimed rep.

Maybe this just means I need to practice angled insertion. I guess since I mainly use areas *behind* me (namely my behind and my lower back) angled insertion is actually kind of difficult. My only experience with angled insertion is the MM CGM sensor which i place in my stomach... it honestly gives me serious "freak-out-i-gotta-sit-down-and-breathe-deep" every time I put it in.

Major respect to everyone who can perform angled insertions on weird locations (arms? damn.) I probably won't do it until my sides are exahusted.

Just need to get past the awkwardness. And John, I am sure the size of the bloody needle you need to insert has nothing to do with the small amounts of freak and and breathe time. I loved the MM CGM, but you have no idea how glad I am I jumped to the Dexcom CGM.

As for the arms and muscle the only thing you need to remember is that if you are looking in the mirror while giving it a shot, you should not be flexing (I know, I know with manly-man man-muscle in front of a mirror, it is probably hard to not flex, but still). The thing is if you are using your abdomen and you can get the site in there (I am sure you have muscle in that area as well), there should be no difference. Before completely brushing the idea aside I would entertain giving it a shot. Until you try and fail or succeed you just won't know.

As for the angles, it can be awkward, but that is where the inset infusion set is so nice, it is a small self contained set/serter. So it is not completely awkward. I truly feel they are so much less awkward than anything Minimed has. I mean their 90 set is great, again I had my own issues. The Silohuette set was awkward at times, but I was not using that for my arms or anywhere else. All it takes is time, patience, and of course practice (I am sure you thought I was going to say manly-man man-muscle). Sorry, I crack myself up, I truly mean no disrespect. Either way best of luck John.

[quote user="John"]

If my arms weren't 100%, grade-a, manly-man man-muscle devoid of all fat I'd be tempted... but i'm suspicious that putting a site there would be like trying to hammer a nail into a knot of wood. I'll pester my endo about it, maybe ask to talk to another minimed rep.

[/quote]

bahahahahahahahahahha. love this. pictures please? :D

Wow yeah I am late to the party. Yes I wear it on my, as Courtney so eloquently put it, 'love handles' as that's the only fatty tissue I've got going at this point which I guess is good...also one of the few spots that isn't fuzzy so yeah, infusion site goes there.

and C, I don't make fun of you, just the state which you live in. :P

Wait, does this mean I should ignore all the advice she gave me earlier??

 

Good to know.

this may come out the wrong way, but reading through all of these posts, I just kept thinking "Dude, John, eat a sandwich and all of your problems will cease to exist."

On a more serious note.  I hate using my stomach also.  Not for the same reasons as you -  I have plenty of fat in various places!  I agree that the inside of the thigh is super uncomfortable.  I like the outside of the thigh, in the back, kind of under and to the side of my butt.  It's out of the way, and I havent noticed much of an absorption problem.

No me gusta putting it in my arm.  It was like being hooked up to an IV all day.  Hated it.

So far in 10 mos on the pump, my 5 yr old only allows sites (inset 30s) to be put into his butt. It is OK, because he's pretty skinny, so that is about the fattiest place on him. We have lucked out so far that we seem to have no hypertrophy and just keep switching back and forth between sides and rotating around as much as possible. Our endo seems to think that until we have problems, we don't have to force him to try his abdomen. I guess what I'm trying to say is that on an adult, there should be plenty of space on your back side to be rotating around and allowing for adequate healing before you go back to a certain location. Since we only know 'butt' absorption, we just work with that. I don't know if it would change his basals or meal ratios if we used other sites - do people need to do that depending on where their site is? I'm curious.

Hey John~

I'm very active as well and use the 90 degree canulas...i hate needles so whatever is the fastest insert is what i like :)

I run a lot and so I don't like using my legs.  My butt is the area of choice but recently I've wandered into my stomach area and it isn't too bad.  It takes a while to get used to but if you insert on the side of your stomach it's relatively out of the way. 

Good luck on your pump site quest :)

~Debbie