Infusion Sets: Try them all.

After pumping for a year, I quickly ran into a string of failures.

In general, the sites I was rotating were becoming less useful. It became a problem, with frequent highs and unnecessary rotations. What I needed to explore was not more real estate (although a rotation plan is key); what I found out I needed to do is try different infusion sets.

I had become quite frustrated with the one kind of infusion set - and I felt very limited on where I could use the set. The QuickSet has a large-ish nub on the end of it, where the hose can attach or disconnect. And I had reached all the way around my sides and all over my abdomon and had used about everywhere I could reach. I considered my legs for a moment, but the nub on the QuickSet is too large - I worried it would rub against my pants leg and become uncomfortable or worse, pop out.

When I reported the infusion set problem to my doctor, he asked me "Which other sets are you using?" I was horrified, none. "Well, " he reported "most of my patients use different sets, depending on where they are using them."

Interesting! So the big tip here is to not fall too much in love with your first infusion set; branch out and try the different ones out there. (Remember TSD Manifesto - point 5, try new things, be willing to question what you have been doing.)

Medtronic starts most of their patients out on QuickSets. Automatic insertion device, short 90 degree canula, its a nice easy set to start pumping with. But, in general the soft 90 degree sets have a short insertion length and are made of soft material that can kink/not flow. I like the QuickSets - however I needed options.

So I tested a few other sets.

Sure-T offers the same short 90 degree canula, however uses a steel needle vs the soft needle. So I tried them for a few months. In general, the Sure-Ts seem slightly more reliable - steel needle is nice - for example, if it pops out you can shove it back in - however there is not as much sticky to hold them down - so the will pop off easier after a few showers.

I like the Sure-Ts - they seem to me to be a good option for exploring the upper outside legs. No special tools are needed to inset them, and they seem reliable. The largest con is the 90 degree angled very short length steel canula.

The other interesting feature of the Sure-T is how flat it is compared to the QuickSet. The Sure-T has no large plastic nub - it sits flat at the site - and has a less large disconnect a few centimeters away that also tapes down nice and flat. It seems to me ideally suited for use on the upper legs - and I am confident that they will not want to pop out while running - so now we seem to have more options.

At some point, you will want to get away completely from the 90 degree infusion sets.

The other major set I have been using is the Silhouette. I would first say that the Silhouette is not a beginner set. They do offer a special spring loaded inserter - which probably makes the insertion process easier if you become intiinated by it's very large insertion needle.

The Silhouette is set to 45 degrees - and like the QuickSet has a steel needle for insertion, when removed the insulin infuses through a soft canula. The Silhouette comes in much longer lengths than the QuickSet and SureTs - so they seem to be able to be used in all sorts of areas. Also, there is a load of tape on the top of the Silhouette - I would think these will end up sticking the best over swims and showers. And like the Sure-T, they disconnect away from the infusion site and have a second tape down area at the disconnect - which can act as a relief if you tend to lose your pump and find in hanging every now and then.

Like I said, there is an optional inserter that I purchased - but I was able to man up and insert the first one on my own. It's not at all difficult once done and seems to be a very secure and functional set.

The Silhouette also lacks the large nub at the infusion site and like the Sure-T seems to tape down very flat. Because of it's longer needle lengths I suspect they can go "further" and into areas the 90 degree sets might not reach. And because you inset the Silhoutte by hand - you are not confined to 45 degrees either - you can use them deeper or more shallow - hence far more options and areas that can be used. Oddly they come in 13 and 15 needle / canula lengths - after testing the 13, I am frightened to think of the 15 - but it is good to know that very very long length is also available.

Now I am bask to thinking more about real estate and the options I have available. The pump seems less limited with more infusion set options. I will be testing the Sure-Ts on my upper legs, and the Silhouettes seem able to reach all kinds of areas with extra reach.

Each pump manufacturer has their own spin on these sets - be sure to try the different options.