Candid Diabetes

The Good, The Bad and The Ugly

   I'm an infusion set freak. I love to try new sets, and I'll put them anywhere possible. Including a very uncommon site that is not often mentioned in Polite Company. But since none of us qualify as Polite Company, well, errrrrr, just click the link and spare me from having to figuratively bare myself (again) to the world wide web. And no, there are no pictures.

   Okay, train of thought derailed, many casualties. Moving on...

   Thanks to Rick Lynch and Applied Diabetes Research, I can try every single infusion set available. In Canada. (Which, thanks to Health Canada and it's myriad of restrictions and hoop-and-poodle act, isn't a whole lot.) But I digress (again). The ingeniously crafted ThinSet Reservoirs transform my Paradigm 515 (soon to be the REAL Time 522 system!!) from a proprietary connection to a luer lock, allowing me to connect any standard luer infusion set to my Paradigm Insulin Pump.

   To date I've only had the opportunity to try three luer lock infusion sets:

1. ADR's ThinSet Infusion Set: This one is, by far, one of my favourites. In fact, I like it more  than Minimed's Quickset. The ThinSet is the lowest profile, at-site disconnect set that I've seen. It barely makes a bump even under the tightest, whitest t-shirt. It is a 90 degree, 6 or 9 mm, non-metal cannula. The tape is superb, and I have yet to have any of the corners lift even after three days of wear and tear. It has a see-through window at the connect site, so it is easy to see if you've hit a gusher or not. The self-sealing disconnect on the hub of the set means that there is no need for any sort of cap, even when swimming. And the best part of the ThinSet Infusion Sets? Their price. They are a good $40 cheaper than any of the other teflon cannula sets that I've used, and comparable with Minimed's Polyfin (bent needle) sets.
2. The Accu-check (formerly Disetronic) Rapid-D Infusion Set: I've been waiting on the edge of my seat to try this one. Only to end up flat on my face. The Rapid-D infusion set is a steel cannula needle set  (meaning there is no teflon cannula; the needle stays in for the duration of the set) with its own adhesive and a 90 degree insertion. It has an off-site disconnect, as seen in the picture. I'm a long-time user of the Polyfin sets, so the option of a 90 degree steel needle set was pretty darn exciting. And then I got some samples. I asked for samples of the 6mm needle with 43" tubing. I got the 8mm with 23". OK, fine, I told myself. Just insert them in the (few) areas that are padded enough for 8mm. Should be good to go, right? Wrong. Big, bad, ugly wrong. And if the pain wasn't enough to dissuade me from using these sets, then the tape was. A day after inserting these sets, the tape was bunching and lifting dangerously. Not just the edges, the whole thing. Resulting in my having to resort to medical tape in the first aid kit at work. And then having to cover the site with my Op-Site dressing thereafter. Oh, and I didn't just give up at one. Nope, I tried three of them, in three different areas, three different times. Ouch ouch ouch. Granted, the 6mm would definitely be a better choice for me, but the tape and the price of these sets pretty much decided me. A box of these bad boys is over $200. And you don't even get full sets; the tubing is reused for three sets. So what, I would like to know, is this company charging us for?? Crappy tape and a box of 15 needles with only 5 transfer sets (tubing). Right. Not worth it, IMNSHO. Oh, and yeah, my insurance covers these suckers at 100%. But I, quite frankly, am not willing to give this company any money that is associated with me for these crap-ass sets. I am not a cash cow, Disetronic. But thanks for trying.
3. Accu-check Ultraflex: I received a few samples of this set along with the Rapid-D's. Another flop. Basically, see above. Bad, bad, bad tape. The hub-tubing connection is tight and akward, and even my small fingers found attaching and detaching cumbersome. Long story short: don't like 'em. Won't be using 'em again. It's so bad it doesn't even rate a picture!

**NOTEWORTHY** Minimed's Sure-T infusion set: A 90 degree, 6 mm steel needle set that was initially manufactured for new and young pumpers. It has a proprietary connection and uses the Paradigm reservoirs. The Sure-T sets have a 4", off-site disconnect with its own adhesive patch to prevent stress on the main site and possible dislodging of the needle. It comes only in 23" tubing and 6mm straight needles; longer tubing and needles are not available. I have been using these sets for a few weeks and I LOVE them. The Sure-T has the same connection as the Silhouette sets so I am able to connect the 43" tubing from my Sil's, making sleeping much easier. Personally, I do not like the second adhesive patch, so I just yank it off of the plastic connector and let the tubing roam as it will. The adhesive at the main site is kick-ass; it is so wonderfully tacky that I have yet to require a safety loop even with excessive tugs and twitches (if you have a Border Collie puppy who likes to jump up, you'll know what I mean). I particularily love to use the Sure-T sets (with the Silhouette 43" tubing, of course) in my arms, as manual insertion is simple and quick...no introducer needle to try to remove with one hand. As far as I'm concerned Minimed has a winner in this set...and it'll be even better if they ever decide to package it with 43" tubing.

   Next on my list of To-Try's are the Simple Choice infusion sets and the Cleo 90, if the distributing companies of these products ever return my phone calls and multiple emails. And, though it is not yet available for public consumption in Canada, the insets will remain at the top of the list.

   Until then, I'll ponder the meaning behind the name of Minimed's Sure-T's. Sure-teriffic's? Sure-tremendous? Sure-trombone?

Applied Diabetes Research - Luer Lock Infusion Sets for Paradigm Users

   Remember when I posted a little Teaser many Fridays ago? I told you that I had found a nifty little gadget that would allow all Paradigm users to experience the bliss of product diversity, something that would break the chain of Minimed's Proprietary lock-in?
Something that would allow us - the Paradigm followers - to use Luer Lock infusion sets??

   It's frustrating, isn't it, to be limited to the four sets that Minimed offers; to have no option to try out the many other sets available. Like the inset or the orbit90 or - my own personal choice - any of the Needle Sets  besides Minimed's Polyfins.

   Our day has come, and it's all thanks to a wonderfully ingenious company called Applied Diabetes Research and it's Head Honcho, Mr. Rick Lynch.

   This wonderful little gadget, which is housed in my pump at this very moment, is called the ThinSet Reservoir. It is, unlike the Paradigm counterpart, a syringe reservoir which fits in the Paradigm 51x/71x pumps and allows for use of all standard Luer Lock sets.

   Wait...let me say that again...   

   It allows Paradigm pump owners to use all of the standard Luer Lock sets available.

   The reservoir fits the Paradigm just like Minimed's own product and, with the exception of the male end, looks just like Minimed's. The end sitting externally in the housing shows some major differences; there are two small 'handles' on each side, and the Luer fitting sticks out about an inch from the center once the whole set has been hooked up. The ThinSet reservoir 'clicks' into the pump the same as does the Paradigm reservoir.

   I found the ThinSet reservoir to be easier to fill than the Paradigm, although harder to expel bubbles. The plunger of the Thinset moves much more smoothly than Minimed's and the barrel markings are much easier to decipher. The ThinSet also seems to reflect the remaining insulin more correctly than the Paradigm reservoir; although the design of the ThinSet precludes one from reusing the reservoir. The 'handles' can also be uncomfortable in certain situations and may scratch the skin, depending on where the pump is being worn.

   Along with the Reservoir samples, I was also given three of the ThinSet Infusion Sets. These are 90 degree, teflon cannula sets available in the standard 6 & 9 mm cannula length with a Luer Lock connection. They are extremely low profile and hardly visible even when worn under tight-fitting shirts. What I really enjoyed about these sets, though, is the design of the actual site hub. Not only is it very discreet, but the skin is visible right through the set, which is beneficial in the event of any site disruptions or suspicion of bleeding or bruising.

   The connector of the ThinSet is fantastic; it is very thin and clips in securely to the base. The set has a self-sealing design which omits the need for a cap when bathing or swimming. The tape is very flexible and water resistant and shows no sign of lifting or fraying after two days of use.

   The only drawback to the ThinSet Infusion Sets is the insertion. While the Instructions booklet advises that Minimed's Quick-serter can be used, I found this to be a very difficult proposition. The ThinSet, on a good day, will never fit properly into the Quick-serter. The fit is entirely too snug, and if loosened the needle of the set is butting up against the skin, which is a risk for improper injection. Because of it's positioning in the serter, the tape of the ThinSet will overlap one side of the inserter, causing it to pucker a bit upon insertion. Once injected, the needle cover is exhaustingly difficult to remove from the Quick-serter; I myself had to resort to jimmying the set out with a pen. Unfortunately, it is impossible to remove the needle cover directly with the inserting device, as the removal requires a side to side rocking motion. My advice - which I will take personally upon my next site change - is to insert this set by hand.

   Having only ever used the Paradigm pumps, I found the Luer connection to be a little different and confusing at first. I didn't realize that there was a cap on the Luer fitting and was trying to fit the equivalent of a circle into a square (all the while cursing "why won't it go in? It must be defective!"). But the Instructions that are supplied with the Reservoir and Set cleared everything up - once I actually got frustrated enough to read them.

   End result: I love these reservoirs. And the Infusion Sets are pretty fantastic too. I would - and will - highly recommend both to Paradigm users. Mr. Lynch has, with his great product, gained a future customer in me.

   Should you be interested in using these ThinSet products with your Paradigm, they can be purchased at:

- For US Residents: Fifty 50 Pharmacy

- For Canadian Residents: Auto Control

   * UPDATE: In further conversation with Rick Lynch, I've learned that there is an inserting device in the works for the ThinSet Infusion Sets. One that will be an improvement upon Minimed's Quick-serter. I, of course, humbly offered my trialing skills for the good of everyone. He is also going to work on making the 'handles' of the Reservoir "less obtrusive".

Friday Teaser!!! **FOR MY PARADIGM FELLOWS**

   This post is dedicated to all of my Paradigm pumping friends and anyone who is not my friend (haha) but uses one...

**!!Calling all Paradigm x12 and x15 users!!**

   Are you sick and tired of the Proprietary connection that Minimed locked you in to with the Paradigm pump??? Hell, I am. I love my 512 but I'd really like to try some other sets. Particularily some 90 degree Needle Sets and the fun New sets. All of which are Luer Lock.

   I know something you don't know...na-na-na-na-naaaa-na!!

   What if I told you that four-ish weeks from now, I'm gonna be trying out a new, nifty-difty somethin'-somethin' that will allow me to use luer lock sets with my Paradigm pump? Are you feeling a little jealous?? Would you like to know what this handy-dandy new somethin' is and how YOU can get one???

   Well, my friend..................................TOO BAD.

   This is a Friday teaser. I'm leaving this one hanging but good MWA-hahahahahahahahaha!

   Rest assured, this is not a prank. The somethin' I speak of does indeed exist and I have samples coming to me to try out. Whether or not you have to wait until I've tried out said samples before I tell you where I got 'em from...well, guess you'll just have to keep checking. I may keep it to myself for an indeterminate amount of time. Then again, I may feel benevolent and give it up. Let's see, shall we?

   Ahhhhh, love a good Friday teaser; what a way to start the weekend!!!

Uncommon Infusion Sites

Ya' ever notice how easy it is to get a non-Diabetic to go all squeamish on you? In particular I've found that (discreetly) showing someone my infusion site will result in one of the following:

1. the person is fascinated by the mechanics of the infusion set and the fact that you put that there yourself! and they want every little detail of the procedure; or
2. they get that cringy look on their faces, the one where the corners of the mouth pull down and their eyes get really big and you just know they want to yell at you to cover it up!; and
3. the really fun ones are unwittingly fascinated while being totally disgusted by the thought of a little tube (or needle) being under your skin and staying there...and yet they just can't look away because it's so disgustingly cool...

I've found that there's a way to incite a similar reaction from Diabetics themselves; even those who are on the insulin pump. All it requires is the following little sentence:

"I use my Breasts for infusion sites"

It's inspired reactions of horror, disbelief, gasps and cringes; just recently a fellow pumper and friend thought she misunderstood my statement (understandable, as it's not common knowledge). I've been told that I'm nuts, that I've got some serious cojones; I've been asked how on earth I could possibly do that to myself.

But, all joking aside, I did buck the conventional pictures and diagrams and recommendations and use my breasts in my regular site rotation. I wasn't the first by far, and I won't be the last.

In my experience, my breasts make for great pin cushions. They love insulin, and the insulin loves them (let's face it, breasts are basically just deposits of fat interspersed with all those lovely glands). My TDD drops by at least 10 units when I'm on my breast rotation - I have a significantly lower basal profile and CHO ratio specifically for these times - and the predictability of absorption is fantastic. And there's lots of space to choose from when deciding where to put the set.

Which is not to say that there isn't some yang to balance out all that yin. My breasts can be painfully fickle; sometimes I'll hit just the perfect spot when inserting the set, and it'll sting like a bugger (although that usually subsides within minutes). Or I'll hit another spot that will, within a day, make walking or taking stairs a painful endeavour (bounce; ouch; bounce; ouch). And sometimes, I'll have no stinging or 'bouncing' pain but changing the set will reveal a killer bruise. And last (but not least), ya gotta plan a breast site in order to wear certain shirts.

I may be certifiably insane, I may have some major female ;) cojones; I'm just willing to try anything at least once and (luckily) this one turned out for the better. The more variety of sites used, the less chance of scar tissue or hypertrophy or adipose diposits etc. etc. etc. And I like the variety; I like giving each rotational site the longest time available to heal before the next go-round. (I also use my upper and lower abdomen - including my sides - arms, hips, upper buttocks and thighs)

So, if you can add another infusion site that's not common knowledge give it up, 'cause I'm always looking for more places to insert. Happy Pumping! ;)

**NOTE:  If this inspires you to give your breasts a try, a few things that are good to know are:

• Use the longer tubing! There's nothing worse than going to the bathroom, pulling down your pants and taking your breast with them (ouch)!
• This site is not recommended directly before, during, or after menstruation. Tender breasts do not make for happy sites!
• Small chested women can use breast sites. I have this on authority from fellow breast-pumpers.
• The 90 degree sets are the most comfortable (YMMV) to insert. Needle sets (I use the Polyfins) are a big no-no!