Islets of Hope  care tips for persons with diabetes

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Article disclaimer

Compiled by Lahle Wolfe, who is not a medical doctor but has diabetes, and is a parent of a young child with diabetes who uses an insulin pump.

Sources
InsulinPumpers.org
American Diabetes Assn.


IMPORTANT  DIABETES CARE TIPS  DISCLAIMER

Tips are sent to us and compiled into our "Diabetes Care Tips" section for general information only. Tips are based on the experiences and opinions of those who submit tips to IOH and do not necessarily reflect the opinions and position of IOH.

Advice found in any part of our "Diabetes Care Tips" section is not intended, nor should be as a substitute for the care and advice of a licensed medical health professional.

Have a tip to share?
Send it to us at:
Editor@isletsofhope.com


Tips From Other Insulin Pumpers

Preparing Sites for Canulas

Use Emla cream to numb skin before changing out canula sites.  It also works well on forearms if your child needs to have blood taken from a vein for lab work. Be sure to give it 20-40 minutes to work before inserting the canula. Submitted by Rachel, CA

Getting Canulas to Stick

Sites that won't stick in water need more adhesive.  Try using tincture of benzoine (over the counter cancer sore medicine) as a "glue" prior to putting on bandage.  Sub- mitted by Terry, MD

We found SkinTac pads to work best for keeping canulas in place.  Wipe pad on clean skin, when tacky, stick canula on.  It is very waterproof! Emmarie, WV

Sites seem to come loose when you don't want them to and stick when you want them to come off!  We use Detachol to remove sites, and Mastisol to "glue" it on during site changes.   Submitted by Crystal, VA

Removing Canulas

Sites seem to come loose when you don't want them to and stick when you want them to come off!  We use Detachol to remove sites, and Mastisol to "glue" it on during site changes.   Submitted by Crystal, VA

We use Unisolve and find it works well to remove site adhesive residue. Be sure to rinse skin after using any adhesive remover because they can irritate the skin. Submitted by Stephen, VA

Be Prepared for Emergencies

Change your batteries one day each month and carry an extra set.  In fact, always carry a complete set of extra supplies for EVERYTHING!  That way you won't be out on the road somewhere when your batteries die (this happened twice to us). Submitted by Cathy, VA

Tips on Removing Canulas from Islets of Hope

To remove sites try soaking the canula site with baby oil before getting into a warm tub.  You can also use nail polish remover but this can irritate sensitive skin (be sure to clean off the area with warm soapy water).  Removers like Detachol work well, but again, be sure to clean the site because any chemical remove can cause skin irritation which increases a chance for post-site infection.

To help avoid post-site infections, use Neosporin or an antibiotic cream on the old insertion wound.  Submitted by Mary, AK


 

diabetes care tips                                   
Insulin Pump Tips
Questions from Insulin Pumpers Answered by Islets of Hope


Changing out sites hurts!  How can I help take the sting out of site changes?

Some children do fine without anything other than a hug, but some children, especially those who are very thin, object to the needle being inserted when changing the site.  You can try two things:

Ice.  Try "chilling" the area just before insertion for a few minutes.  Never place ice, or other cold objects directly on the skin, but wrap them in a washcloth.  Cool the area BEFORE cleaning and preparing the site. 

Use a numbing cream. Use LMX or Emla cream to numb skin before changing out canula sites.  (It also works well on forearms if your child needs to have blood taken from a vein for lab work.)  Rub a small amount onto skin taking care not to rub it off with clothing (be sure to wash off your own hands).  Wait 20-40 minutes, then clean and prepare the site.

Caution:  The active ingredient in this topical anesthetic can cause heart arhytmia if too much is absorbed through the skin so use sparingly on small children. The cost is about $65-$80 per tube (that will probably last almost a year for children) and is available over-the-counter at pharmacies (it may have to be special ordered).  Insurance is unlikely to cover the cost.


My child is active and her canula is always coming out.  Is there something I can do?

There are several reasons sites don't stick well; not enough adhesive, too much moisture on the skin (sweating, bathing, etc.), the acidity of the skin, not letting the site dry before being exposed to moisture, and the wrong canula device for your child's needs.

Sites that won't stick in water may need more adhesive, or need more time to "set" before bathing or swimming.  Here are some tips to try:

  • Always let the site dry for at least 1 hour, 2 or 3 is even better, before heading off to the pool.
     
  • Try using tincture of benzoine (over the counter cancer sore medicine) as a "glue" prior to putting on bandage.  Apply it BEFORE disinfecting the area just until tacky.  Sterilize the site, then insert canula and cover.
     
  • SkinTac pads work well for keeping canulas in place.  Wipe pad on clean skin, when tacky, sterilize site, stick canula in, and cover site.  It is very waterproof!
     
  • Another product you can try is Mastisol.  It works as well as SkinTac but is messier.  You can buy it in spray mist or apply it with a sterile gauze pad (don't use cotton balls they leave too much fuzz behind).  Apply Mastisol, prepare site, insert canula, and cover.  (Caution:  there is warning label on the bottle that too much applied can be toxic.)
     
  • A tip that I learned from a nurse who works at a diabetes camp who was used to dealing with canulas in muggy, wet camping weather was to insert the canula first.  She then took the cover bandage and cut a hole in the middle of it so that raised canulas could "peak out."  She applied Mastisol spray, then the covering.
     
  • Another woman told me that her pump support rep had her apply a sterile bandage UNDER the canula set rather than over it.  She then applied a second one on top.  Her daughter was on a swim team and never had problems with sites coming out after doing it this way.
     
  • Different canulas have different "staying" power.  Some are designed to be easily inserted and therefore, also come out easily.  Rapid D is one set for children (usually only worn in the bum) that stays put.  Sideways flexible canulas also tend to stay in better then straight-in flexible canulas.  Talk with your doctor or pump support rep.
  • If none of these things work, trying cleaning the skin with a solution of hydrogen peroxide. Let dry, sterilize the area, and proceed to change out the canula as your doctor instructed.


    My husband had to take shots (for diabetes insipidus) for many years as a child.  His thighs and bum are really scarred up from all the shots.  I am now worried about my daughter getting "pock marks" on her bum from all the canula sticks.  Can I use "scar" cream to help prevent this from happening?

    Unfortunately, no.  The type of tissue damage that occurs from needle sticks has a lot to do with the insulin being injected, not just the needle sticks.  Repeatedly using the same canula sites can cause fat deposits to build up (called lipohypertrophy).  These can make the skin look dimpled, lumpy, or pock-marked.  It also decreases insulin absorption rate.

    The best thing to do is to rotate sites often.  You are more limited in site rotation when your child is on an insulin pump (even more so if they are very thin) so talk to your doctor or pump representative about other canula styles that may allow you to use her tummy and thighs as well.  The more you rotate sites, the less tissue damage.


    My child has low blood sugar during the night and I think she is still honeymooning because other nights she is fine. On nights when she is low sometimes, I can turn off her pump so I don't have to wake her up to feed her.  Is this okay?

    Even during the honeymoon phase, turning off a pump at night is not safe -- especially in young children and those who are newly diagnosed.  When a person takes shots, the usually take some sort of long-acting insulin to act as a "background" or basal insulin.  That is, it stays in the body more than just a couple of hours.  People on insulin pumps usually use only a rapid acting insulin which does not stay in the body more than a few hours.

    When you turn off an insulin pump there is no long-acting insulin circulating (as in the case of those taking shots).  The body needs to have a certain amount of insulin circulating in the bloodstream at all times in order to prevent diabetic ketoacidosis.  By turning off your pump you may help stop some hypoglycemia at night, but you also deplete the level of circulating insulin that helps prevent DKA.

    Normally, DKA may take days to set in, and typically occurs at blood glucose levels of 240 mg/dL or higher.  However, for those on pumps who only use rapid insulin, turning off the pump can result in DKA faster and at much lower blood glucose levels.  This also occurs more rapidly in children and in those newly diagnosed or, who have recently been treated for DKA.

    Contact your doctor to learn a safer way to handle nighttime lows.  You can also find more information about hypoglycemia through the following Islets of Hope links:

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    Page Updated 04/25/2006