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As a healthcare provider, you know that lumps or hardened areas are often caused by injecting insulin into the same sites over time; a habit that can often cause a patient to experience impaired insulin absorption. Perhaps you’ve encountered a patient who uses an insulin pump and reports frequent episodes of high glucose values related to an infusion set cannula bending or kinking. If this is the case, you may want to suggest the patient choose a softer/newer site and avoid the previous site for about one month as this may help prevent poor insulin absorption.1 This is also a good opportunity to review the importance of proper infusion site selection and rotation.
As seen here, when using insulin therapy and selecting an insertion site, patients have many areas to choose from. This includes the abdomen (at least 2 inches away from the belly button), upper buttocks, hip flexors, back of the upper arm, lower back, and flanks. Outlined below are also two methods worth reviewing when discussing optimal insertion site rotation with a patient.
Encourage the patient to visualize an imaginary clock drawn around their belly button. They should choose their site by starting at the 12 o'clock position and then rotating clockwise to 3 o'clock, 6 o'clock, and so on.
Encourage the patient to imagine an "M" or "W" on either side of their belly button. They should begin at the end of one letter and proceed through the letter, rotating to each intersection.
To speak to the value of reinforcing this best practice with patients, here’s a glimpse into the firsthand experience from a fellow educator:
“I had a [patient on the MiniMedTM 670G] recently and the healthcare provider asked me to review their report and see why the patient was having so many high sensor glucose readings; she was only in [the target] range 23% of the time, [weighed] 140 lbs and [was] using 105 units [of insulin per day]. After a discussion, the patient had been told to “rotate sites” however she was keeping [her] infusion set […] in only two areas on her abdomen. The patient agreed to try the infusion set on the upper buttocks area and in one week her TDD went from 105 units to 45 units and her time in range improved from 23% to 76%. We all work together to emphasize site rotation importance, but this showed the patient how truly important it is”.
If you or your patients need additional information or support related to insertion site management you can access it here. As always, training and support are also available from your local Medtronic Clinical Territory Manager and StartRight™ clinical team by calling 1-800-646-4633 extension 22818 (Monday - Friday, 8:00 a.m. to 6:00p.m. CT).
Thethi TK, Rao A, Kawji H, et al. Consequences of delayed pump infusion line change in patients with type 1 diabetes mellitus treated with continuous subcutaneous insulin infusion. Journal of Diabetes and Its Complications. March 2010 (Vol. 24, Issue 2, Pages 73-78).