#552 Diabetes Variables: Bad Sites

October 1, 2021Scott Benner

Diabetes Variables: Bad Sites

Scott and Jenny Smith, CDE share insights on type 1 diabetes care

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Scott Benner 0:00
Hello friends, and welcome to Episode 452 of the Juicebox Podcast.

Hey everybody, this is the next episode in the diabetes variable series. So it's going to be me and Jenny Smith. Jenny, of course, is a 30 plus year type one, a CDE, a nutritionist, she says a whole bunch of stuff. And she's here today to talk about a new topic, something that might come up in your life that very well may impact blood sugars. Today, the variable that Jenny and I will be talking about is bad sites. Please remember, while you're listening, that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan are becoming bold with insulin. On the front page of Juicebox Podcast comm a lot of the series that are within the podcast have their own space, like on the website so you can see them because I know there's a lot of episodes. Today I've added the variable series. So that's there now as well. So if you're looking for a certain episode, you're not sure what episode number it is head there and do a little scrolling, you'll find it. I'll get started right after this brief message from our sponsor.

This show is sponsored today by the glucagon that my daughter carries g vo cuyp open, Find out more at G Vogue glucagon.com forward slash juice box. Alright, Jenny, so I have four of them set aside to try for today. One of them. I can't wait to see how you respond. But the other ones are our I want to start with a couple that are shorter I think and and then see see what we're going to get to so Okay, this one I think is going to be a really short variable. But I want to talk about bad sites. So just you're using an insulin pump. And the site stops being as effective as you expect, or as you've I guess, experienced already with the site. But people have the hardest time baling changing, it's like, yeah, it's that they the hope that sticks with them is sometimes fascinating. I can't tell if it's the if it's this thing supposed to last this long, dammit. Like I'm not given up or I mean, I even get if it's money. But right. You know, like if you're saying, I don't want to take this thing off. But if you have insurance. So I guess the first thing to say to people is if you have insurance, and you experience bad sites, your provider can write you a prescription for more stuff, if that becomes necessary

Jennifer Smith, CDE 3:00
to change more frequently, not at all. No. In fact, with all the pumps, I think there are people who definitely find I get today to I can maybe make it today, two and a half. If it looks like it's really, really still working well. But I don't push it anymore to day three. So yes, I mean, if you're one of those people then just don't push it. Know what you know, and ask your doctor to write for changes every 48 hours instead of every 72.

Scott Benner 3:26
Yeah, it's so an example is you know what the funniest thing about diabetes is whenever I go to talk about I always have a fresh example because that's never stops. But Arne and I are going to go shopping this afternoon together, we're going to find little baskets to put on her shelves that she put up. She put up shelves and she wants to put baskets on the shelves. I've been a stay at home dad for a long time. So that seems like a reasonable way for me to spend my afternoon to me,

Jennifer Smith, CDE 3:50
but for bunny eggs or something or what is she putting?

Scott Benner 3:54
I don't know what she's putting out there. Hopefully she's not hiding, you know, paraphernalia which I don't believe she is. But not the point. The point is that I woke up this morning to find that Arden's blood sugar had been fairly sticky at like 140 overnight. And I thought, Oh, we must have missed on the last thing that she ate and you know, the basil is holding her nice and steady. I'll Bolus this I Bolus it and it doesn't move. And as soon as that happened, I thought this site is shot. Like it just it hits me like immediately. Now do I yank the pump off or right away? No, I turned to all of our settings up a little bit and made all of her insulin stronger. And it worked. And then when the settings reverted back, it drifted back up again. So in my mind, she's not getting insulin correctly anymore, because I'm not getting what I expect. Right? And so I told her just before you and I did this, I said Listen, do one more Bolus because that's going to bridge this time. I'm going to be talking to Jenny and then I said and then we're going to pull your pump before we go before we go. Cuz, I mean to get eight more hours out of this thing. I mean, I guess we could just jack it up, it's probably leaking, right or something get or what? So what are all the things that could go wrong with a site?

Jennifer Smith, CDE 5:12
Yeah, it's like a rabbit hole of information about site, right? It really is. So what could it be, it could be that the site is in a place that just got bumped or nudged or something. And so now, it's not really working as well under the site, maybe you develop like a little tiny, like, I don't know, like a clap, let's say it, but it's not absorbing quite as well. Thus, when you bump everything up, and now you're jacking in a little bit more insulin, it's kind of pushing out enough to overcome whatever the reason for the resistance is at the site, it just could be that this area, especially if you've documented enough to know the, you know, the right hip and the left hip don't absorb as well after day two, so let's just change it when it's in those locations sooner than later. So it could be the site, right? You know, variables of site, it could be infection at the site, especially in infections, I usually, usually you know that you have something starting, even if it's a mild infection, I'm not talking something major, but usually the site hurts. It's sore. You might even notice a little bit of bruising, like outside the canula kind of area, but definitely it's sore in sites should not be sore. I mean, they should be with the little flexible canula under the skin, and or even the ones who use the steel infusion sets. It shouldn't hurt.

Scott Benner 6:45
Okay. So if I'm going to make an admission here are not an admission and admission. I'm going to admit something. omission is when you leave something out. Yeah, admit

Jennifer Smith, CDE 6:55
Okay, when you you have to admit something. What are you going to admit,

Scott Benner 6:59
I Arden's had diabetes since she was two. And I hear people say my pumps occluded all the time, I've never figured out what they mean when they say I mean, I understand the word. But mean physically, like the word makes me feel like somebody stuck bubblegum in your tubing, you know, like, but that's obviously not it. So, when people say, I got an occlusion, what are they talking about?

Jennifer Smith, CDE 7:30
Well, a true occlusion is different than a site, that's technically gone bad, okay. In a site that is occluded, occluded, means like, you know, like the tubing is straight underneath the skin. And typically, tubing will be bent visually, to some degree when you remove it. And most pumps I know, at least Omni pads. If you have an occlusion and your pad errors, it will tell you that it's either a pod error, or it will tell you that a pod occlusion is detected. And to change the pod at that point. So and all of the pumps will register an occlusion based on a certain amount of insulin that gets backed up into the pump. And it triggers the alarm to say this insulin hasn't gone in up to this certain amount. And each pump has kind of a designated amount that triggers that occlusion alarm. So an occlusion is definitely different than a sight problem. Now an occlusion could be it could be something that starts to make the site not feel good to because obviously, if you've got like a bent canula under the site, that might be more irritating than something that's just supposed to be sitting straight, right? Most often though, what I've found is that an occlusion will happen soon after a site change.

Scott Benner 8:58
Okay? But a bad not always

Jennifer Smith, CDE 9:01
but a bad site could be two, three days in, etc. But an occlusion usually is sooner than later in the life of a site, mainly because it usually happens on the sight being put under the skin. Okay? Something has triggered it to bend, etc. could it happen while you're wearing it? Yes, it could, if

Scott Benner 9:24
we're likely from the injury,

Jennifer Smith, CDE 9:26
more likely from the actual puncture under the skin,

Scott Benner 9:30
I should knock on some wood but in 13 years or more of using Omnipod arms had one bent candle ever. And I've never seen the occlusion thing. I actually think it's kind of cool that on the pod. If Omnipod thinks you're not getting insulin correctly, the thing just errors and shuts off. Yes. Like it's just like, Look, this is bad for you. I'm going to force you to put on a new insulin pump now. Yeah,

Jennifer Smith, CDE 9:51
I've always thought to it has more checks and balances to alerting sooner than later that something isn't right internally. Then the other pump So

Scott Benner 10:00
I also don't see them as much since they took the manufacturing in house. Oh, you know, interesting. Yes. Since they moved from China to I just did an interview with them not too long ago. But since they moved that they have a, if you've never seen it, it's astounding, like the man in mass in Boston. Yeah. So maybe that's it, too. Okay, so so here's the bigger question, I guess and how to wrap this up. You learn what a bad site and bad sites just a colloquial phrase, it's not a technical term, it's a phrase that stops working the way you want it to, excuse me a site that stops working the way you want it to work, you start to notice them, after experiences, like and then kind of like figure out when you can be like, This is bad. I'm jumping on this. So there's no real. I don't think there's any way in this conversation to say just look for this, this and this other than to say, if the site's not acting like you expect, if it's towards the end of the site, life, maybe switching now's a good idea. Do you have anything to add to that? Or is that kind of it?

Jennifer Smith, CDE 11:03
It's kind of true. I mean, if you have enough hindsight from your life with diabetes, right, from experiences, you can say, Well, my lunch usually does this my breakfast usually does this, my run in the afternoon usually does this kind of thing. And if it's not, and considering other variables that could be impacting towards a higher blood sugar. If none of those are really in the picture. I usually our recommendations, take take a correction. Like you kind of did you drove a correction in and you're like, Huh, I didn't do anything. Don't, don't play, just change it out. Just change it out, get some insulin going again, who knows what the reason was when you could play with thinking about what the reason is forever. Just change it out deal with the high blood sugar and move on.

Scott Benner 11:52
Okay. All right. So cool. Thank you.

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So the diabetes variable series is coming along pretty well. So far. There's trampolines, temperature, travel, exercise, hydration, food quality, tunneling, video games, stress masturbation school and today's episode bad sites. I think it's working out well putting them out on Fridays. So expect that to keep happening. And that's pretty much it, I guess, on the variables front. Now, if you're new to the podcast, don't miss out on other series like the diabetes pro tip episodes, defining diabetes, after dark algorithm pumping how we eat, there are so many to choose from. I'd also like to let you know about the private Facebook group that's dedicated to this podcast. It's called Juicebox Podcast type one diabetes, it is a private group, as I just mentioned, meaning you're going to have to answer a couple of questions to prove you're a real person to get in. But once you're in there, you're going to be with at least I mean, at this point, it'll probably be 16,000 by the time you hear this, but at least 15,000 people just like you talking about type one diabetes, it really is a kind and valuable space. So don't go there expecting like, Oh, it's Facebook, I'm gonna fight with people. It's not like that. It's actually pretty great. There's a link in the show notes if you need it. Anyway, if you don't want to, I mean, you know, cool, but I just want to let you know it was there. I hope you're very much enjoying the podcast. I hope you're just enjoying the podcast actually very much seems excessive. If you are, please share it with someone else who you think might also enjoy it. And if you're a practitioner, and you're listening Hi. And if you're a practitioner and you're listening, and you're suggesting this podcast other people hi and thank you really appreciate it. Alright guys, I'll be back really soon. plenty more to come. We're going to finish the year up super strong with a ton of great episodes. By now, the podcast has crested easily 4 million downloads. There were more downloads in 2020 One by August. Then there were in all of 2020 and 2021 might reach a real milestone at the end. So keep your eyes out for that. We'll do a little celebration when it happens at the end of the year.