"I forgot to change my infusion set on time - again"

Being a diabetes publisher professionally and having type 1 diabetes myself, I follow all diabetes news and I read summaries of most scientific articles. I do this not only for my work but also to gain better insight in managing my own diabetes. So I know that ‘the scientific articles’ show the absorption of insulin changes after three days. In real life it means your insulin sensitivity is dropping at the injection site and that you need more insulin to manage your blood glucose. Despite knowing the scientific evidence, I changed my cannula when changing my reservoir. Since my reservoir was not always empty on the third day it would give me some spare time before changing my reservoir and infusion set. I bet a lot of you do the same?

An epic cycling tour for people with diabetes

At the mHealth tour in 2013 – an epic bicycle ride for people with diabetes – some problems occurred that changed my ‘bad habit’ of not changing the infusion set on time. This demanding cycling tour from Brussels to Barcelona was 2,100 kilometers long with more then 33,000 meters of climbing. It was almost like a Tour de France: 13 days of ‘living on a bike’; sitting on a small racing saddle; and pushing the pedals for up to ten hours a day. Although used to long bike rides of one day, managing diabetes on a tour like this is definitely more challenging.

My basal rate dropped to only 10% on day 3

Starting on day one with a new reservoir in my pump I lowered my basal rate to about 40%. On a one day ride, that works most of the time flawlessly. Besides one tiny low – detected in time by the sensor, so it wasn’t a real hypo at all – no problems occured that day. However, being on the bike for consecutive days, insulin sensitivity increased rapidly. So starting with a reduction to 40% on the second day, it was really too much basal insulin. My first hypo occured: with every pedal stroke my blood sugar dropped further. Besides a gel with 75 grams of quick acting carbohydrates to recover from the hypo, I needed to go down with my basal rate to 25% to get steady blood glucose values that day. The next day I anticipated on this and started with a basal rate of only 10%. It went perfectly. No hypos at all.

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Struggling to control my diabetes on day 4

On day four things changed dramatically. Starting at a 10% basal rate my blood sugars went up instantly. No matter how hard I pushed the pedals, the injected insulin didn’t work anymore. A 10% basal rate wasn’t enough for steady blood glucose values. Even an extra bolus didn’t help to get it down again. It kept going up. Only after adjusting my basal rate to 25%, I was back in control. The next day my values went up even higher. A temporary basal rate of 40% was needed to gain only reasonable control.

Changing my infusion set was the solution

What was happening here……? Why did I need so much more insulin than the days before? What was going wrong? Then I got it…. , I needed to change my infusion set. Was this the reason? Normally I would have changed my reservoir already. And by doing so I would have changed the infusion set as well. By using so little insulin over the last days the reservoir was still half full. I quickly changed my reservoir and ‘put in’ a new Silhouette. In the course of that evening the insulin started working better already and the next day everything was back to normal. On day six I once again needed a temporary basal rate of only 10% to have perfect control. I felt so stupid. Even knowing that I should change my infusion set and reservoir every three days, I did not always do that. But these problems on the tour made it perfectly clear to me that I should change every three days, for having the best possible control.

Written by Frans Luijendijk, T1 patient

Tip: How to fill your reservoir?

If you want to avoid the waste of insulin you can fill up your reservoir with the amount of insulin you need  for three days. But when doing it like this do keep in mind the amount of insulin needed for priming the tubing and the cannula. Here are some indications for you:

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