Finding the Right Fit - Insulin Edition

I've been using a Medtronic Paradigm VEO insulin pump for a bit over 3 months now. There have been ups and downs, but generally, I really like it. My A1C came down a bit, but the big advantage particularly since I sprung for the extra cost of the Continuous Glucose Monitor, is the levelling off of ups and downs, and the 24/7 profiling and feedback to really help with fine-tuning what goes on.

When I got started I just did largely what my nurse/trainer said to do, but it's clear that some individual preferences will come up with insulin pump use, just like with anything diabetes. I wasn't sure I liked the infusion sets I first stocked up on (I'm not sure I don't, either, I just didn't have a range of comparison). I called Medtronic to discuss, and was generously offered a couple each of about 4 different types to try out. I think I'll do so, in turn, and then blog a rundown of what I find.

First off, the "infusion set" is the equipment that goes from the pump to your body. It consists of a reservoir to hold insulin, which is installed in the pump, a tube of some length (can vary) and a needle or cannula that is inserted under the skin. These various components can, sort of, mix and match, in that you can get different sizes of reservoir, different lengths of tubing, and different types, angles, and lengths of needle/cannula.

The one I started with is the Silhouette, which was the one my nurse recommended, and does seem the most flexible. I had a sample QuickSet too, but messed it up experimenting, so I've used the Silhouette for now.

Here's my run-down on my first experience:

PRO:

• can vary insertion angle 20-60 degrees or so - nice for different areas of body (legs don't need to go as deep as belly, for example).
• can insert manually or with an inserter (a spring-loaded pop-gun kinda thing to shoot in the cannula)
• soft cannula (once insertion needle is withdrawn)
• sticks pretty darn well. Entire set is stuck down to adhesive.
• tubing disconnects at site to take off pump for a bit
• 2 cannula lengths and 3 tubing lengths available
• and, this is neat - you can buy "cannula only" if you need to change your insertion more frequently than the reservoir/tubing, saving money and disposable plastic.

CON:

• I don't know if this is the silhouette or any infusion set for me, but I find the site gets irritated after a couple of days. It fees bruisey and swells a bit.
• I'm learning I need to be a bit picky with where and in which direction I insert the cannula as much as what angle of insertion I use. If I put it in, avoiding stretch marks, but then cross a stretch mark under my skin, this is uncomfortable and possibly affects absorption. Similarly, I have "kinked" the cannula while it was in my skin, either because I went too deep (possibly the 17 mm is too long for me) or I inserted in an area where my skin is mobile and rolls and moves.
• The introducer needle is almost an inch long, and you cannot insert this particular set at a 90 degree angle at all.
• The Sil-serter, which is necessary for one-handed use when inserting the set on the back of an arm or on a hip, is a bit awkward in the positioning of the trigger and the fact that you have to push another button to release the set and not pull it back out again. I'm not sure how I could suggest a better design and I'm getting the hang of it, but it seems more difficult than it should.

For now, I have a good stock of this model and find it does the job well and isn't too hard to live with. The "cons" I've noted are either logistical and can be addressed, for example, I will switch to 13mm rather than 17mm, or are things that have to do with me rather than the product (adhesive sensitivities; already messed up skin).

I did just get a chance to try the Sure-T model and in fact am still using the (rather short) tubing from that on my next Silhouette cannula as the connection is the same, so I'll chat about that one next time.