Ad hoc

One problem, which posed a bit of a challenge during Emilie’s first year of pumping was infections at the infusion site. In total, Emilie has had around five of those, of which two had to be treated with antibiotics.The most common cause in our opinion had to do with swimming – even though we disconnected the pump in those situations and covered the needle with a self-adhesive waterproof Tegaderm film. In some cases, the film did not stick to Emilie’s skin so the water got in. In other cases – well, we just do not know.

We were very careful to follow every procedure that we had been taught when changing the infusion set: Washing hands several times, disinfecting the infusion site, not breathing at anything and so on. But nevertheless, we had those nasty and painful infections. Why?

Well, we do not know for sure, but one thing we know: We have not had a single infection since changing two things:

1. We started using the 6 mm Rapid steel needle instead of the 17 mm angled Teflon Tender needle and
2. We were advised to put a tiny spot of chlorhexidine lotion where we would insert the needle.

We have also been told by a very experienced endocrinologist and pump user, that children often do have problems with infections, that grown ups do not have – so maybe Emile has just outgrown the problem.

But we cannot help thinking about the physical difference between the Tender and the Rapid needles. The former injects 17 mm into the skin just beneath the surface. The latter only injects 6 mm and is much thinner. Also, we noticed a remarkable difference between infusion sites when the two kinds of needles were removed: After the Tender, we could see a distinct puncture in the skin, which remained open for some time. And the skin was clearly irritated around the puncture. Today, when we remove a Rapid needle, sometimes it is hard to tell where it has been inserted only a few minutes later.

Another problem, which we had with the Tender, was inexplicable ‘bendings’ on the needle. Suddenly Emilie’s blood glucose would rise dramatically and without any explanation. Of course, the first solution would be to check the infusion site and change the needle. And sometimes we would notice a bending of the needle maybe 6 or 8 mm from the tip. The pump had not made an alarm for occlusion, so the infusion had not been totally blocked. But enough to make the blood glucose rise. How this could happen is a mystery to us, but it did, several times.

On top of that, we never made it to inserting the Tender without the locally anaesthetizing Emla lotion. And because Emla has to be applied for around an hour to take effect, a change of infusion set had to be planned. The Rapid needle Emilie inserts herself without any anaesthetizer and it is much easier to handle.

But how can it be, that the Rapid works so well now when Emilie had so much pain from it in the beginning? Well, the explanation to some extent may be psychological – but the story in our opinion also illustrates that treating a child with the insulin pump, you have to be prepared to change methods, type of infusion set and other things as the child grows older.

This is the twelfth post in a series - read the first post here.

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