Written By: ADCES staff. Supported by an educational grant from BD.
PDF Download: Insulin Troubleshooting Guide
It is imperative that clinicians and people with diabetes develop effective problem-solving skills for detection, prevention and treatment of problems arising from continuous subcutaneous insulin infusion.
Following this step-by-step troubleshooting chronic infusion set/site issues process to prevent rapid deterioration of glucose management and avoid ineffective corrective steps.
Recurrent infusion set/site issues require prompt attention and correction. Some, but not all, are preventable through proper training/education for the person with diabetes.
Possible Causes: Adhesion
Preventative Action: When adhesion failures occur repeatedly, many individuals benefit from simply moving their infusion sets to a body part that moves/stretches/pulls/perspires less, such as the upper buttocks.
Other strategies for improving adhesion:
Possible Causes: Infection
Corrective/Preventative Actions: Infections at infusion sites are relatively rare. However, all individuals should be careful not to allow the infusion set needle (or introducer needle) to touch anything prior to insertion, and to wear each infusion set for only two to three days. Users with a history of cellulitis, compromised immunity, staph or other skin infections are at an increased risk of site infections.
A strong antiseptic should be applied to the skin prior to infusion set insertion. Individuals should be provided with signs/symptoms of site infections and instructed to seek medical attention at the first sign of erythema, edema, warmth, pus and blistering.
Possible Causes: Allergies
Corrective/Preventative Actions: A variety of skin barriers can be used to minimize exposure to infusion set materials that may cause allergic reactions. In some instances, use of OTC antihistamine medications such as diphenhydramine can prevent symptoms and provide relief.
For extreme/stubborn allergic reactions, individuals should be referred for dermatologic care.
Possible Causes: Lipoatrophy
Corrective/Preventative Actions: Insulin absorption is impaired when infused into areas of skin that are affected by lipoatrophy or lipohypertrophy.
Palpation of infusion sites at each office visit can aid in the detection of lipodystrophy. Feel for unusual indentations, inflammation, softness and hardness below the skin surface. Affected areas must be avoided to ensure proper and consistent insulin absorption.
Note that temporary, minor inflammation is common at recently-used infusion sites and may not indicate the presence of lipodystrpohy. All insulin pump users should be instructed on proper infusion site rotation in order to prevent the development of lipodystrophies. This includes selection of appropriate body parts.
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