July 23: Sturgis, Michigan to Bremen, Indiana
There’s nothing like a morning ride in the summer and Sunday mornings are even better. There’s not much traffic. Temperatures are mild. The air is clear and the winds are calm. Today had all of those. In fact, for the first time in a very long time, I started out the ride today wearing a vest for an extra layer against the cool air.
I spent a lot of time yesterday evening trying to decide where to ride to today. We need to be in Chicago by the 28th because I have an interview scheduled with Ron Santo at a Chicago Cubs game on July 29. Our route around the Chicago area has been chosen to avoid super-congested urban areas and is about 260 miles, so I need to get in as many miles as I can each day in order to arrive in Chicago on time.
At the same time, I don’t want to get too far down the road, because we have a couple of events in this area in the next couple of days. On Monday, July 24, we have an opportunity to get a tour of Bayer HealthCare’s manufacturing facility in Mishawaka, Indiana. On Wednesday, July 26, I’ve been invited to speak before a Know Your Healthy Steps program at the Sturgis Hospital in Sturgis, Michigan. Know Your Healthy Steps is a Bayer HealthCare program designed to help people with diabetes understand the role of blood glucose monitoring, good nutrition and activity to maintain or improve their health. So, we can’t get too far down the road because we’ll be driving back to Sturgis on Wednesday.
Decisions, decisions! Last night, I decided to head for La Porte, Indiana because it would give me an opportunity to do more riding in Michigan. This morning, however, I decided it would be better to take a more southerly route to avoid the congestion that heading towards La Porte would involve. So, today, I headed for Bremen, Indiana, a small town that would be a nice 65-mile ride through rural northern Indiana farmlands.
One of the cool things about today’s ride is the towns I went through. First, there was Shipshewana, which claims to be the home of the midwest’s largest flea market. The flea market is named, oddly enough, the Shipshewana Flea Market. We also went through Nappanee which has been listed by TIME magazine as one of the top ten small towns in America and is famous for fine woodworking and kitchen cabinet shops. Both of these towns have large Amish populations and I saw plenty of horse-drawn carriages in the area.
One of the troubling things today was my insulin pump infusion site. I changed it Friday evening and it was loosening up even after Saturday’s ride to Sturgis. In Sturgis, I got it dried out as quickly as possible after a shower and it looked like it would stay in place one more day. Unfortunately, it wasn’t but ten miles into my ride today when it looked like it was close to falling out once again. My current site is located near my waistline. I spent most of the ride today being very careful to not twist too much or bend over too far or to bump it too hard. Any of those might cause it to come off completely. I’ll definitely have to change my site today after my ride.
For those of you who might not be familiar with the use of an insulin pump, an infusion site is where my supply of insulin is delivered subcutaneously. To apply an infusion site, I first thouroughly clean an area of skin. Then, I apply a layer of a product called Skin-Prep. Not all pump users use Skin-Prep and there are other similar products, but I’ve found that Skin-Prep works well for me because I’ve found it really helps keep the infusion site attached to me. After the layer of Skin-Prep, I use a sheet (about 2 and one half inches square) of IV3000 which is an IV site dressing. Again, there are a number of similar products on the market and I’ve found that IV3000 is the one that works the best for me. After I’ve applied a sheet of IV3000, I insert the actual infusion needle. And, actually, it’s not a needle; it’s a very small piece of hollow teflon about one half inch long called a cannula. The cannula is inserted with a metal inserter needle. The metal inserter needle is inserted under the skin and when you pull it back out, the cannula stays behind. Since the cannula is made of flexible teflon, it is very comfortable. Once inserted, there’s rarely any pain whatsoever. The cannula has adhesive “wings” that adhere to the IV3000 and that also helps keep the cannula in place.
That’s how it’s all supposed to work anyway. Usually, I find that an infusion site will stay in place securely for three days. It might start loosening up on the third day if I’ve been particularly active for those three days.
But recently, my sites haven’t been staying in place very long at all. Even after a day they’re loose. When I say “loose” I mean the adhesive on the IV3000 isn’t sticking to me very well at all and that forces me to remove the site and re-insert a new site.
I don’t know why I’m having these troubles, but I do have some theories:
- It could simply be that I’m not used to the extra humidity. The procedures and materials that worked well in the dry air of Salt Lake City don’t work so well in the more humid air of the midwest.
- The Skin-Prep adhesive isn’t sticking as well as it normally does. My supply of Skin-Prep stays in our car all day and it doesn’t like being exposed to the heat day after day.
- The IV3000 adhesive isn’t sticking as well as it normally does. My IV3000 supply is right next to the Skin-Prep, so it’s exposed to the heat day after day too.
I’m looking for a place to get a small supply of Skin-Prep and IV3000 so I can test theories 2. and 3. I’ll post the results here when I do.
July 24th, 2006 at 4:46 pm
Hi Peter,
Reading about your adventures and thought I may offer some advice on the pump set/site issues. Below is a copy of Medtronic’s tape tips- thought you might try to obtain some of the Mastisol. ONe of my pts who had this trouble with his set staying in place uses it and finds it to work very well. Not sure if one of the educators in the sturgis area could get you some or not or at least get you to a pharmacy that has it- better yet, call ahead and see if they will order it in so you will have it when you arrive. Otherwise, let me know and I’ll try to get you some and send it- I’ve also had people use the antiperspirant and the double iv3000 (one underneath and one over the top of the set.) Do you loop the tubing under the second tape covering? sometimes that helps decrease the pulling. I can’t remember which set you use-
Glad all is going well otherwise and that the land is a bit flatter for you. I continue to enjoy touring america thru your eyes. Hi to Pat. Jackie Carlson
Summer Tape Tips
When you’re perspiring in the summer heat, or enjoying a swim in the pool, your infusion set tape may not stick well to your skin. Several products are available that may help you secure your site. For example, Medtronic Diabetes carries IV Prepā?¢, which you can use on your skin as an antiseptic skin preparation; Mastisol adhesive and its remover, Detachol ā?? which many pump wearers swear by for keeping infusion set adhesive in place when nothing else works ā?? and IV3000ā?¢ tape, which can help secure the infusion set when you sweat or bathe. Here are some tips to keep in mind if you have a difficult time keeping your infusion set in place.
The following tips come courtesy of Medtronic Diabetes pumpers Mathew Whitaker, an Ironmanā?¢ triathlete, and Jessica Ching, who rows and runs marathons.
Change the site when you are showering: Before you shower, remove your old infusion set. Clean off all of the old adhesive with an adhesive remover such as Uni-Solveā?¢ or Detachol (for removing Mastisol). In the shower, wash off the solvent with soap.
Let skin dry THOROUGHLY before applying either the infusion set or the adhesive.
Apply IV Prep in a large area around the site and fan it, allowing it to become tacky. (You can also try a stronger adhesive, such as Mastisol. However, be sure to have Detachol solvent available for removal.)
Touch as little of the adhesive as possible on the infusion set so as to avoid getting skin oils on it.
On days you know you will be very active, sweating or swimming, cover the site with a piece of IV3000 tape.
To prepare the IV3000 for the SilhouetteĀ® or Quick-setĀ® infusion sets, fold it in half with only a slight crease. Cut out a half-moon that’s half the size of the plastic ā??bumpā? on the infusion set. When you unfold it, it will be just the right size. If the tape peels off, you can replace it to last until the next site change.
You can try using additional tape on the corners to prevent them from peeling up and lifting the entire infusion site out.
Additional suggestions:
Keep the infusion site clean-shaven and try exfoliating (removing dead surface skin cells) with a facial scrub, brush or loofah, followed by an alcohol swab, then soap and water.
Stretch skin taut before using bonding agent or tape.
Use antiperspirant spray (not stick or roll-on) around the site.
After you apply the tape, go back around the edge of the tape with the IV Prep pad to seal the edges to your skin.
Try applying an IV3000 patch before inserting the needle, and then apply another over the top.
Use medical cloth tape (the really sticky stuff) over the infusion set when you have to be absolutely sure the infusion set doesn’t come looseā??for instance, when you compete in athletic events.
Check regularly to make sure the tubing is not pulling on the site and adding stress on the adhesive.
Avoid wearing seams or waistbands over the site because they may rub and loosen the tape.
If all else fails, change the site!
July 24th, 2006 at 5:34 pm
Hi Peter and Pat,
I sure hope that some of the people who work for the companies who develop and manufacture Infusion Sets are reading your comments and taking notes. I run hot and cold over trying an Insulin Pump but after reading about all the problems that you are having with the infusion sets I am getting cooler and cooler to the thought of giving the pump a try. Have you tried other brands and types of infusion sets and do they all have the same type of adhesive system to keep the cannula in place? Maybe you need to roughen the skin area a little with some sandpaper to make it stick better. Only kidding.
Thanks to your comments about snacking on bagels and peanut butter, I recently changed my breakfast on the morning of my weight resistance workouts to an English Muffin with peanut butter and all fruit jam along with a banana. I was eating cereal with milk and banana. I take 3 U of Novolog. I have noticed that my blood sugars come down much more slowly during my exercises. I try to start out at 150 to 180 and end up at 80 to 100 after doing 3 sets and 12 reps of 12 to 14 different exercises. Its been working well so thanks for the peanut butter tip.
Be well, stay healthy, and keep on pedaling and writing. I am learning a lot. Thanks.
Florian (T1, dx1967)