Tuesday, May 28, 2013

Scar Tissue and Insulin Absorption


When I was diagnosed in 1945, 67 years ago, I do not think my doctor knew that I should rotate sites when injecting insulin. My parents were so good about listening to my doctor, and we followed his advice without fail. We injected into the muscle on my upper legs for many years, and there were always very high blood sugar reports from the doctor's lab every six months. I think that was because we were not using different body parts and rotating sites. Scar tissue had probably formed on my very small legs, even though the animal insulin I was using required only one injection per day. By the time I was in my twenties I was using my upper abdomen, and my blood sugar reports improved. There was no meter for measuring my blood sugar at home until the mid 1980's, so the biannual reports from the doctor's lab was the only thing I had to determine how I was doing. A1c's were not available until 1980.

In the 1990s I had a meter and much better insulin. Several injections were required each day, and I was still using my upper abdomen. Eventually it became very difficult to push the needle into my skin. I actually had some needles bend, and had to get a different disposable syringe, reload and try a different spot. I had not been told that this might be scar tissue, no doctor had ever mentioned that. No doctor had suggested alternating sites. Maybe my doctors in the 1990s assumed I knew about this since I had been type 1 for 50 years at that time. In the new century I was using basal and bolus insulins, and doing as many as 8 injections every day. The toughness of my skin in my upper abdomen made it necessary for me to start using my lower abdomen and upper legs. It was common sense on my part that caused me to make that change. My blood sugar tests improved significantly, but I still did not know it was because I had moved away from the toughness in my upper abdomen.

In 2007 I started using a pump, and things were going very well until I tried my upper abdomen. I got a 'No Delivery' alarm on my pump and did not know what that meant, so I called the Medtronics help line. After a long discussion it was decided I had scar tissue. That was the first time I had heard those words. A very young sounding lady at Medtronics made that diagnosis, but my very experienced doctors had never mentioned it. This made me very angry, and it has taken me a long time to stop feeling bitter about it. At least one doctor should have told me about site rotation. I have permanent scar tissue in my upper abdomen and can never use it again. The skin will always be tough, and the insulin absorption almost nonexistent. I tried using my upper ab earlier this year, and saw very high blood sugar in the next few hours. I am presently using my lower ab and upper legs, rotating infusion set locations. If I don't change sets after three days I start seeing high blood sugar. That is because scar tissue is beginning to form there. I keep the sites about one and a half inches apart, and change every three days. I have now had A1c's in the 5.5-6.4 range for almost ten years. Finding someone who told me about scar tissue has greatly improved my control. I will never know why I managed to avoid diabetes complications for the many years that I was not rotating sites, and having so much high blood sugar. I have some mild nerve damage, but my overall diabetes health is very good. That almost seems like a miracle to me.

I have frequently advised pumpers to rotate sites, and not use a site longer than three days. Most of my friends who pump are doing that, but I have met online pumpers who say they are using an infusion set for more than three days. One pumper says he uses sets for as much as a week, without having problems. I did not think that was possible. To keep scar tissue problems from occurring, and poor absorption giving very high sugar results, I strongly advise all pumpers to rotate sites, and avoid using a site more than three days.

I feel so lucky to have avoided serious complications after experiencing scar tissue and high blood sugar for so many years. I wish I could meet the young lady at Medtronics, and give her a big hug! lol

8 comments:

  1. Agree, took me 10 years of pumping to figure it out. 35 years of injections and used same site over and over, loss of tissue and big indentations. ROTATE, ROTATE, ROTATE

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  2. Yeah, I do think you were one of the lucky ones, to have diabetes SO long (since before I was even born, and I ain't young!), and only minor complications! Which is why I'm glad you're participating in the Joslin study. :-)

    I do think that different people have different tendencies to scar. That is, some people scar quite easily, and others not so much. I have a mere 20 years on insulin, and still using my upper abdomen (pumping now), and while I do rotate sites, the area I'm using is not very large. And I only have one scar -- a keloid, which I'm not sure how it came about, because I don't remember any infection there. It's very easy to avoid, because of it being a keloid, but I can go close to it and have no problem.

    But since people don't know at the outset whether they're going to scar easily or not, the advice to rotate, not just on the belly, but also on the legs and hips and back of the arms is very sensible. I keep telling myself that I ought to branch out on pump sites, but when changing my set, I keep forgetting. I think I'm going to call it Richard's Rule, and put up a card with that on it next to my bed, which is where I always change my sites! :-)

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  3. Hey Richard, I rotate my sites (2 on my stomach and 2 on my hips) is this enough rotation or do I need to use more areas?

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  4. I would also like to ask you about how you maintain such a great hba1c? Do you have any posts on this? Cheers :)

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  5. It is amazing how much information is available these days with diabetes and how much it has changed. I can't imagine not having a monitor constantly by my side! For switching sites, I can't believe your friend leaves it in for a week! That is asking for scar tissue. I am trying to follow the pumping insulin idea and I have about 9 spots for my pump that I rotate, that way I don't get back to the same spot again for almost a month :).

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  6. Sarah, I'm not sure what you mean by 2 sites on your stomach, and 2 on your hips. Are talking about areas the size of your hand? I use as much area on my lower stomach and upper legs as possible, but I avoid the areas that have scar tissue from the past.

    I would have to write a very long blog to tell you how I keep my A1c's low. If you have specific questions I will try and answer them.

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  7. I also would like to know what things contribute to your lower A1C. Diet? Excercise? Stress reduction? There are so many ideas on diet. Some people say avoid gloten, others say avoid gluten and dairy, there's GAPS, primal and paleo. If you could list the biggest factors in lowering A1C levels, what would they be?

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  8. I follow a very consistent and regulated schedule. I eat, exercise, and relax at the same times of day. I can do that because I am retired, but it was impossible when I was still employed. My blood glucose (BG) is much easier to control with this kind of schedule. I avoid fast acting carbs like rice, cereal, and white bread. If I want pasta then I limit myself to a half cup. The same with potatoes. The glycemic index (find on Google) gives a list of food types and how fast they will act to raise your BG level. I try and stick with the slower acting ones. My bread is whole grain, low carb , only 9 carbs per slice. If have a sandwich then I use only one slice of bread. I do not eat at restaurants unless they are listed in the Calorie King, so I will know the carb count in everything I eat. That makes my boluses on target.

    I have a daily chart that includes all my BG tests, carbs eaten, and insulin dosages. Pumping insulin allows me to adjust my basal rates, and other things, so my BG is much more stable.

    I workout at a gym 3 times per week, one hour each time. On good weather days I walk for one hour on roads with hills, usually 3 days per week. In prior years I worked on my house in the spring, summer and fall. Carpentry work, and climbing ladders and painting the house, etc. I am 73 now so I have curtailed much of my work on the house.

    The way I eat, consistent schedules, and exercise help me have low A1C's.

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