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Scott Benner 0:00
Hello friends, and welcome to episode 930 of the Juicebox Podcast.

On today's episode of Best of the Juicebox Podcast, Jenny Smith and I are going to be talking about bad sites. That's bad sites for your insulin pumps, doesn't matter what kind of pump you have. Sometimes those sites just kind of stop working, they go bad, we're going to talk about it. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. You can get 35% off your entire order at cosy earth.com. When you use the offer code juice box, you can get a free year supply of vitamin D and five free travel packs with your first order of Athletic Greens that's ag one from athletic greens at athletic greens.com forward slash juice box and to get 10% off your first month of therapy with better help go to better help.com forward slash juicebox.

This episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter contour next.com forward slash juicebox. That's where you're going to find an amazing array of meters from contour. They have beautiful Second Chance test strips so you don't waste any strips and they are so so so accurate. So accurate contour next one.com forward slash Juicebox Podcast is also sponsored today by us med now us med is the place where Arden gets her Dexcom and Omni plod, plod and Omni pod supplies from sorry, they have Omni pod five Omni pod dash Dexcom G six G seven libre three. Tandem they got stuff us med.com forward slash use Box, get your free benefits check today and get started with us med don't like the internet. Here's a phone number just for Juicebox Podcast listeners 888-721-1514, give them a call and tell them hey, I'm thinking of switching to us med Can you help me out? Hey, everybody, this is the next episode in the diabetes variable series. So it's going to be me and Jenny Smith. Jenny, of course, is a 30 plus year type one, a CDE a nutritionist she's the she has a whole bunch of stuff. And she's here today to talk about a new topic, something that might come up in your life that very well may impact blood sugars. Today, the variable that Jenny and I will be talking about is bad sites. On the front page of juicebox podcast.com. A lot of the series that are within the podcast have their own space, like on the website so you can see them because I know there's a lot of episodes. Today I've added the variable series. So that's there now as well. So if you're looking for a certain episode, you're not sure what episode number it is head there and do a little scrolling. You'll find it. All right, Jenny. So I have four of them set aside to try for today. One of them. I can't wait to see how you respond. But the other ones are our I want to start with a couple that are shorter I think and and then see see what we're gonna get to so Okay, this one I think is going to be a really short variable. But I want to talk about bad sites. So just you're using an insulin pump. And the site stops being as effective as you expect or as you've I guess experienced already with the site. But people have the hardest time bailing changing up site. Yeah. It's that they the hope that sticks with them is sometimes fascinating. I can't tell if it's the if it's this thing supposed to last this long, dammit. Like, I'm not giving up or I mean, I even get if it's money. But right. You know, like if you're saying, I don't want to take this thing off, but if you have insurance. So I guess the first thing to say to people is if you have insurance, and you experience bad sides, your provider can write you a prescription for more stuff, if that becomes necessary

Jennifer Smith, CDE 4:43
to change more frequently, not at all. No. In fact, with all the pumps, I think there are people who definitely find I get to day two, I can maybe make it to day two and a half if it looks like it's really really still working well. But I don't push it anymore to day three. So yes, I mean if you're one of those people that just don't push it, know what you know? And ask your doctor to write for changes every 48 hours instead of every 72.

Scott Benner 5:09
Yeah, it's so an example is you know what the funniest thing about diabetes is whenever I go to talk about I always have a fresh example because never stops. But Arden and I are gonna go shopping this afternoon together, we're going to find little baskets to put on her shelf that she put up, she put up shelves, and she wants to put baskets on the shelves. I've been a stay at home dad for a long time. So that seems like a reasonable way for me to spend my afternoon to me,

Jennifer Smith, CDE 5:33
but for bunny eggs or something or what is she putting?

Scott Benner 5:37
I don't know what she's putting out there. Hopefully she's not hiding, you know, paraphernalia. Which I don't believe she is. But not the point. The point is that I woke up this morning to find that Arden's blood sugar had been fairly sticky at like 140 overnight. And I thought, Oh, we must have missed on the last thing that she ate. And you know, the basil is holding her nice and steady. I'll Bolus this i Bolus it and it doesn't move. And as soon as that happened, I thought this site is shot. Like it just it hits me like immediately. Now do I yank the pump off or right away? No, I turned to all of her settings up a little bit, it made all her insulin stronger. And it worked. And then when the settings reverted back, it drifted back up again. So in my mind, she's not getting insulin correctly anymore, because I'm not getting what I expect. And so I told her just before you and I did this, I said, Listen, do one more Bolus, because that's going to bridge this time, I'm going to be talking to Jenny. And then I said, and then we're going to pull your pump before we go before we go out. Because I mean, to get eight more hours out of this thing. I mean, I guess we could just jack it up. It's probably leaking, right? Or something good? Or what? So what are all the things that could go wrong with a site?

Jennifer Smith, CDE 6:55
Yeah, it's like a rabbit hole of information about site, right? It really is. So what could it be, it could be that the site is in a place that just got bumped or nudged or something. And so now, it's not really working as well under the site, maybe you develop like a little tiny, like, I don't know, like a class, let's say, but it's not absorbing quite as well. Thus, when you bump everything up, and now you're jacking in a little bit more insulin, it's kind of pushing out enough to overcome whatever the reason for the resistance is at the site, it just could be that this area, especially if you've documented enough to know the, you know, the right hip and the left hip don't absorb as well after day two, so let's just change it when it's in those locations sooner than later. So it could be the site, right? You know, variables of site, it could be infection at the site, especially in infections, I usually, usually you know that you have something starting even if it's a mild infection, I'm not talking something major, but usually the site hurts. It's sore. You might even notice a little bit of bruising like outside the cannula kind of area, but definitely it's sore and sites should not be sore. I mean, they should be with the little flexible cannula under the skin. And or even the ones who use the steel infusion sets. It shouldn't hurt.

Scott Benner 8:28
Okay. So I have I'm going to make an admission here or not an admission and admission. I'm going to admit something. omission is when you leave something out. Yeah, admit Okay,

Jennifer Smith, CDE 8:39
when you you have to add MIT something. What are you going to admit?

Scott Benner 8:43
Arden's had diabetes since she was two. And I hear people say my pumps occluded all the time. I've never figured out what they mean when they say I mean, I understand the word. But I mean physically, like the word makes me feel like somebody stuck bubblegum in your tubing, you know, like, but that's obviously not it. So, when people say I got an occlusion, what are they talking about?

Jennifer Smith, CDE 9:13
A true occlusion is different than a site that's technically gone bad. In a site that is occluded, occluded, means like you know, like the tubing is straight underneath the skin. And typically tubing will be bent visually, to some degree when you remove it and most pumps I know at least Omni pads. If you have an occlusion and your pod errors, it will tell you that it's either a pod error, or it will tell you that a pod occlusion is detected and to change the pot at that point. So and all of the pumps will register an occlusion based on a certain amount of insulin that gets backed up into the pump and it triggers the alarm to say this in insulin hasn't gone in up to this certain amount and each pump has kind of a designated amount that triggers that occlusion alarm. So an occlusion is definite ly different than a sight problem. Now an occlusion could be, it could be something that starts to make the site not feel good to because obviously, if you've got like a bent cannula under the site, that might be more irritating than something that's just supposed to be sitting straight, right? Most often though, what I've found is that an occlusion will happen soon after a site change,

Scott Benner 10:41
okay? But a bad not always,

Jennifer Smith, CDE 10:44
but a bad site could be two, three days in etcetera. But an occlusion usually is sooner than later in the life of a site, mainly because it usually happens on the site being put under the skin, okay? Something has triggered it to bend, et cetera. Could it happen while you're wearing it? Yes, it could,

Scott Benner 11:07
if we're like, from the inject,

Jennifer Smith, CDE 11:10
more likely from the actual puncture under the skin,

Scott Benner 11:13
I should knock on some wood. But in 13 years or more of using Omnipod arms had one bent cannula ever, and I've never seen the occlusion thing. I actually think it's kind of cool that on the pod, if Omnipod thinks you're not getting insulin correctly, the thing just errors and shuts off. Yes. Like, it's just like, look, this is bad for you. I'm gonna force you to put on a new insulin pump now. Yeah, I've always thought

Jennifer Smith, CDE 11:35
to it has more checks and balances to alerting sooner than later that something isn't right, internally than the other pumps.

Scott Benner 11:43
So I also don't see them as much since they took the manufacturing in house. Oh, interesting. Yeah. Since they moved from China to I just did an interview with them not too long ago. But since they moved that they have a if you've never seen it, it's astounding. Like the facility in in mass in Boston. Yeah. So maybe that's it, too. Okay, so So here's the bigger question, I guess and how to wrap this up. You learn what a bad site and bad sites just a colloquial phrase, it's not a technical term, it's a phrase that stops working the way you want it to, excuse me a site that stops working the way you want it to work, you start to notice them after experiences, like and then you kind of like figure out when you can be like, This is bad. I'm jumping on this. So there's no real. I don't think there's any way in this conversation to say just look for this, this and this other than to say, if the site's not acting like you expect, if it's towards the end of the site, life, maybe switching now's a good idea. Do you have anything to add to that? Or is that kind of it?

Jennifer Smith, CDE 12:46
It's kind of true. I mean, if you have enough hindsight from your life with diabetes, right, from experiences, you can say, Well, my lunch usually does this my breakfast usually does this, my run in the afternoon usually does this kind of thing. And if it's not, and considering other variables that could be impacting towards a higher blood sugar. If none of those are really in the picture. I usually our recommendation, take take a correction. Like you kind of did you drove a correction in and you're like, huh, I didn't do anything. Don't, don't play, just change it out. Just change it out. Get some insulin going again, who knows what the reason was, I mean, you could play with thinking about what the reason is forever. Just change it out deal with the high blood sugar and move on.

Scott Benner 13:35
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But are you just already online getting it done? Are you even listening to me anymore? Where have you already called 888-721-1514 don't like the phone us med.com forward slash juice box. The other day I got an email from us Med and it said are you You want some more supplies? I guess it was time and I said yes click the button and then they just showed up. You want to do it like that. It's pretty damn easy. Us med.com forward slash juice box if you enjoy this episode of The diabetes variable series there's more it begins episode 491 With trampoline Did you know that was a variable that could impact your type on and your blood sugar again? Also episode 505 temperature 507 Travel 511 Exercise 524 hydration. We talked about food quality in Episode 526 In Episode 530, leaky sites and tunneling episode 535 playing video games that can impact blood sugar 540 stress 544 masturbation 548 School 552 Bad sites you just heard that one here 556 growth hormone number 560s Asleep episode 564 Pumped site placement episode 568 A full moon episode 572 diabetes technology five ad is weight gain five ad for Walmart Walmart can change your blood sugar get out of here and episode 588 We call it the final episode sort of. And then there were two more 592 menopause and 596 alcohol. You can find a complete list of these just like I read to you at juicebox podcast.com. Up at the top you click on diabetes variables takes you to all of them. Or if you're a member of the private Facebook group, you just go into the feature tab. And there are lists of all the series there. That group of course, this Juicebox Podcast, type one diabetes, but we don't care what kind of diabetes you have. Come on over and check us out. There's almost 40,000 members in there, and the group is completely free for you to use just like this podcast. If you enjoyed this, please share it with someone else who you think might also enjoy it. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. If you're interested in learning more about betterhelp.com, forward slash juicebox therapy available from BetterHelp. There'll be an ad that plays after this. But that's all that's left. So if you're not interested in learning about that, go ahead and shut this off. A huge thank you to one of today's sponsors better help, you can get 10% off your first month of therapy with my link better help.com forward slash juicebox. That's better. H e lp.com. Forward slash juicebox. If you've been thinking about speaking with someone, this is a great way to do it on your terms. Better help.com forward slash Juicebox Podcast is sponsored today by better help. 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