By: Barbara Bradley
Are you an expectant mother with diabetes? If so, are you wondering about the disappearance of infusion sites as your baby grows and your abdomen expands? Do you anticipate that “pinching an inch” will become more of a challenge? Are you concerned about the angle and depth of insertion, and how often you should rotate insertion sites? Here are a few suggestions for you:
Location: You can still use abdominal sites for the duration of your pregnancy, but for the eighth and ninth months, you might consider using the upper thighs, hips and arms for your comfort. When using the upper hip area, avoid inserting into an area that you will be sitting on. Instead, place the set in the “pocket” area of the hip. Ask your partner to assist with insertions, if necessary.
Angle and depth: Ninety-degree insertion sets may still be used as long as you can pinch up an inch of skin. If less-fatty tissue is a concern, then a good choice would be to use an angled set—either a needle or catheter set. If you have been using a longer 9- to 12-mm catheter, perhaps the mini-sets (6 mm to 8 mm) would be useful. You might also consider using the Simple Choice Patch, which has 5-mm and 2.5-mm 90-degree micro needles. Comfort, Tender and Silhouette sets can be manually inserted at a less than a 30-degree angle.
Rotation frequency: The recommended site rotation frequency during pregnancy is every 48 hours and any time you have unexplained high blood glucose levels. Site changes should occur at least four hours before bedtime. These recommendations are made because it is essential to avoid ketoacidosis. Be prepared to occasionally bolus with a syringe or pen when troubleshooting a possible “No Delivery” alarm. When in doubt—change it out!
If you are uncertain about which sets would be most useful for your needs, ask your CDE or pump trainer for recommendations. Ask your pump manufacturer if it is possible to obtain samples of infusion sets to try for use in pregnancy. And be sure to consult with your “baby team” for their specific guidelines for a safe and healthy pregnancy.