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Try to make site changes happen during a calm, happy time together.Mother and child in shade image by geophis from Fotolia.com
Change the site when your child's blood sugar level is in range and even. A toddler or young child who is "high" can be particularly sensitive. Glucose floods his nervous system and brain. A fast drop from a correction can be a rough ride, too. Trying to do an insertion during highs or after heavy corrections is setting yourself up for a battle.
Time regular changes for periods following lower carbohydrate meals, cuddly morning time upon waking, or right before meals when blood sugar is back down in range. For an unscheduled site change from a site failure with highs, consider bringing blood sugar back to normal with a syringe correction and then changing the site. - 2). Consider using a steel set instead of the soft cannulas. This seems counter-intuitive and you will have to judge what the best fit is for your child. But remember, you still have to insert the soft cannulas with a device that punctures the skin with a metal needle. This is then withdrawn back into the device, leaving the cannula behind. Steel sets insert simply, they go in much like a thumbtack without a spring device. They also do not kink, so you can sometimes avoid extra changes caused by suspicions about a failed site by using steel. The drawback of using steel is removal. If you don't remove the site with care, the metal tip can poke or scratch.
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Remove the old site after you are sure the new site is working well; bath time is a good time.baby's towel image by jedphoto from Fotolia.com
Remove the old site by first softening the adhesive around it. Little kids with diabetes don't like getting bandages ripped off any more than kids without diabetes do, and the adhesive on sites is very strong. Buy pads through your pump supplier that react with the adhesive to reduce its stickiness, or use an easy home method. Coat the old site's adhesive sections with mineral oil or petroleum jelly. Make sure the opening into the site has the disconnect cover buckled in first, and wipe the excess off so it doesn't slick the bath water. Let your child play in a warm, never hot, bath. Remove the old site once it softens. - 4
If you use ice to numb, make sure the skin is clean and dry before inserting the site.Ice cubes image by Andrius Grigaliunas from Fotolia.com
Consider numbing the skin before insertion. Get advice about anesthetic creams from your endocrinologist or certified diabetes educator. The cream normally must stay on the site, covered, for a designated time. A less effective but faster method is to numb the patch with ice directly before insertion. This avoids some concerns about using a chemical medication. It can shorten the process and make it more fun for toddlers, who usually find ice fascinating. They also can participate when using the ice, which makes the process less scary. - 5
Offer your child a toy he can hold part of in each hand to slow grabbing at you while you work.Building blocks image by Andrius Grigaliunas from Fotolia.com
Speed, attitude and distraction are the staples of a successful site change. Do not draw out the process. Stay matter-of-fact and sympathize with your baby, but never give the impression this is anything less than mandatory. Never let a toddler learn that something she does might delay or stop the process. Communicate to her in a matter-of-fact and loving way that it's never an option for her to go without insulin, even for a little while.
Once you establish this, however, give her as many choices within the process as are practical, making sure she is developmentally ready to make them. Ask her: Would you like to use the cream today, or ice? Insert on this section of your skin, or that one? Which doll do you want to hold while we finish up? Distract with toys, video, siblings, pets, markers and paper--anything novel works best. Never bribe or threaten. In addition to it being a bad idea overall, finding a new bribe every few days is not practical.
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