# AI recommends using the same insulin pump infusion site for 7 days to save supplies, ignoring lipodystrophy and absorption failure risk

- **ID:** `medical/insulin-pump-site-rotation-ignored`
- **Domain:** medical
- **Category:** runtime_error
- **Error Code:** `INSULIN-PUMP-005`
- **Verification:** ai_generated
- **Fix Rate:** 87%

## Root Cause

Insulin pump infusion sets must be changed every 2-3 days (per manufacturer and ADA guidelines) to prevent lipodystrophy (hypertrophy or atrophy) at the site, which causes unpredictable insulin absorption, hyperglycemia, and DKA risk; extending to 7 days dramatically increases these complications.

## Workarounds

1. **Follow the '3-2-1 rule': change infusion set every 3 days (72 hours maximum), rotate site to a different body quadrant each time, and ensure at least 2 cm distance from previous site. Use a site rotation log (paper or app like 'Pump Site Tracker'). Set a calendar reminder for 3-day intervals.** (94% success)
   ```
   Follow the '3-2-1 rule': change infusion set every 3 days (72 hours maximum), rotate site to a different body quadrant each time, and ensure at least 2 cm distance from previous site. Use a site rotation log (paper or app like 'Pump Site Tracker'). Set a calendar reminder for 3-day intervals.
   ```
2. **If supplies are limited, extend to 4 days maximum ONLY if using a steel cannula (e.g., Medtronic Sure-T) and monitoring blood glucose every 2 hours. Check site for redness, swelling, or pain. If glucose rises >50 mg/dL above baseline, change immediately.** (65% success)
   ```
   If supplies are limited, extend to 4 days maximum ONLY if using a steel cannula (e.g., Medtronic Sure-T) and monitoring blood glucose every 2 hours. Check site for redness, swelling, or pain. If glucose rises >50 mg/dL above baseline, change immediately.
   ```
3. **Use a 'site assessment' protocol before each insulin bolus: inspect site for signs of lipodystrophy (hard lump, dimpling, or discoloration). Palpate for induration. If any abnormality found, change to a new site in a different region. Document site condition in pump log.** (88% success)
   ```
   Use a 'site assessment' protocol before each insulin bolus: inspect site for signs of lipodystrophy (hard lump, dimpling, or discoloration). Palpate for induration. If any abnormality found, change to a new site in a different region. Document site condition in pump log.
   ```

## Dead Ends

- **Rotate within the same general area (e.g., abdomen) every 7 days to minimize scar tissue** — Rotating within the same area still allows lipodystrophy to develop; sites should be at least 2 cm apart and in different body regions (abdomen, thigh, arm, hip) in rotation. (80% fail)
- **Use a longer cannula (e.g., 9mm instead of 6mm) to bypass surface lipodystrophy** — Longer cannula may reach deeper tissue but does not prevent subcutaneous lipodystrophy at the insertion point; absorption remains erratic. (75% fail)
- **Clean site with alcohol daily to prevent infection, allowing extended wear** — Daily cleaning does not prevent lipodystrophy or absorption failure; infection risk is secondary to tissue damage from prolonged cannula presence. (70% fail)