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Does Your Diabetes Device Bother Your Skin?

By Nena Kotsalidis and Matthew Garza

Wearable diabetes technology and its adhesives can irritate the skin. Read about common skin reactions, what to look out for, how to prevent skin issues, and more tips for skin health

As wearable diabetes technology – like continuous glucose monitors (CGM) and insulin pumps – becomes more common among people with diabetes, skin reactions to diabetes technology insertion and adhesives have also become more common. Following a presentation at the Association of Diabetes Care and Education Specialists’ (ADCES) 2020 conference we created the following guide to help you care for (and prevent!) skin issues and conditions. 

Nick Galloway and George P. Trotter Jr., both nurses and Certified Diabetes Care and Education Specialists, described at the ADCES conference the common skin complications that come from using wearable diabetes technology and discussed several solutions to help address these challenges.

Galloway and Trotter shared a 2018 report on keeping skin healthy for people who wear their diabetes technology. These are the common skin complications that result from chronic device use:

  • Tissue damage and scarring

  • Hypersensitivity

  • Lipodystrophy (uneven distribution of fat)

  • Infection and complex wounds

Tissue Damage and Scarring

Tissue damage results from the insertion of devices under the skin, including insulin infusion catheters and CGM insertion devices. Tissue damage can lead to bleeding, bruised skin, or liquid discharge. It can also be caused by the stripping away of tape or other adhesive materials which remove the outer layer of skin. 

Scarring occurs from the constant insertion of these devices under the skin. Each time a device pokes through your skin, it causes a small reaction from your immune system (the cells in your body that fight off diseases and help your body heal). This immune response can sometimes lead to scar formation. Scars can make it harder to insert your CGM or insulin pump, and more importantly, scarring can affect insulin absorption and glucose measurements – so areas with heavy scarring should be avoided when selecting new insertion sites.

Allergic Reaction (Hypersensitivity)

Allergic reactions (otherwise known as hypersensitivity) comes in four types, but the ones that are most common in people using wearable diabetes devices are types 1 and 4. 

  • Type 1 hypersensitivity is caused when your body reacts to an allergen. Allergens are any substances that cause allergic reactions, such as the adhesives used for insulin pumps and CGMs. Type 1 reactions can lead to hives, eczema, and reddening of the skin, and often happen very quickly, within minutes.

  • Type 4 hypersensitivity is similar but characterized by a delayed response to contact with an allergen. The allergic response is not immediate; it takes a few days to appear.

Allergic reactions unfortunately do not just go away. To help avoid these allergic reactions, healthcare professionals can conduct patch testing. Patch testing exposes your skin to small amounts of several adhesives so that your healthcare professional can see if your body reacts to any specific one over time. Though this test cannot improve or eliminate the reaction, it can single out the chemical or product that the body is reacting to. The only way to eliminate an allergic reaction is to create a near total barrier between the allergen and the body, or discontinue using the product altogether.

Lipodystrophy

Lipodystrophy is described as an uneven distribution of fat in the body. It is characterized by either lipohypertrophy (excess growth of fat tissue) or lipoatrophy (loss of fat tissue in one area). Though lipoatrophy is less common than lipohypertrophy, it can still occur as a result of insulin therapy. Several studies have shown that lipohypertrophy can affect insulin absorption and cause it to be erratic or uncontrolled.

Infection and Complex Wounds

Insulin infusion sets and CGMs can lead to infections if a person does not carefully keep the site of insertion clean. If an infection or a wound appears, contact your healthcare team right away; your healthcare professional will most likely use antibiotics to fight the infection. Infections that are not treated can worsen and may develop into complex wounds.

How to Prevent Skin Reactions

To help avoid these complications, the first thing you can do is prepare your skin for device insertion: 

  • Wash your hands.

  • Clean the area of your skin with an alcohol wipe.

  • Avoid putting lotions and oils on the area of insertion.

  • Make sure the site of insertion is cool and dry before proceeding with insertion.

It is also important to switch the site of insertion each time you place the device – this way you are not damaging the exact same area of skin over and over (which could lead to scarring). Make sure to read the insulin pump or CGM guidelines for your specific device, but here are general recommendations:

  • For insulin pumps rotate sites every 2-3 days.

  • For CGMs rotate sites every 10-14 days. 

  • Choose a site at least 2-3 inches away from the previous insertion site.

  • Insert your device in a flat area where there are not many skin folds. 

  • Do your best to insert the device 2 inches from the belly button, and avoid scars, moles, tattoos, and stretch marks (since they can interfere with medication absorption).

Galloway and Trotter recommended several products that can help you avoid skin issues. Most of these items are over-the-counter medical supplies that you can find at local pharmacies:

  • Alcohol wipes, IV preps, skin preps, and barrier film for skin cleaning

  • Tapes and adhesives to help with attachment

  • Corticosteroids that lessen inflammation and skin irritation at the site of insertion

  • Adhesive removers to prevent skin damage upon removal of the device

With the advent of telehealth, it is important to be able to assess your own skin since you will want to discuss any new conditions that arise virtually with your healthcare team. To assess your skin, regularly look at the skin around your insertion sites, carefully removing your device. You should also maintain healthy eating, drink plenty of water, use only the adhesive that is necessary, and avoid putting pressure on the insertion site.

If you want to learn more about the different skin reactions check out this slideshow from Dr. Laurel Messer – “Skin in the Game”. Additionally, here are company-specific resources for wearable device best practices and managing skin issues:

Abbott Libre:

Dexcom:

Medtronic:

Insulet Omnipod:

Tandem:

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