Management of type 1 diabetes (T1D) has gotten much easier as the technology for checking blood sugars and dosing insulin has improved. Continuous glucose monitors (CGMs) worn on the body check blood sugars every five minutes, so that people with T1D no longer need to poke their fingers numerous times a day. Similarly, insulin pumps allow for insulin dosing without an additional needlestick for each meal or snack. Wearable devices are not only more convenient for many people with T1D, but they also lead to better glucose control with lower HbA1C levels and more time in range.
Skin irritation from T1D tech is a common issue
Over the last decade, more people have been using wearable devices, which is good for the overall management of T1D. However, with devices stuck to the skin for days at a time, skin reactions are relatively common across many different brands of T1D tech.
Mary Burgess, who developed a reaction to her patch pump, explained, “My skin was getting so irritated and itchy that my pump would literally fall off in my sleep. My glucose numbers were high because I was scratching off my pod and the absorption was awful because my skin was so bad.” She continued, “It added one more layer of this disease I have to deal with already and that really started to tire me out.”
Caitlin Stauffer, a parent to a teen with type 1 diabetes who developed a reaction to the adhesive on his CGM, described her son’s experience in similar terms, “It looked like a burn and a whole layer of skin would come off. It was painful, itchy, and just one more thing that made this disease seem unbearable.”
Shamron Cook, another parent to two children with T1D who have had skin reactions, summed up the frustration: “I want pump infusion sets, CGM sensors, and overpatches that stay in place, but don’t destroy my kids’ skin!”
Dr. Jessica Ferris and Dr. Radhika Purushothaman, pediatric endocrinologists at Randall Children’s Diabetes and Endocrine Center in Portland, OR, agreed that skin complaints from type 1 diabetes technology happen frequently. Dr. Ferris estimated that about half of her patients have skin issues from their device. Both endocrinologists said that they mostly see mild reactions, characterized by redness, itching, and dry skin. Severe complications are much less common, but they do occur. Dr. Purushothaman explained, “Very occasionally, I see more serious reactions like breakdown of the skin, bleeding, or redness that lingers for days.”
Why do skin reactions from T1D technology occur?
Skin problems caused by type 1 diabetes technology can develop for different reasons:
- The adhesive patch can trap sweat and moisture close to the skin.
- Friction from the patch and damage to the skin from patch removal also can lead to irritation. This is called irritant contact dermatitis.
- People may develop allergic contact dermatitis from an allergy to the patch adhesive and/or a part of the CGM or pump housing. Allergic contact dermatitis can result in significant inflammation and even blistering or skin breakdown. Acrylates and colophonium (rosin), which help create a strong adhesive, are common culprits in allergic skin reactions.
- Products used to prep the skin also can trigger an allergic reaction.
Dr. Susan Massick, Associate Professor of Dermatology at the Ohio State University Wexner Medical Center, cautioned, “Anything that contacts your skin could cause an irritation or allergic reaction. With any new product, I recommend trying things on a small test area first. And, since these devices are worn for longer and longer periods of time, maintain your test area for at least a week to see if there is any delayed reaction.”
Tips on managing T1D tech skin irritation
People with type 1 diabetes rely on their diabetes technology, and healthcare providers want to do all they can to avoid device discontinuation. If you are noticing skin irritation from your device, there are interventions that your doctor may recommend:
- As a first step, doctors often try a spray or cream on the skin to calm the inflammation.
- If that is not effective, then your doctor might suggest using a skin barrier wipe or a thin film dressing to create a buffer between the device and your skin.
- Doctors may further advise patients to avoid harsh skin preps, like alcohol wipes or adhesive enhancers, if they are not needed.
In the event of severe skin reactions, seeing a dermatologist for patch testing can be helpful. Dr. Massick explained, “Patch testing done by a board-certified dermatologist can confirm allergic contact dermatitis when positive. Negative patch testing may point to more of an irritant contact cause.”
Additionally, she suggested that you try contacting the device manufacturer. “Some manufacturers have formal reporting systems where you can request information on adhesives and alternative adhesive options,” Dr. Massick said. Another measure to consider is switching to a different brand of device. Dr. Purushothaman reported that she sometimes recommends that patients switch brands, but only as a last resort when other interventions have not helped. While changing brands can be an adjustment, it might help you avoid reducing device use or discontinuing devices altogether.
As always, be kind to your skin. Use gentle cleansers and moisturizers to keep your skin healthy, and make sure your skin is fully dry before applying the device. If you need to remove hair, trimming rather than shaving the hair can lead to better results. With some simple measures, most people will be able to comfortably wear their pumps and CGMs while we work towards the day that the T1D community can remove their devices for good!
Written by Breakthrough T1D Guest Contributor Laura Tremblay
