Skincare advice for injecting, infusion and CGM sites from DSN Geraldine Gallen.
It’s good to state from the beginning what we’re trying to achieve by working with people with diabetes when it comes to looking after their skin. It affects more than you might initially consider, everything from improved HbA1c, improved quality of life, a reduction in the number of hypos and when it comes to CGMs and insulin pumps linked to CGM we’re looking at usage greater than 80% and a higher time in range (greater than 70%).
As many as 40% of people who stop using CGM do so due to skin reactions such as scarring, contact dermatitis, and lipohypertrophy – lumps, bumps and dimples under the skin. At clinic appointments (even virtual ones), your HCP should look at the sites where you are putting your technology on your body and be able to advise you. Much of the advice is similar to that for skincare for injecting, other advice is more specific.
On the level
Users are advised to wear CGM infusion sets and patch pumps on ‘flat plains’ on the body – it is not good to put any of these onto a curved body surface. Also, there needs to be some subcutaneous fat, or else there is the possibility of persistent discomfort. So, this can be a bit of a hinderance for the young or more slender body types.
“It’s also important,” says DSN Geraldine Gallen, “When taking about CGM, to avoid compressing the sensor, as this can lead to some false readings. There is basically a choice between how much adhesives you need to use to keep the sensor in place versus putting too much on and compressing the sensor (also called pressure-induced sensor attenuation, or PISA).”
Beyond site-specifics such as those above, there are the basics of skincare, such as cleansing the skin daily, sometimes exfoliating the skin, and generally keeping hydrated in order to keep skin healthy.
Back to the idea of keeping on-body diabetes tech stuck on, there are items out there that can help, but nearly all have some drawbacks. There are barrier sprays, such as Skinsafe and Cavilon which, as the name says, create a barrier between the skin and the product. They seem to have been developed for the entertainment industry for sticking on special effects make-up, insulating sensitive skin from harsh adhesives before applying them. However, these are not recommended for use by DSNs as they are not available on prescription. Users can fund for themselves if they wish.
Says Gallen, “It is possible to use nasal steroid sprays, such as Beconase, on the skin if the person has skin hypersensitivity. Spray it on the site, then wait for it to dry before putting the CGM on; it works really well and does not appear to affect CGM readings. It is also possible to use topical steroid creams (or gels, mousses or ointments), but these might need a referral to a dermatologist if someone is having severe allergic reactions.”
As well as the skin having hairs, it also has oil and sweat glands Says Gallen, “People are inclined to put bandages over sensors, but this can trap water which then loosens adhesion. For those who do a lot of swimming – or work or live in places with high humidity or are athletes and likely to sweat more – there is a product called Skintac which can be used to help to keep diabetes tech in place.”
Low and slow
Another important factor to putting the technology on, is taking it off. Says Gallen, “We advise careful removal and say, ‘take it low and slow’. If you peel the item off slowly, you’ll damage the skin less and stop any chemicals from the adhesion enter the skin, which will irritate it.”
Inserting and keeping in place
- Employ site rotation
- Avoid where clothing will rub on the technology which could lead to discomfort
- Do not put on body bends or curves
- Do not put on scar tissue, do not use cavity on et cetera
- Do not insert through tape
- Keep yourself hydrated to keep your skin hydrated
Cavilon products from those masters of adhesion, 3M.
Skintac from Funky Pumpers