Skin care essential to preventing infections while using diabetes devices
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Good skin care and proper use of wearable diabetes technology can help prevent skin issues related to insulin pump or continuous glucose monitor use, according to two speakers.
“If we can avoid preventable complications through assessment, education and intervention, then let’s do it,” Nick Galloway, BSN, RN, CDCES, a clinical diabetes specialist at CeQur Corporation, said during the presentation. “We want to maintain the use of diabetes technology, especially when it’s working. If the device is really causing problems with their skin, then we need to find options or a solution to alleviate the concerns.”
Galloway discussed three types of skin issues that may occur with wearables.
Contact dermatitis
The first, irritant contact dermatitis, or hypersensitivity type 1, can occur from stripping off medical tape and removing part of the epidermis layer. Clinical presentation of this condition can include erythematic, edematous, blistered weeping and bruised skin during early stages and hyperpigmented or hypopigmented skin with dryness in the latter stages.
“The main culprits of contact dermatitis stem from the use of continuous glucose monitor sensors, infusion sets used with continuous subcutaneous insulin infusion therapy, insulin patch pumps, and additional use of medical tape to reinforce device adhesion,” Galloway told Healio. “In particular, the physical act of removing tape, exposure to tape adhesives, and the tape’s ability to trap moisture and bacteria are all common mechanisms to skin damage.”
Allergic contact dermatitis
Allergic contact dermatitis, or hypersensitivity type 4, is a cell-mediated immunologic response to a component of tape adhesive, Galloway said. Allergy patch studies have shown various acrylate monomers in medical adhesives can cause allergic contact dermatitis. The condition typically leaves well-defined areas of erythema, edema, hives or skin erosions.
Patch testing can be done to identify the cause of contact dermatitis, but often involves trial and error, Galloway said, as many companies do not advertise which adhesives are used in their tapes.
Lipohypertrophy, lipoatrophy
Users of wearable devices could also develop lipohypertrophy — abnormal growth of subcutaneous adipose tissue — or lipoatrophy — loss of subcutaneous adipose tissue — due to an adverse immunologic response to insulin therapy.
Conduct regular skin checks
If a person using a pump or CGM has no known allergies but begins to have a reaction in the area around their device, they should have allergy testing.
“Palpate the areas the patient is using or has used for insertion,” George “Joe” P. Trotter Jr., BSN, RN, CDCES, a nurse clinician at Emory Healthcare, Emory University Hospital Midtown in Atlanta, told Healio. “Check for lipodystrophy, that may be overused and not giving the patient adequate insulin absorption or accurate glucose readings. Look for areas of skin that may appear inflamed or have remnants of adhesive or skin shearing, and offer over-the-counter aids, medications or prescriptions.”
Diabetes care and education specialists should teach proper skin care and the signs of common skin infections, Trotter said. A skin assessment should be done at regular appointments, and people using devices should check their skin daily. A person’s knowledge of skin allergies can also help their provider choose a device that will not cause an allergic reaction.
Infections can also occur at an insertion site, making skin care and wearing devices properly crucial.
“Infection can lead to bacteria trapped under the skin and give it more time to grow and spread under the adhesive — from the device itself or from the added adhesive many use for the extra support to keep device adhered to skin,” Trotter said.
Educators should demonstrate how to place and remove devices to keep skin healthy. Devices should not be placed near any moles, scars, tattoos or stretch marks and at least 2 inches away from the navel. Devices should be placed in areas of the skin with a flat surface and not in areas near the waistband or anywhere there will be a lot of skin bending. Any use of additional adhesives should be limited, and an adhesive remover should be used to limit the risk for skin shearing.
People with diabetes should shower or bathe just prior to a site change. The area should be cool and dry before insertion. Frequent hand washing can help to prevent infection. In addition, device wearers should always follow manufacturer’s guidelines for duration of wear.
“Multiple techniques and products may need to be tried before a person finds what works for them,” Trotter said. “Unfortunately, it’s not one size fits all. Each insulin pump, patch pump and CGM manufacturer has links to skin care tips and products available for all wearers on their respective websites.”
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Trotter GP and Galloway N. Can Education Put the Brakes on the Progression of GDM to Type 2 Diabetes? Presented at: Association of Diabetes Care and Education Specialists Annual Meeting; Aug. 13 - 16, 2020; (virtual meeting).
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