15 Solutions to Reduce Irritation and Keep Sets & Sensors Stuck On
so you can keep using your insulin pump, CGM, or Libre!
(D-Mom; Writer & Creator of WaltzingTheDragon.ca)
Here we share with you a comprehensive and objective review of number of different expert- and user-approved strategies to reduce the pain, hassle and obstacles of using insulin pumps and Continuous/Flash Glucose Monitoring systems.
Diabetes technologies like insulin pumps and glucose monitoring systems are life-changers. But for some, the use of these devices comes with adverse reactions to their infusion sets and sensors. At best these reactions impact the functioning of the device; at worst, they create pain, exasperation and health risks, compounding the burden of daily diabetes care. If you fall in this category, there’s hope!
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Our Family’s Experience
My son has been using diabetes-tech for nine of the 11 years that our family has lived with type 1 diabetes. He got his first insulin pump a week after he turned three, and his first CGM a year later. Both brought new freedom and key information, changing how we managed diabetes within our family: he could have seconds, thirds and fourths without another shot; his blood glucose swings evened out because we could tailor insulin doses to his teeny body; we now had details about what was happening between finger pokes; we could see the effect certain foods had on his blood sugar; and we had warnings about lows (which he was otherwise unable to recognize at the time). Those were the golden years.
Skip ahead some years and we saw red, raised skin more often at the infusion site or sensor site. CGM readings started to get wonky; our trust in their accuracy was eroding. We were receiving wildly swinging glucose readings that did not match his symptoms, nor the fingerstick readings. Too often, the CGM was offline, producing only a series of question marks instead of glucose readings.
Once on a road trip home from a family gathering, the itching became so intense at the site that we had to remove his CGM sensor on the side of the highway. Then when we tried new technology a few years ago (Flash Glucose Monitoring)
after a few days we discovered liquid seeping from the middle of the sensor housing. We took it off to find the skin underneath inflamed, painful and raw: in the exact shape of the sensor tape/housing, the skin had blistered, and then the blisters had popped, leaving the tender skin exposed and extremely painful. It took several weeks to heal.
In an effort to find a device that would give us valuable blood glucose data while reducing the hassles of frequent finger pokes, we tried another manufacturer, just to find a similar reaction to those CGM sensors: a mushroom-shaped patch of inflamed and itchy skin was all the evidence we needed to convince us to press pause on glucose monitoring technology.
What we found out along the way may help many of you overcome your own family’s struggles with infusion sets and/or sensors.
Signs and Symptoms of a Problem at the SiteHow do you know if all is not going as well as it could? What does a troublesome sensor or infusion set reaction look like?
More about the symptoms of a bad site, as well as some potential causes:
What Can Go Wrong with Infusion/Sensor Sites?
15 Steps to Reduce Skin Irritation, Itching and Pain… AND Keep Sets/Sensors On
A successful strategy to reduce or eliminate site irritation often depends upon the cause of the problem. Once you and your child’s health care team (which may include your child’s endocrinologist, diabetes nurse, CDE (Certified Diabetes Educator), dermatologist, allergy specialist, or immunologist, etc) have narrowed down the potential cause(s) of the trouble, there are a number of possible interventions which you can try to deal with the obstacles that get in the way of effective use of an insulin pump, CGM, or Flash glucose monitor.
Below are some potential solutions for you to consider, suggested by both experts in the diabetes field, as well as real-life d-tech users. You can pick and choose a few steps that are relevant to your individual issue, or you can go whole hog (if you do, it’s best to sequence them in the order presented). I would suggest trying new products alone first, to see if they’re tolerated well; if you’re using four applications and have a reaction to one, it will seem as if the whole process failed, when it might actually work if you used only the three products which do not lead to irritation.
Step 1. Try a Different Set or Sensor
The components that create problems in one product may be absent in another product. For this reason, a good first step may be to try products made by a different manufacturer.
Step 2. Let the Sensor Breathe
User-approvedSome community members have commented on the strong odor of plastic that they smell when they first open a sensor package (particularly Libre Flash Glucose sensors). These users suggest that after you open the sensor packaging, you let the sensor “air out” until it no longer smells like plastic before inserting it. They also suggest that they have found success with using a hair dryer to speed up this process.
Step 3. Numb the Site
Although numbing the site does not directly reduce skin reactions, if you use topical numbing as a pain reduction strategy, this is the place in the process in which you would use it.
Topical anesthetics have a numbing effect, so are used to block pain.
Some suggestions include:
The creams need to be left on the skin for a period of time in order to take effect; a barrier tape such as Tegaderm or Opsite™ Flexifix™ over a dollop of cream will keep it in place for the required amount of time. The cream is then wiped off before moving on to the next step. (See manufacturer instructions for correct use of a particular product.)
More on Numbing:Numbing the Infusion/Sensor Site
Step 4. Cleanse the Site
It’s important to thoroughly clean the skin in the area where you plan to insert the infusion set or sensor, both to reduce the bacteria on the skin that may cause an infection if it gets under the skin, as well as to remove any products that may cause irritation or keep the set from staying stuck on to the skin.
A variety of soaps or antiseptics cleansers can be used to cleanse the site. Some suggestions include:
In choosing a soap/cleanser, it may be helpful to keep in mind that perfumes/dyes may irritate the skin and so are best avoided. Also, if you have trouble with infusion sets/sensors falling off, it’s best to avoid Dove and other moisturizing soaps, as they interfere with adhesion. It’s such a balance between too dry and too moisturized!
More on Cleansing:Cleansing the Infusion/Sensor Site
Step 5. Let the Skin Dry Completely
Moisture trapped against the skin (under an adhesive product) can lead to irritation, regardless of whether you use any additional preps and products. For this reason, it’s important to allow the area to dry thoroughly and naturally between each step of preparation – without blowing on it, which can introduce bacteria to the area. This step is so critical, that if you are experiencing minor skin irritation, simply letting the area dry completely may resolve the problem, eliminating the need for further interventions.
Step 6. Apply an Anti-inflammatory Spray
Although these products are only rated for up to 24-hour effectiveness in reducing itching and other inflammatory responses, it seems that when they effectively suppress the initial reaction at the time of insertion, that effect often lasts for the duration on the infusion set (2-3 days) or sensor (up to 7, or even 14 days); that is, if the initial reaction is interrupted, that may eliminate the reaction all together.
BUT… an important warning: corticosteroids (Flovent® and Flonase®) must be used with caution! We do not know the long term effects of consistent use of topical steroids, and those effects (which are likely to include the thinning of the skin, as well as permanent discolouration of the skin, among other undesired effects) could be more detrimental than the original reaction that we are trying to prevent. Therefore, it’s wise not to take the risk unless other, safer interventions have failed, and even then, only if your health care team agrees that the anticipated benefits outweigh the possible risks.
It’s important to note that the package insert for Flonase® allergy spray says it’s not recommended for children or adolescents under 18 unless on the advice of a doctor, if you are pregnant or breast-feeding, as well as a whole host of other exclusions (including an allergy to the contents of the spray); check with your health care team before use.
Step 7. Use a Barrier Wipe or Spray (to Decrease Irritation)
Expert- and User-approved
One way to protect the skin from the irritants that may be in the infusion set/sensor adhesive or plastic housing is to apply a layer of liquid, and then allow that liquid to dry into a film that acts as a barrier between the skin and the products that are applied over it.
Note that although 1-2 layers is usually enough, some users report needing up to 5 layers (letting each layer dry completely before applying the next layer) before the rash is successfully prevented.
Consider any one of the following barrier wipe trade names (in random order):
Step 8. Use a Liquid Adhesive (to Increase Adhesion)
Expert- and User-approved
If you have problems with the infusion sets or sensors falling off early, before the life of the set/sensor is done, you may also want to try adding an adhesive layer on the skin as a tacky base, before applying adhesive products (sets and sensors). It’s important to note that such a product is not designed to reduce irritation per se (as are the products in Step 6, above), though some products do fulfill both purposes, keeping the set/sensor stuck on, and at the same time acting as an effective barrier between tape and skin. On the other hand, some users find that extra adhesives actually increase irritation. So give them a try, but be prepared to ditch it if the problems outweigh the benefits.
Also note that you should avoid blowing on the skin to dry an adhesive layer, as this may actually create problems with adhesion if the top layer dries while the liquid below does not. Some users have pointed out that in one device manufacturer’s online instructional videos, they advise against blowing on the area, but instead suggest letting it dry naturally.
Consider any one of the following adhesive products or trade names (in random order):
You can get costume glue anywhere you would buy Halloween costumes, or Theatre makeup. In Calgary, we have bought it at Don’s Hobby, a local costume shop.
Step 9. Add a Tape Barrier
Expert- and User-approved
The use of a physical barrier of tape, in addition to or instead of a barrier wipe, may also reduce irritation at the site of an infusion set or sensor. Whether or not this is a useful step depends on how well a given product fits the problem you are trying to solve. For example, to reduce an allergic reaction, our family found that using a thin or water-permeable tape (IV3000 or Hypafix, respectively) did not reduce the reaction at all. However, for minor irritations, a tape barrier may be just enough to solve your set/sensor issue. Also, any of the following may be used on top of the sensor or infusion set, to keep it securely in place (see Step 11, below).
Consider any one of the following adhesive tape trade names (in random order):
Tradenames for Hydrocolloid Adhesive Pads include: Band-aid® Advanced Healing Pads, Band-Aid® HydroSeal™ patches (previously marketed in the USA as “Tough Pads”); Compeed®; DuoDERM®.
Some users who did not find enough protection with the above Band-aid® products have found success with DuoDERM® – one even called it the “gold standard,” so it may be worth a try if you have not had success with other products.
There is some debate about whether or not you should cut a hole in the hydrocolloid pad before inserting the sensor or infusion set. Some users say they punch right through it with no problem, others say they have to cut a hole or risk ruining the sensor or set. Some users report that if they don’t cut a hole in the pad, the sensor fails within a few days (perhaps the sensor filament isn’t seated deeply enough into the fat layer due to the extra thickness?) Some users say that if they cut a hole, they still get a reaction where the irritant gets past the pad to the skin; others say that they still get adequate protection even when there’s a hole in the pad. As with most things related to diabetes, individual results will vary, you may have to experiment to see what works for you / for your child.
If you decide to cut a hole in the hydrocolloid patch, you can do so with a crafting hole punch, or by folding the pad lightly in half and then in half again the other direction, then cutting off a tiny bit of the inner corner with a pair of clean, sharp scissors, leaving a small hole in the dead centre of the patch.
Step 10. Remove the Factory-installed Adhesive?
Before they insert the infusion set or sensor as it comes assembled from the manufacturer, some users have found success with removing the factory-installed adhesive backing (as well as any residue), and then using an alternate (non-irritating) adhesive in its place (such as double-sided body/lingerie tape, or a liquid adhesive – see Step 8, above), with an adhesive patch over top of it all to keep it in place (see Step 12, below). As many users have commented, this may not be the first approach to try, and it does void any warranty on the sensor, but for those who have not found success with other strategies, this “last ditch” effort may be the only thing that allows them to continue using their Flash or Continuous Glucose Monitor.
One user has even shared their process on YouTube: Libre Freestyle 14 Day Sensor Adhesive Removal in English by A C (May 2019). (Be sure to review the warnings provided in the video description!)
Step 11. Insert the Sensor or Infusion Set
Having applied one or more of the previous steps, now is the time to insert the insulin pump infusion set, CGM sensor, or Libre sensor, according to manufacturer directions for that device.
Some users have found that the skin on some parts of their body is more sensitive than others, and that eliminating reactions is as easy as moving the insertion site to a new location, where the skin is tougher, more resistant to irritation.
Step 12. Add an Overlay of Protective Tape
Expert- and User-approved
Most of the products listed in Step 9 (above – EXCEPT Hydrocolloid Adhesive Pads) may be used on top of the sensor or infusion set, to keep it securely in place.
For convenience, Smith&Nephew makes an IV 3000 patch (6cm x 7cm) for infusion sets with a hole pre-punched in the middle, for the plastic housing of the set or sensor to poke through. Why is this useful? Leaving a sensor uncovered may help reduce the occurrence of “signal loss”, in which the transmitter is unable to send the glucose reading to the receiver, leaving gaps in your glucose data. It can also be a pain to get the sticky residue from adhesive tapes off of the back of the re-useable CGM transmitter so that you can pop it into the next sensor housing – if the tape goes around the transmitter instead of on top of it, then there’s no sticky residue on the transmitter itself, saving you a step.
If you want to avoid the expense of pre-punched tape patches, you can cut a hole in a patch yourself by folding the pad lightly in half and then in half again the other direction, then cutting a rounded or square hole from the inner corner with a pair of clean, sharp scissors, leaving a gap in the centre of the patch that approximately matches the particular shape of that brand of infusion set or sensor housing.
Step 13. Use Adhesive Remover
Expert- and User-approved
If the products have done their job well (or even a little TOO well!), then pulling off a well-adhered set or sensor may damage the skin under it; you may want to use an adhesive remover to take the set or sensor off at the end of its recommended usage life (2-3 days for infusion sets, 7 or 14 days for CGM sensors, depending on manufacturer recommendations).
Consider any one of the following adhesive removers (in random order), when it’s time for a set change:
Step 14. Treat the Affected Skin (if needed)
Despite your best attempts to reduce or eliminate inflammation and irritation, sometimes tender, itchy, red skin persists after you have removed an infusion set or sensor. For the best chance at successful healing, consider these first aid tips to avoid infection, promote healing, and reduce scarring:
- Aloe Vera extract
- Polysporin®Heal-Fast® Formula (a medicated cream which “prevents Infection, minimizes scarring, speeds healing”). The cream contains lidocaine hydrochloride for pain and 2 antibiotics (Polymyxin B Sulfate and Gramicidin) to prevent or treat an infection.
Step 15. Share Your Experience
Some of the most valuable things that our family has learned about managing diabetes, we have learned from others in the diabetes community; skin reactions and keeping sets stuck on are no exception. If your child has a serious adverse reaction to an infusion set or sensor, consider these follow-up steps.
Do you have a process that works for your family to keep sets/sensors on, and to avoid skin reactions???? We would love to hear from you:Contact Us
This material has been developed from sources that we believe are accurate, however, as the field of medicine (in particular as it applies to diabetes) is rapidly evolving, the information should not be relied upon, as it is designed for informational purposes only. It should not be used in place of medical advice, instruction and/or treatment. If you have specific questions, please consult your doctor or appropriate health care professional.
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