Do you ever experienced CGM skin irritation or any other skin reaction from wearing your diabetes device? We will discuss in this article the most common signs and symptoms of skin sensitivity in relation to CGM devices. We will also give you some tips and tricks on how to protect your skin and prevent future problems.
The skin, believe it or not, is considered an organ by medical standards; the largest organ in the body, actually. Our skin is our first line of defense against the external environment and the pathogens, germs, and irritants which threaten our health and wellbeing. Unfortunately, some of these antagonistic elements can be found on items we apply directly to the surface of our skin.
For example, CGMs (Continuous Glucose Monitors) are composed of a collection of materials, including, but not limited to, plastic, metal, cloth, and various lubrication and adhesive components. Any, or all, of these elements can be irritating to the biological components which make up the human body, including the SKIN.
– Scarring often occurs from the frequent insertion of the CGM device under the skin. Over time, this repetitive activity can lead to scar formation.
– Scars can inevitably make it harder to insert your CGM, as well as affect insulin absorption, and compromise accurate glucose measurements.
– Areas with heavy scarring should be avoided when inserting a CGM.
– Tearing of the skin, as well as the underlying tissues, can also be caused by the repeated insertion of the CGM device under the skin.
– Tearing of the Epidermis (outer layer of skin) can be caused by the stripping away of tape or other adhesive materials which are found in CGM devices.
– Damaging resultants such as scarring and tearing can cause visible changes in skin and underlying tissues, including: redness, bleeding, bruising, and even liquid discharge.
There are (4) types of Hypersensitivity regarding the skin; Types (1) and (4) are the mostcommonly seen with Diabetic Devices. Both Type (1) and Type (4) involve CONTACT WITH ALLERGENS.
Allergens are any substances that cause allergic reactions, such as the adhesives used in CGMs. Allergen contact can lead to hives, eczema, and reddening of the skin.
Type (1) Hypersensitivity involves the body’s immediate reaction after contact with an allergen. Type (4) Hypersensitivity presents with a delayed response by the body, typically displaying similar characteristics as a Type (1), but may take a few days for signs and symptoms to appear.
Typically, the most common allergen found in CGM devices involves the adhesive substance used to keep the device attached to the skin. Mild-to-moderate allergies can usually be treated with anti-histamine and/or anti-inflammatory creams and topical ointments. For more severe cases, seeking a healthcare provider’s intervention is recommended.
**For all instances, avoiding the irritant and seeking a new device is considered necessary. **
Lipodystrophy can be caused by either Lipohypertrophy – which is excess growth of fat tissue – or the less common Lipoatrophy – which is the loss of fat tissue in one area. Several studies have shown that lipohypertrophy can affect insulin absorption and cause it to be erratic or uncontrolled.
Infections and wounds can develop from any and all of the above types of skin irritation. It is important to remember to keep your skin clean and properly moisturized, especially in the areas
of CGM insertion.
Diabetics are often encouraged to be mindful of the skin on the bottom of our feet and the palms of our hands, as that is where neuropathy – numbness, tingling, burning – tends to reside. But it is imperative to be aware of any changes in the skin where we place our CGMs as well.
If an infection or a wound appears anywhere, make note of the size of the affected area (length, width, and depth), location, color, sensation, and drainage (blood, pus, etc.) and contact your healthcare provider right away. Often times antibiotics may be used to fight the infection, and general first aid can be rendered if a wound is not serious and is treated promptly.
Before inserting CGM…
1. Wash your hands prior to insertion of CGM.
2. Clean insertion area with an alcohol wipe.
3. Avoid putting lotions and oils on the area of insertion with 12 hours of insertion.
4. Examine the site of insertion to be sure it appears free from irritation and excess moisture.
Be sure to alternate the insertion site of your CGM each time you change it; this helps to avoid repetitive cgm skin irritation to the same area of skin over and over. Reading the CGM guidelines for the particular brand you are using can help provide valuable information regarding use and care for that specific device as well; guidelines including when to change/apply a new sensor and ideal location(s) of the body to place sensor can help to avoid common skin irritations as well.
There are also a variety of over-the-counter medical supplies that you can find at local pharmacies, including:
● Alcohol wipes, IV preps, skin preps, and barrier film for skin cleaning
● Tapes and adhesives to help with attachment
● Corticosteroids that lessen inflammation and cgm skin irritation at the site of insertion
● Adhesive removers to prevent skin damage upon removal of the device
Popular Product Protests…
Three of the most ‘Popular Products’ in the CGM & Insulin Pump marketplace nowadays are:
● Dexcom – CGM
● Freestyle Libre – CGM
● Omnipod – Tubeless Automated Insulin Delivery Pump
Discussion of CGM skin irritation regarding all 3 of these products have become typical conversations being had by the Diabetic Community and include:
The ‘Dexcom Rash’ has been described as red, itchy, pussy skin around the edges of the adhesive patch of the Dexcom sensor. The skin is also characterized as feeling hard to the touch, lacking the natural elasticity and pliability of normal skin.
The Dexcom Rash can often be treated with a topical steroid, antibiotic, and/or antifungal cream/ointment, and/or prevented by initially applying a hydrocolloid bandage to the insertion site, and then insert the Dexcom sensor straight through it. Dexcom does provide a list of recommended products for cgm skin irritation that can be used prior to and concurrently while applying and/or wearing the Dexcom sensor. You can find the list of products, their purposes, and helpful tips on how and when to use them, for irritated and sensitive skin in this Dexcom summary .
Allergy-based Contact Dermatitis – an inflammation of the skin due to contact with an allergen – is often characterized as a red, itchy, and painful rash. A known cause of Allergy-based Contact Dermatitis is a substance called Isobornyl Acrylate (IBOA), which can be found in the adhesive parts of both the Freestyle Libre CGM and the Omnipod Insulin Pump.
In the article from the Journal of Diabetes Science and Technology there is a description of Isobornyl Acrylate (IBOA) reactions from these devices
Oftentimes it is better to halt and hinder the fire, rather than having to fight off the flames. Products that act as a barrier between the skin and the CGM or Insulin Pump adhesive patches are often the best way to prevent CGM skin irritation. These barriers come in a variety of shapes and sizes and formats.
One of the more popular lines discussed within the Social Media forums are Skin Barrier wipes. These have a double effect of 1) making skin stickier and 2) creating a thin barrier that reduces
chances of skin reaction. One such product is Skin Glu – skin barrier wipes.
In addition to the actual CGM or Insulin Pump patch causing skin irritation, products which are used to improve the adhesiveness of the device can also cause discomfort; especially for those
with extra-sensitive skin.
Each of the 3 ‘Popular Products’ mentioned, Dexcom, Freestyle Libre, and Omnipod, have guides available to improve adhesiveness, recommendations on application and removal of sensors, as well as suggestions on products for various uses:
There is also a large assortment of products available for purchase through a variety of online stores that can provide ideal adhesiveness, while preventing skin irritation as well. An excellent source of information on such products can be found through Social Media groups and forums. Preferably those which cater to Diabetics and those that use these devices.
Our skin is a magnificent organ and our largest. It exists to protect us from harm and occasionally it overreacts in carrying out this function. One of its functions is to prevent unwanted invaders from causing us harm. In performing this function the skin occasionally overreacts and this leads to uncomfortable and occasionally painful skin reactions. Like any bodily immune reaction e.g. hay fever, these reactions can be predicted and are hard to avoid for some people with overly sensitive immune systems. This means that it doesn’t matter how “hypoallergenic” a product or adhesive is, our immune systems overreact and this overreaction causes us discomfort.
Sadly, there is no way to really know who or why this can occur and the only course of action is to completely avoid even the most hypoallergenic adhesive. Our anecdotal evidence demonstrated a reaction rate of around 2.3%, meaning 2.3% of people using our patches will have a skin reaction. Interestingly, we report several occasions where reactions have occurred one time but subsequently have no longer occurred. Perhaps the skin has become mediated to the adhesive and the immune reaction settles on subsequent application.
We recommend using a product like Skin Glu which creates a thin barrier between the skin and the adhesive. We also ensure that latex is not used in the production of our patches. Latex is a common allergen that can cause serious reactions and irritant dermatitis and allergic contact dermatitis. For this reason Not Just a Patch Patches do not contain latex. One of our proudest achievements is hearing from customers and diabetes nurses who regularly report that Not Just a Patch Patches cause less skin reactions than other patches.
Here’s an example of the type of feedback we collect:
Feedback from a diabetes nurse in New Zealand: “I love your patches and have used all the samples you previously gave me. I know several of our cohort are now using these patches for their CGM or FGM sensors. They are particularly good for sensitive skin. The range of colours, including skin coloured is also awesome.”
We will always have hypersensitivity with some patients using CGM’s and any skin adhesives. Manufacturing processes are improving but given the fickle nature of our immune systems any foreign bodies introduced to skin will result in a subset of patients who are randomly hypersensitive and need to cease therapy. Dexcom have recently started using “heatstaking” to simplify the assembly process and reduce the amount of adhesives. This has helped but we know patients still report bad reactions unfortunately.
As a Type 1 Diabetic, and an avid CGM user, I feel that a detailed description of the components of CGMs should be available to the consumer. The materials used in these devices are not provided with the actual CGM device when purchased.
The unearthing of information on Isobornyl Acrylate (IBOA) in Freestyle Libre and Omnipod adhesives was hard pressed to discover. This data should be blatantly clear to any and all consumers looking to purchase these products.
Injectable insulin, for example, is accompanied by an extensive description of its components, possible side effects, and contraindications when purchased. This product is certified by the same FDA (Food and Drug Administration) as the CGMs we purchase. Why do we not receive detailed information regarding these medical devices that are also injected into and adhered to our bodies?
Just some food for thought.