FreeStyle Libre Sensor and Tattoos

Tattoos are a form of permanent body art that involves the injection of ink under the skin.  Getting a tattoo is generally safe with the exemption of a few medical concerns with the inking process. However, the number of people that get tattoos has consistently increased over the last couple of decades and projected estimates are expected to increase.

Type 1 diabetes and tattoos

The focus of this write-up is not exactly on tattoos. We are examining how getting a tattoo can affect how you use medical equipment used to manage diabetes such as CGMs. Tattoos are completely safe for diabetics. In fact, a lot of diabetics are choosing to tattoo their medical conditions on their bodies as an alternative to wearing medical ID bracelets. Since tattoos are becoming more fashionable, it is common to see more diabetics wearing a tattoo than wearing a medical ID bracelet.

Tattoos and CGM device Sensors

Maybe you might have seen a CGM sensor before or not. These devices revolutionized diabetes medical care, making it possible to accurately measures blood glucose trends without performing a fingerpick. Not only do these devices eliminate the hassles of multiple daily finger pricks, but they also alert the user to extreme levels of glucose concentrations in the blood. 

This article will be focusing on the FreeStyle Libre 3 relationship with tattoos – however, as CGMs are similarly designed,  feel free to substitute your device whenever we mention the FreeStyle Libre 3.

Now, you might wonder why the subheading here reads ‘Tattoos and CGM device Sensors.’ The connection is more of a utility than functionality. Almost all CGM devices have a sensor designed to be worn on the skin. These small compact units are not implanted but simply attached to the skin. Usually, these sensors are worn on the parts of the body that guarantees easy access to the user and at the same time will not fold during daily activities like walking, sitting, and running. The upper arm and the upper abdomens fit these descriptions making them the most common region where diabetics wear their sensors. At the same time, these regions are the most commonly tattooed parts of the body.

Diabetics often find it hard to install their sensors on the parts of the body already covered with a tattoo. The problems linked with installing a CGM sensor on tattooed parts of the body are precisely summed up in this question excerpt from Reddit

‘I have a half sleeve of tattoos on my upper right arm/ shoulder and have noticed the libre doesn’t stick onto my tattooed arm. I have to wear the libre on my left arm as it doesn’t stick as well or completely falls off when I have used my right arm. I know the advice is to switch regularly, but I genuinely can’t as it’s a hassle when it doesn’t stay on! Is this because of my tattoos? Does the freestyle libre stick to arms that have tattoos?’

Apparently, installing a CGM sensor on the tattooed part of the body comes with a few problems. It does not stick well and falls off flowing rigorous movements of the body parts. This means diabetes with their sensors installed on a tattooed part of the upper arm might have minor problems getting it properly fixed. In the event of running or jogging, the sensors may fall off. The problems created by a loosely fitted sensor are many. First, the sensor is required to be firmly attached to the skin for continuous blood glucose measurements to be guaranteed. Sensors that fall off frequently may interrupt the reading and cause a break in the daily trend of glucose level measurement.

Secondly, consistent readings from the sensor are very important in determining the risk of complications in diabetics. If readings are interrupted, extreme lows and highs of glucose measurements may be missed. This reduces the accuracy of assessing the risk of diabetic complications that might arise as a result of poor management of poor adherence to diet plans. In younger people, this problem has been linked to poor management of diabetic status and therapy failure.

Lastly, the stakes of mortality are higher when a poorly fit sensor is worn over a long period, giving misleading information when diabetes management decisions are made. If users stick to the readings to make decisions on the dose of insulin to use, the probability of therapy failure and adverse drug effects are significantly increased. Users basically derive more from CGM sensors by making sure it is fitted properly on the skin. Based on multiple reports from users; tattoos, moles and skin scarification make it hard to wear CGM sensors perfectly. This alone exposes the users to all the aforementioned problems if they wear the CGM sensor on a tattooed part of the body.

Do Tattoos Affect the Accuracy of FreeStyle Libre 3 Sensors?

Tattoos can impact the accuracy of FreeStyle Libre 3 sensors because the extra layer of ink in the skin can interfere with the proper placement and functionality of the CGM electrodes. The electrodes are essential for measuring the glucose concentration in the interstitial fluid, which provides an estimate of the blood glucose concentration. If the electrodes are not well-fitted, they may not be able to provide accurate readings.

Abbott, the FreeStyle Libre CGM product line manufacturer, generally recommends that users avoid applying the sensors on skin regions with moles, scarring, and tattoos. This is because these skin regions can reduce the firmness of the sensor on the skin, causing it to slip off more frequently. In some reported cases, diabetics with tattoos have found that the extra layer of ink in the skin reduces the firmness of the sensor, resulting in it slipping off more frequently.

However, not all tattoos will affect the accuracy of the FreeStyle Libre 3 sensors. The extent to which a tattoo can impact the readings depends on several factors, including the location of the tattoo, the type of ink used, and the size and depth of the tattoo. For diabetics with extensive sleeve tattoos, it may be challenging to follow Abbott’s guidelines, as it may not be possible to avoid all tattooed skin regions.

In some reported cases, diabetics with tattoos have found that the tattooed skin does not affect the functionality of the sensors, but the extra layer of ink in the skin reduces the firmness of the sensor on the skin. This can result in the sensors slipping off more frequently when applied on a tattooed area.

It is important for diabetics with tattoos to take extra care when applying the FreeStyle Libre 3 (or any CGM sensor) and to follow the manufacturer’s guidelines. If the tattoos are causing the sensors to slip off frequently, it may be necessary to consider alternative placement options. Additionally, diabetics with tattoos should double check the accuracy of their CGM readings just in case a variability has occurred.

How to Better Wear Your Sensors on Tattooed Skin

The main problem with wearing CGM sensors on tattoos is the poor firmness widely reported. Since this problem can directly affect the number of readings recorded during the day, it is important that diabetics with tattoos find a way around it.

Ever heard about CGM patches?

If keeping your FreeStyle Libre 3 (or any CGM sensor) firmly in place is a huge problem, CGM patches are designed to help you out. They are designed to be hypoallergenic for sensitive skin and adhesive enough to keep the sensor in place for a long period. Premium patches are designed to serve a double purpose of protecting the sensor and simultaneously keeping the sensor firmly attached to the skin.

Diabetics with a full sleeve tattoo may invest in patches like this to solve the problem of the sensor slipping off the skin. Depending on the design, some patches may keep your sensor in place for more than 10 days when applied correctly. Today, you can easily search online for a catalogue of patches that are compatible with most CGMs including FreeStyle Libre, Dexcom G5, Dexcom G6, and Medtronic Guardian. 

As an alternative to using CGM patches on the arm, they are also designed to fit perfectly on the lower abdomen. Although these intuitive designs are not made exclusively for tattooed skins, they serve multiple purposes. Users with a rigorous work schedule that might include continuous moving of the body or rigorous movement routines can also secure their CGM sensors in place with a patch. Their use on tattooed skin serves an additional purpose to help diabetes patients with extensive body tattoos properly manage their blood glucose trends without interruption caused primarily by sensors slipping off the skin.

Conclusion

Tattoos do not exactly affect the functionality of the Freestyle Libre Sensor, but they can affect how these sensors fit properly on the skin. As an extra layer of ink under the skin, these body art forms may cause different levels of obstructive interferences that affect the management of diabetes. Getting a good CGM patch can solve these problems and also help the user secure the sensor firmly in place on the tattooed skin.