Released Monday 17 November 2025
Guest: Dr Laurel Messer, PhD, RN
VP Medical Affairs, Tandem Diabetes Care
Nurse & Researcher, Barbara Davis Center
Founder, Panther Program
Author of multiple landmark skincare and AID studies
Host: John Pemberton, RD
Your skin is not decoration — it is a piece of life-critical infrastructure. Every CGM reading and every unit of insulin depends on healthy, intact skin.
This episode reframes device wear from “just stick it on” to intentional management of limited skin real estate — a core pillar of modern type 1 diabetes care.
Skincare for CGM and Pump Sites
What does this episode discuss?
- Why device-related skin problems are common, predictable and preventable
- How to prepare the skin for reliable adhesion and healthier long-term outcomes
- How to distinguish irritation from allergy — and why that distinction matters
- The “Soap–Water–Dry → Rotate → Low & Slow” framework
- The hidden link between skin quality, CGM accuracy and insulin absorption
- Why Control-IQ performance hinges on one setting: the correction factor
- How to tune AID systems for children, teenagers, alcohol use and sick days
- What’s coming next from Tandem: Control-IQ+, Mobi, patch-based wear options, Libre 3+
This is the practical, evidence-based guidance many people wish they had years earlier.
The real-world challenge: skin as a limited resource
CGMs and pumps place continuous demands on fragile skin:
- Strong adhesives
- Needles and introducers
- Moisture, sweat and occlusion
- Friction and mechanical shear
- Consistent rotation requirements
- Early-life use in children with very limited surface area
Most device-related problems fall into five categories:
1. Mechanical irritation
Caused by aggressive removal, friction or adhesive shear.
2. Chemical irritation
Due to adhesives, acrylates, sweat or improper preparation.
3. Allergic contact dermatitis
A rare but intense immune-driven reaction — reproducible, persistent and very itchy.
4. Lipohypertrophy or tissue damage
Particularly common with poorly rotated infusion sets.
5. Infection
Lower risk overall, but higher when the skin barrier breaks.
Up to 95% of problems are preventable with simple structure and good habits.
The three core prevention pillars
Dr Messer’s framework is intentionally simple — complexity kills adherence.
1. Preparation: Soap–Water–Dry
The single most important — and most commonly ignored — step.
2. Rotation: more sites than you think
“I don’t want you developing horns on your abdomen.”
Rotation prevents:
- Lipohypertrophy
- Scarring and tissue fatigue
- Reduced insulin absorption
- Sensor failures and early detachment
General guidance:
- Use 6–10 zones
- Rest each zone for at least one week
- Keep 1–2 inches away from recent sites
- Avoid bony areas, belts and friction zones
- For children: arms, flanks, buttocks, upper thighs
3. Removal: low and slow
- Use baby oil, olive oil or adhesive removers (Lift Plus, Uni-Solve, TacAway)
- Support the skin with one hand
- Fold the adhesive back over itself
- Never pull upward
- Cleanse and moisturise afterwards
Barrier strategies: from light touch to full protection
Barrier wipes
Cavilon or Skin-Tac — thin protective film.
Light films
IV3000 or Tegaderm under CGM (cut a window for insertion).
Hydrocolloids
Compeed for cushioning and moisture-absorption.
Key principles
- Less is more — minimise layering
- Allow films to dry fully
- Thicker barriers reduce insertion depth — caution with infusion sets
For deeper adhesive science → World’s Finest AID, Session 5 (Dr Anna Berg)
Irritation vs allergy: a crucial distinction
Irritation
- Redness, dryness, mild itch
- Unpredictable onset
- Improves with barriers and rotation
Allergic contact dermatitis
- Intense itch
- Blistering or vesicles
- Spreading inflammation
- Reappears every time the adhesive is used
- May take months to develop
- Requires dermatology support
Why skin quality affects CGM accuracy and AID performance
Poor skin integrity causes:
- Noisy CGM signals
- Compression lows
- Early sensor degradation
- Unpredictable insulin absorption
- Night-time variability
Skincare is not cosmetic — it is performance engineering.
Control-IQ: the hidden lever behind better outcomes
Dr Messer and Dr Marc Breton analysed data from over 20,000 users. They found basal and carb-ratio changes help — but one setting matters most:
The correction factor.
- Increases algorithm responsiveness
- Improves time-in-range
- Does not increase hypoglycaemia risk compared with basal/carb changes
- Allows fine-tuning by time of day
Read the full GNL Control-IQ guide
Time blocks: circadian tuning for real life
Different age groups follow predictable insulin-sensitivity rhythms.
Children under 5
Strong 5–10 p.m. insulin-resistance spike → followed by much higher sensitivity overnight – The Dusk-then-Drop Phenomenon that almost all AID sytems cannot handle.
Why? The change in insulin sensitivty to just to wicked for the maximum increases that are limited by total daily insulin dose drivem algortims!
See the Under-5s guide for how Control-IQ can overcome the dusk-then-drop phenomenon: it uses assertive correction factors and higher early-evening basal delivery to manage the 17:00–22:00 window, then relaxes insulin delivery substantially overnight. This level of stability is only possible with a system that hands meaningful control back to the user.
As we always say at GNL about Control-IQ:
“With great power comes great responsibility” — which is why we chose Spiderman as the superhero name for Control-IQ
Teenagers drinking alcohol
AID systems may over-deliver insulin if glucose is high. A “drinking profile” with relaxed correction factor + reduced basal is safer.
The Partying with T1D guide walks through how to manage alcoohol when using Control-IQ
Sick days
Control-IQ+ allows safe temporary basal changes during automation.
Coming soon from Tandem Diabetes Care
Control-IQ+
- Temporary basal during automation
- Extended bolus up to 8 hours
- Official label expansion to age 2
Libre 3 Plus integration
- 15-day sensor
- 1-minute data
- Seamless Control-IQ compatibility
Tandem Mobi
- Smallest pump to date
- Fully phone-based
- Patch-based “Mobi” option in development
- Designed for lighter on-body footprint
Practical take-homes
- Skincare is diabetes care
- Follow the Soap–Water–Dry → Rotate → Low & Slow pillars
- Use 6–10 zones and rest each area for a week
- Distinguish irritation from allergy early
- Children need more deliberate skin protection
- If skin breaks down, stop using that area until fully healed
Guidance for healthcare professionals
- Conduct regular full-skin assessments
- Teach Soap–Water–Dry explicitly
- Encourage broad rotation
- Ask about sleep position (compression lows)
- Differentiate irritant vs allergic patterns
- Use hydrocolloids and barriers appropriately
- Adjust correction factor before basal or carb-ratio changes
- Develop time-block profiles collaboratively
- Prepare families for automation
Evidence supporting this episode
Skin integrity & adhesives
• Messer LH et al. Preserving Skin Integrity with Chronic Device Use.
• Berg AK et al. A Skin Care Programme to Prevent Skin Problems.
AID systems & algorithm optimisation
• Consensus recommendations for AID systems (Phillip, Messer, et al.)
• CARES paradigm for advanced devices (Messer et al.)
• Practical considerations for AID (Messer et al., 2025)
Behavioural & adolescent adoption
• Barriers to device use in adolescents (Messer et al., 2020)
Related GNL resources
• Skincare for Diabetes Devices
• AID Systems Guide
• CGM Accuracy & Regulation FAQ
• Control-IQ Deep Dive
• Exercise & AID Systems
• World’s Finest AID – Session 5
Disclaimer
This episode is for educational purposes only. It does not constitute medical advice or create a therapeutic relationship.
Prepared by John Pemberton, supported by AI assistant (“Chad”).
