FAQ: Skincare for CGM & Pump Sites

“Healthy skin is essential for accurate CGM, reliable insulin absorption and comfort.”

Dr Laurel Messer
Dr. Laurel Messer, All round T1D and Tech Legend
 

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Q1. Why does skin care matter for diabetes technology?

Continuous glucose monitors (CGMs) and insulin pumps depend on healthy skin. Repetitive adhesives, introducer needles, sweat and friction can damage the skin barrier over time.

Good skin supports:

  • Accurate CGM signals
  • Better insulin absorption
  • Longer device wear
  • Fewer infections
  • Fewer site failures

As discussed in Episode 24, your skin is not decoration – it is a piece of life-critical infrastructure. Skincare is diabetes care.

Q2. What are the most common skin problems with CGMs and pumps?

In real-world use and published studies, most problems fall into five categories:

  • Mechanical irritation – from friction, shear, or aggressive “rip-off” removal
  • Chemical irritation – from adhesives, acrylates or sweat
  • Allergic contact dermatitis – rare (around 1–5%), intensely itchy, can blister
  • Lipohypertrophy or tissue damage – particularly around infusion sites
  • Infection – warmth, swelling, redness, pain, pus

Most of these are predictable and preventable with simple, structured routines.

Q3. How should I choose the right site?

Site placement determines both comfort and performance.

General guidance:

  • Use flat, fatty zones: upper arms, buttocks, thighs, flanks
  • Avoid bony creases and high-friction areas: waistbands, belt lines, rib edges
  • Maintain six to ten rotation zones: map them and cycle through them
  • Rest each site for at least one week before reuse
  • Stay one to two inches away from old sites or active insulin delivery areas

Children have limited “real estate”, so thoughtful rotation across arms, flanks, buttocks and upper thighs is critical.

Q4. What is the best skin preparation routine?

Dr Messer’s core framework is deliberately simple: Soap → Water → Dry.

  • Clean with oil-free soap and water before each new site
  • Rinse thoroughly
  • Let skin dry completely – no steam, no dampness

For sweat-prone skin:

  • Apply solid unscented antiperspirant to the area
  • Leave for around ten minutes
  • Wipe off completely before applying adhesive

For sensitive skin or recurrent irritation:

  • Use barrier wipes such as Cavilon or Skin-Tac
  • Consider light barrier films such as IV3000 or Tegaderm under the CGM or pump (with a cut-out for the inserter)
  • Some clinicians use fluticasone nasal spray (off-label) under the adhesive – it must be sprayed, spread thinly and allowed to dry completely

Q5. How do I improve adhesion when devices peel or fall off?

If devices are not staying on long enough:

  • Use over-tapes such as RockaDex, GrifGrips or Simpatch
  • Apply “picture frame” taping around the edges of the original patch to lock down lifting corners
  • Consider kinesiology tape or Coban elastic wraps for sport, swimming or heavy sweating
  • Avoid stacking too many layers because thick barriers can reduce insertion depth and increase device failure

Q6. What is the safest way to remove sensors and tapes?

Most skin damage happens at removal. The goal is low and slow, not “rip it off”.

Recommended technique:

  • Use baby oil, olive oil or adhesive removers such as Lift Plus, Uni-Solve or TacAway
  • Start at one corner and support the skin with one hand
  • Gently fold the adhesive back over itself, keeping it low to the skin
  • Avoid pulling straight up or away from the skin
  • After removal, wash the area, pat dry and apply an unscented moisturiser

Q7. How do I prevent irritation or rashes?

Start with the basics and build up in layers:

  • Follow the Soap → Water → Dry routine with every site change
  • Use a simple, gentle moisturiser on resting areas daily
  • Rotate more widely and avoid overusing “favourite” zones
  • Add a thin barrier film (Cavilon, Skin-Tac) if you see redness under tapes

If irritation persists despite these steps:

  • Discuss fluticasone spray under adhesives with your clinician (off-label)
  • Consider a short course of topical steroid cream under medical guidance

Q8. Is it irritation or allergy? (They are not the same)

Irritation (most cases)

  • Causes redness, dryness or mild itch
  • Often appears unpredictably
  • Usually improves with better prep, barriers and rotation

Allergic contact dermatitis (less common but more serious)

  • Causes intense itch
  • May produce blisters or small fluid-filled bumps (vesicles)
  • Inflammation often spreads beyond the tape edge
  • Reappears every time the same adhesive or device is used

True allergy usually requires dermatology input and often a change in adhesive or device type.

Q9. How do I prevent lipohypertrophy?

Lipohypertrophy – the thickened, rubbery tissue that develops with repeated insulin infusion – can seriously disrupt absorption.

  • Rotate infusion sites aggressively
  • Avoid reusing any infusion zone for at least six weeks
  • Avoid “favourite spots” even if they feel comfortable
  • Ask for an ultrasound assessment if you or your clinician are unsure about tissue quality

Treat any area with obvious lumpiness, thickening or tenderness as “off limits” until it has healed fully.

Q10. What should I do after removing a site?

Post-wear care is the recovery phase:

  • Use a rich, unscented moisturiser on the area once it is clean and dry
  • Give each site at least one week off before you return to it
  • Watch for warning signs of infection: heat, spreading redness, pain, swelling or pus

Q11. How do weather, sport, altitude and sweat affect sites?

Environment can make a big difference:

  • Cold can reduce adhesion – warm the skin slightly before applying adhesive
  • Altitude can increase micro-lifting of adhesives, especially around the edges
  • Heavy sweating in sport or hot weather increases chemical irritation – use the antiperspirant trick and consider extra barrier films

Q12. What should I do when things go wrong?

Use this simple troubleshooting table as a starting point and seek medical advice where needed.

Skin issue First steps Then consider
Redness or rash Clean, moisturise, add barrier wipes or film Fluticasone spray or mild topical steroid (clinician guided)
Eczema Use a barrier under the device (such as IV3000 or Duoderm) Two to four week course of steroid cream (under medical supervision)
Persistent itching Moisturise and optimise barriers Topical steroid or antihistamine as advised by a clinician
Lipohypertrophy Improve rotation and avoid the area completely Rest for six or more weeks and seek specialist review if severe
Wound or skin tear Use gentle removal techniques, rest the site, clean and moisturise Antibiotic cream or GP review if signs of infection develop

Q13. How does poor skin affect CGM accuracy and AID performance?

Damaged or inflamed tissue can create:

  • Noisy CGM signals
  • More compression lows
  • Shorter sensor lifespan
  • Inconsistent insulin absorption
  • Greater overnight glucose variability

Skincare is therefore a performance enhancer for CGM and automated insulin delivery (AID) systems, not a cosmetic extra.

Q14. What does the evidence say?

Q15. What are the practical take-homes?

  • Skincare is diabetes care – your skin is an insulin-delivery organ and a sensor interface
  • Follow the three pillars: Soap → Water → Dry, broad rotation, low and slow removal
  • Keep your site real estate fresh: use six to ten zones and rest each for at least one week
  • Distinguish irritation from allergy because treatment pathways are completely different
  • Protect children’s skin deliberately – their surface area is limited and devices start early
  • Stop using any zone that breaks down until it is fully healed

Q16. Related The Glucose Never Lies® resources

Disclaimer: This FAQ is for educational purposes only. It does not constitute personal medical advice or create a therapeutic relationship.

Prepared by John Pemberton, supported by AI assistant (“Chad”). Ideas, insights, and responsibility remain with John.

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