I never seem to be able to insert pictures well to my blog posts. If you are interested, you can see the pics at: This is Caleb…
Caleb has been using the DexCom Seven Plus continuous glucose monitoring system since September of 2009. For quite a while he used it without any skin issue whatsoever. After about seven months of use (or at approximately the time that this picture of Caleb was taken, and yes, that is the only tie-in of this post to that picture, but I didn’t want the next picture to be the one that you are first greeted with for obvious reasons) things started to get a little tricky.
His skin started to react and frankly, it was nasty.
It was also heartbreaking. This tool which provided such valuable information, and comfort in otherwise stressful times of blindness, was working wonderfully but for this acid-like burning of Caleb's skin.
My heartfelt thanks to so many of you who gave me suggestions. I don't think I can remember all of the things I've tried over the last six or so months. Here is a list of many of them:
- Wipe the skin really, really well with alcohol to clean away as much of your skin's natural oils as possible
- Use anti-bacterial soap
- Apply Benedryl spray/gel/cream on the skin before placing the sensor on
- Apply IV3000 or similar tape on the skin before placing the sensor on
- Apply Bard's Barrier Wipe
- Apply Cavilon Barrier Wipe
- Apply Skin Tac Wipe
- Apply IV Prep
- Apply Skin Prep
- Any combination of the above applications
- Place a cotton round under the sensor to absorb moisture
- Dry the adhesive after showering/swimming with hair dryer
One time I placed IV3000 on his skin, then the sticky side of another piece of IV3000 to the sticky side of the DexCom sensor. It took quite a bit of coordination to then apply tape over the sensor with the inserter still attached to be able to adhere it to his body. As desperate as we were for a solution, I was glad this technique did not work.
We had some improvement at times. This picture shows Caleb's arm a couple days after removing a sensor. You can clearly see the oval shape of the DexCom adhesive on his skin. The area was less irritated in this case - mostly a big dry patch. Whatever we did though, Caleb would inevitably end up scratching and complaining about the site and we would never get the full seven days out of a sensor.
I am hesitent, after so many unsuccessful attempts, to formally document that I do believe we have found a remedy to Caleb's issue, for fear that the diabetes gods will strike me down for even daring to think that I might have something under control. Nevertheless, I feel behooved to share for those who may be going through the same torment that we have over the last half of a year.
The absolute, number one, critical element for Caleb is to ensure that his skin has been given adequate time to recover from the last site. His skin needs to be smooth without any dryness, otherwise he will complain of itching within hours, even minutes of putting a new sensor on.
Assuming we are dealing with healthy skin, I do the following:
- Clean the area well with an alcohol wipe
- Apple a barrier wipe on the area, careful to leave a small spot unbarriered for the insertion (I found when I wiped the entire area including the insertion, Caleb would get site infections)
- Cut a small hole out of a piece of IV3000 (or Opsite Flexifix) for the insertion and apply to the site
- Repeat the above step so that there are two layers of tape (this was the last piece of the puzzle that seemed to make all the difference)
- Cut the DexCom adhesive down on all four sides to minimize the adhesive surface area
- Soak the DexCom adhesive with a Skin Tac wipe then apply the adhesive to the two layers of tape, careful to place the insertion spot over the open area
- After insertion, apply the Skin Tac wipe to the top of the adhesive to seal it
- Dry the adhesive after getting it wet with a hairdryer whenever possible
I'm not sure which part of the above steps is actually resolving the issue or whether one or more of the steps could be elliminated; I've recenty skipped the barrier wipe and seem to have equally effective results. For all I know maybe he's just simply gotten over it and none of the steps are doing a darn thing. If I muster the courage to apply the tape directly to his skin, I'll report back. I expect that won't be for a while though. In the meantime, we're enjoying the heavenliness of his smooth, itch-free skin that's revealed when we remove a sensor that's lived its expected lifetime.
Please be kind, diabetes gods. I don't mean to taunt you. Rest assured, you are still keeping us on our toes and I know we will never be completely in control. :)
Here's a nifty resource from OmniPod which includes some of the above plus additional adhesive tips and suggestions. It's intended for OmniPod, but the ideas are transferrable to other products as well.