Sticking Tips for Infusion Sets
Tips for keeping your insulin pump cannula or needle in place
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Infusion Sets 101
Here's the thing no one tells you about infusion sets: Sometimes the adhesive fails to, well, adhere. Or it sticks but slides. Or it comes off before you're due to change your set. It can happen to CGM sensors, too. "During one of my half marathons, [my continuous glucose monitor] fell off," says Greg Florian, 33, a runner with type 1 diabetes. "I felt it, but when I looked at my site, it was being held on by just the [sensor]. It's not an ideal time to lose your CGM."
The good news is that as annoying as poor adhesion can be, it's fairly easy to fix. Of course, what makes someone else's infusion set stay in place might not work for you. But even athletes doing the most demanding workouts—including water sports—have discovered tools that ensure safe insulin delivery.
Prep the Skin
Dirt, oil, and moisture can reduce adhesion, so step No. 1 is to clean the skin with an alcohol pad or IV prep wipe (which leaves behind a tacky surface) where you'll wear your infusion set. Then dry thoroughly. From there, you have two options for increasing the stickiness of your set: layering adhesive or a skin-prep product on the skin to make it stickier before you insert or adding adhesive once your set is in place. Which you choose is a matter of personal preference.
A cheap and easy trick is to use an antiperspirant after you clean the site, says Jan Wall, MS, RD, LD, CDE, project coordinator of the diabetes program at the University of Arkansas for Medical Sciences. Skip deodorant; it's the antiperspirant feature you really need, and chemicals used to mask scent can be irritating. And use a solid or spray, not a gel or cream. Apply to the skin where you plan to insert your infusion set, and wait at least 10 minutes for the antiperspirant to dry before inserting the set.
CGM Sensor Dos and Don'ts
What works for keeping your pump's infusion set in place isn't always the best technique for CGM sensors.
|When applying an antiperspirant or a skin-prep wipe, leave a patch of clean skin into which you can insert the sensor.||Cover the skin in antiperspirant or tacky skin prep and then insert the sensor; it can cause the sensor to fail or compromise the accuracy of the readings.|
|Cut a sensor-sized hole in any pre-insertion adhesive covering you put on the skin.||Insert your sensor through adhesive coverings such as IV3000 or Polyskin.|
Products such as Skin Tac and Mastisol, which are applied to the skin and create a tacky feel, are used in a similar way to antiperspirant. They form a barrier between clean skin and an infusion set's adhesive to keep a site in place longer. In fact, they attach so well that some people use other products, such as Detachol, to gently remove the adhesive.
Another option is thin, flexible "tape" that sits on the skin and attaches to an infusion set's fabric adhesive pad. If you're using a pump, you can insert your infusion set directly through the sheer covering once it's stuck to your skin. Brands such as IV3000, Polyskin, and Tegaderm are diabetes-educator favorites. The key to making them last? "As you take the adhesive backing off, be sure you're pressing out any air bubbles," says Wall. For extra staying power, use a product such as Skin Tac beneath the covering before inserting an infusion set.
Regardless of what pre-insertion product you use, keep a close eye on how your skin reacts. If one causes irritation, another brand might do the trick. Bradford Gildon, a 28-year-old triathlete with type 1 diabetes, relies on pre-insertion products to keep his pump in place during races, especially when he's in the water. While he's found a product that works for him, the first he tried aggravated his skin. That said, Wall says that skin irritation isn't a problem for most people, provided that they change their site regularly.
Cover It Up
The same dressings you'd use over your skin—IV3000, Tegaderm, Polyskin, and the like—work on top of your infusion set's adhesive pad as well. If prepping the site doesn't work for you, consider adding extra adhesive once your set is in place.
Whether you're using a pump or CGM, be sure to cover only the adhesive pad, not the plastic "dock" or tubing you'll need to disconnect. Doing so leaves room for air, moisture, and dirt, which in turn leads to a less sticky site.
"The flatter you can get the [product] on the skin, the less moisture you will get from water," says Tom Kingery, 37, a triathlete and runner with type 1 diabetes. "If you can prevent outside water from coming in, then it's going to help a lot." To keep his patch pump in place, Kingery cuts a pump-size hole in a sheet of adhesive, which he places over the device, reinforcing the pump's adhesive patch without touching the pump.
Athletes who want extra assurance that their site won't slip may employ other methods on top of added adhesive. Spandex sleeves, which Gildon uses, or Velcro bands can keep an infusion set on your arm from pulling out.
Make a Move
Generally speaking, one area of the body isn't stickier than the rest. But depending on your lifestyle, infusion sets may be dislodged more often from certain sites than others. "Consider where you're wearing it," says Wall, noting how a belt or waistband could brush against a site and knock it out of place—changing clothes or dropping your trousers during a bathroom break are prime times for dislodging a site. Typically, sets rip out when the tubing catches on something (such as a doorknob) or when you drop the pump and it swings on the tubing from the site. Secure the excess tubing (tuck it in your waistband or pocket) to avoid such snags. The best area for keeping your set stable may change based on the day or your activity. Surfers, for instance, may avoid their arms because crashing waves can more easily tear away an infusion set from there than from the abdomen or back.
Examine Your Technique
Sometimes, seemingly inexplicably, an infusion set or CGM sensor may become dislodged despite your best efforts to tape it in place. The issue may not be adhesives at all, but your insertion technique. "If your infusion set is not inserted properly—for instance, if it's inserted at the wrong angle—it could slip out," Wall says. A person using a site at the back of the hip, for instance, might not be able to reach around well enough to insert the needle properly or to keep an insertion device flat and steady.
Whatever the reason for your set's slippage, keep in mind that your first attempt may not fix the problem. "You may need to try a few things," says Wall, "and see what works for you."