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By Janis Roszler, R.D., C.D.E., L.D./N.
While visiting Washington, D.C., several summers ago, I spotted a young teenager holding a political sign in front of the Capital. I don’t recall the issue that she and her group endorsed, but I do remember her appearance. Like many young ladies her age, she wore a midriff-baring sports top and low, hip-hugging jeans. What caught my eye was the red mark on her abdomen. It was left by an insulin pump infusion set. Insulin pump tubing is attached to a person’s skin by a small, plastic disc that is changed and moved to a different site every three days. Her new set had been repositioned on the other side of her stomach and the previous location had left this spot.
Diabetes can leave its mark on your skin in a variety of ways. It can cause bruising from injections, red marks from infusion sets, itching, thickening, tenderness and other changes. Here is a brief discussion of some of the changes that may occur and how to address them.
Pump bumps. Small, raised spots may appear at a pump infusion site after it is removed. This is what the young girl had on her abdomen. The source of the redness is not known, but according to John Walsh, co-author of “Pumping Insulin,” pump bumps may be a reaction to the coating on the outside of the needle or catheter, or to preservatives and other trace chemicals found in insulin. He suggests that pump wearers cover the infusion site with a special intravenous prep product before inserting the set, use sterile technique when applying the set, change the infusion site every 48-72 hours and consider trying a Teflon catheter. Different adhesive products and IV prep products are available from most pump companies.
Darkened skin on the back of the neck and under the arms. Known as acanthosis nigricans, this velvety-feeling skin change is a sign of insulin resistance seen in children. It usually improves as diabetes becomes better controlled.
Reddish-brown color. Necrobiosis lipoidica diabeticorum is a skin condition that leaves reddish-brown patches on the shins and lower leg area. It is more commonly found in women than men and generally responds to steroid injections. See your physician.
Itching. Several diabetes-related issues may cause itching. Dry skin can develop if high blood sugar levels cause nerve damage. This damage makes it more difficult for the body to sweat, so it becomes dry and irritated. A medication allergy or kidney problem can also cause itching to occur. Improved blood sugar control will help all these situations.
Thickening. Frequent finger sticks can cause calluses to build up on your fingertips. Rotate your testing sites. If possible, use an alternate test site, such as the forearm, to give your fingers a extra few days of rest. Before you begin testing on the palm or forearm, you should read the Owner’s Booklet and talk to your health care professional.
Insulin hypertrophy. Fatty tissue can accumulate around an insulin injection area. Rotating injection sites can prevent this.
Janis Roszler is a registered dietitian, certified diabetes educator, insulin pump trainer, author and radio host. Find out more at www.dearjanis.com.
