One great thing about my job is that I occasionally get to hear some of the best in the biz (and by “biz” I mean diabetes…) talk about some very high level science, advancements, and treatment regimens. I’m always curious to hear what doctors who have been doing this for decades have to say about living well with diabetes. A few weeks ago, a tenured physician in the northwest said that he’s recently had to take several patients OFF their insulin pumps due to a build-up of scar tissue. We are now finally at a time in the world of diabetes where some people have spent double decades in a row on pumps – and others also on a CGM at the same time.
As anyone who wears an infusion set knows, cannulas don’t feel like cute little kittens gently licking your skin when they go in. No, it’s a bit more intrusive than that, as the hole it makes has to be large enough to get insulin’s big-ass molecule into your bloodstream. And most of us have a favorite spot for our pump sites – you know the one that’s a little hard to reach, because it’s out of the way and not somewhere you’ll yank it out? That spot that’s started to look like the skin of an orange left out in the sun, all pock-marked and leathery? Yeah that spot. It’s tired. And the tissue under it is tired too. And if you’ve been rotating through limited sites with your pump and your CGM for a few years, you probably know what I’m talking about.
The doctor giving the talk has now encountered folks whose tissue was beat-up enough from repeated infusion sets that he had to force them to take a break from their pumps and go back to injections for a time – how long of a break he prescribed I am unsure. Perhaps indefinitely. And he said this is a very real problem in his practice, and one that he’s seeing much more often as folks with diabetes are now progressing from diagnosis to tenure on devices without a break.
This was news to me. The concept totally makes sense, but I had not considered this in my long-term thoughts about diabetes. I’m usually concerned with what the best/coolest/most accurate/up-to-date technology is, and of course also thinking about how I can best minimize my glycemic excursions. For me, that answer involves technology, and I’d be heartbroken to give it up right now, and also a lot worse off in the control department. That said, I want to be able to preserve the tissue underneath my devices so that I’m not forced to take a break at a tougher time or worse – damage my tissue in a way that would prevent my use of closed-loop system one day or another solution.
So, questions for the crowd are: 1.) What’s been your experience with this and 2.) do you know of any ways to prevent this – is rotating pump sites enough? Would love to know how others are dealing with this!