#656 Defining Diabetes: Barriers

April 4, 2022Scott Benner

Scott and Jenny Smith define diabetes terms

In this Defining Diabetes episode, Scott and Jenny explain barriers.

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Scott Benner 0:00
Hello friends, and welcome to episode Wow 656 of the Juicebox Podcast. That number took me by surprise

today, today's episode defining diabetes with Jenny Smith is going to be just a little different than usual. First, Jenny and I are going to define a term, we're going to talk about barriers. Jenny and I are going to talk about some situations where you might need barriers between your medical devices and your skin. And then I'm going to read to you a ton of suggestions from the private Facebook group about the barriers and creams and wipes and all the stuff that they find helpful. little bonus content on the end of a defining diabetes episode. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. Don't forget that Jenny Smith does this for a living you can find her an integrated diabetes.com. And if you're a US resident who has type one, or is the caregiver of someone with type one, I would personally appreciate it if you took the survey AT T one D exchange.org. Forward slash juicebox.

This show is sponsored today by the glucagon that my daughter carries G voc hypo Penn Find out more at G voc glucagon.com. Forward slash juicebox. Alright, Jay, so my only my only only experienced with this came when Arden was about eight years old. I haven't thought about this in a while I wrote a blog post about a really long time ago. But she was starting to get irritation under her insulin pump. Okay, and I was at my wit's end, I really didn't understand that I wasn't as entrenched in all this back then as I am now. The Internet wasn't as helpful as it is now. And I I didn't know what was going on, right. So I stand there one day like thinking I swear to you like just standing thinking. And I was, I don't know what happened was rubbing my fingers together while I was thinking. And I was like, wow, my fingers are so dry, like dry and cracked. And like, why are my hands dry and cracked. And I thought about I thought about it, I was like, I am touching alcohol constantly. Right? I'm cleaning Arden sites, I'm cleaning her pod sites, I'm always my hands always behind them. And that sent me to the internet, where I did some Googling and learned that in Europe, I believe this a long time ago. So you know, don't hold me to exactly where but the standard of care is that you don't prep sites with alcohol, right? You prep them with I forget what they do a mild soap and warm water or something like that. And then just dry the site, dry the site. And I switched to that and art and stopped having irritation. And my fingers aren't crusty and hard anymore. So that's how I fix that. Now Arden obviously didn't have a real significant reaction because the alcohol I think was just drying her skin and then making her more susceptible to whatever was in the adhesive, which I imagine the adhesives probably made out of something completely different now than what it was made up back then. But that was the first time I thought about it. And then in the first like 20 episodes of this podcast, a woman came on. I can't even remember the kid's name still Mason. Because this kid had, like he put on any kind of medical graded he's of and his entire body broke out. It was horrifying, right? And but she wanted to use these things. And this woman just man, she just figured it out. Like she built a concoction of barriers and wipes and everything and made it to this kid could wear it. But it's a world I don't know much about so I'm going to ask you like how many people do you think out of 10 or 100 have to put some sort of adhesive barrier on is it many?

Jennifer Smith, CDE 4:25
I think that a an easier estimate is probably out of 10 I'd say that there's probably one person out of 10 Give or take that probably has experienced some type of adhesive irritation at some point. So like you found you removed something that was essentially just it was literally taking all of the natural oils out of the body. That's what alcohol wiper Alcohol does, right? It just it's a degreaser it takes everything off. So does it clean your skin? Sure, but it cleans it almost to the point that then when you're putting something else on top of it, that kind of like locks in that dryness and is sticky, you're irritating skin that's now dry, and you're doing it over and over. It's not just like one time, right. So sometimes it's cleaning up enough of what you're doing that can take care of it. Other people though, definitely have to use a barrier of some type. I mean, I've seen rashes that are very just specific, right around the edge like the the underneath the adhesive doesn't seem so bad. But it's like right around the edge of the adhesive. That gets irritated enough that it almost looks like the pump site is still there. Or the CGM site is still there, even though it's not. Some people have it bad enough that it it blisters, like horribly like blisters, like almost like you'd see in Oh, what is it leaves of three, let it be, you know,

Scott Benner 6:13
poison ivy or poison ivy,

Jennifer Smith, CDE 6:14
poison ivy, I couldn't like I knew the little rhyme but I couldn't think of the plant like poison ivy, poison oak, which I actually had, I had one of them, they didn't know which one it was, but I had one of them in the blisters. And it's so itchy like unbelievably right. So some people get that degree, and it takes forever to heal. And when you have I mean any kind of body, but little tiny bodies have such little real estate to begin with. That if you've got this big inflamed site on one area that takes an entire month or six weeks to heal up. That's now you're sticking it someplace consistent enough that you can start to cause problems in another place just because you're not rotating well. Right, right. So I mean the kinds of barriers there are some, like hypoallergenic types of barriers like tegaderm, there's another one called IV 3000. It's like a really, really clear thin that you kind of cut a little hole in where the infusion set or the sensor is going to go into the skin. Clean the skin, put that on top of it, put the pump site or the in the in the sensor on top of that. So really, it's adhesive is sitting on top of this barrier not on your skin. That works for some people. Other people as a barrier can get away with just using like a topical kind of like a spray Benadryl let it dry, put the side on top of it or a spray floaties can spray it right over their skin same thing and that can be enough. So I've seen I've seen everything that we

Scott Benner 7:54
have to be a little bit so I went to this so after this this lady came on and and she actually the kid's name was Henry. That makes me feel bad. Why did I say Mason? I don't know. Damn, I was so confident when I said Mason. But the woman's name was Rachel and after she was on the podcast I actually asked her to write a blog post which I still have on the on the face of my of my my website because people use it so much. But here here's this is from 2015 But she washed the area with warm water and antibacterial soap Do not use alcohol. Completely dry the area. She applies one puff of Flonase she says you can sweet talk or demand this prescription from your endo if it's necessary. Then she applied a thin layer of have Alon barrier cream that she got from Amazon it's made by three MC a V i l o n again this is like eight years ago. Then she says she applied a layer of tegaderm HP 9534 HP not just tegaderm and I'm like boy this lady dug deep you know

Jennifer Smith, CDE 9:00
and the ticketor comes in multiple sizes too. So if you're looking for it know the size of your site that you want to cover because it comes small to big she listed

Scott Benner 9:09
six by seven centimeters. Place the inset through the tegaderm HP. Then she said they placed another layer of tegaderm on top of the pump to provide an extra layer or barrier for the adhesive of the detached inset. Not sure what she means there when wet blow dry sight with a hairdryer on a cool setting. Apply prescription hydrocortisone after removing the tegaderm hp on at on an old site and she only removes extra adhesive with something called Callan doula oil. Yeah, so she this is I mean, if anybody wants to see it's this this little kid. His face is red. He's got splotches all over him nowhere near where his medical adhesive is either. He was just allergic to this.

Jennifer Smith, CDE 9:56
I had a gentleman who emailed me an adult diagnosed as an adult, who all of a sudden for some reason, started having irritation around his sensors, like had been using them forever. And on a business trip was itchy itchy around the site and he removed it. And it was like that blistered that blistered level of skin. And then he was like, Well, maybe it's just the site, you know, maybe it got like, maybe I didn't clean it well enough. So he put a new one on, and by the next morning, he had irritation, same thing around the skin. And the funny thing is, it went on and into that week, places up the same side of his body where he had no sights at all sounds like the same little boy. He had, like, Welty blistery places on his body that had not even been touched by a site yet something

Scott Benner 10:51
else. It's terrible. If anybody's interested, I can't believe I'm saying this, as we're in the six hundreds now, but it's episode 14 of the podcast. Wow, that was a long time ago, Scott 2015. And

Jennifer Smith, CDE 11:05
she's got a lot of really awesome. I mean, all it sounds like she's gone through like, all of the products, the only thing that that we would usually caution is what we call green housing, a pump site, or even to CGM

Scott Benner 11:21
because of humidity. Right? Right. You

Jennifer Smith, CDE 11:23
would, in fact, if I'm glad it worked for her again and have one great, we don't recommend it, though, because the humidity or any moisture underneath that could actually create more irritation underneath yet. But again, her story, it works for her and her son, so that's great. Yeah,

Scott Benner 11:42
I mean, it's a it's a real indication, at least to me that if you I mean, try hard enough, get the right information, get a little lucky, you might be okay with it. But I see people who just persevere and there's no need for that, like, there's some of these barriers are just too available and work too. Yeah, you know,

Jennifer Smith, CDE 12:00
well, and the one thing I was gonna bring up to about this is that in terms of when you might see a seasonal need to use barriers versus other times of the year that it's not necessary at all. So you know, if that's something that you're noticing, don't think that you're crazy, you know, once you get into like, fall and winter, your issues go away, or once you get out of the dry season and you get more into summer, it goes away. It could certainly just be seasonal, based on kind of the humidity and nature of the air.

Scott Benner 12:31
Yeah, well, okay. Well, I'm, I'm glad we talked about this, I'm going to put you know what I'm gonna do with this one, I'm going to, I'm going to do some work, Jenny, I am going to go back to the Facebook group. And I'm going to ask people for what they're using modern day here. And I'm going to put the list at the end of the podcast. Awesome. All right. I mean, I'm busy, but I'll do it. Thank you very, very, so helpful for everybody. Well, I'm looking for a pat on the back here because this is extra effort. But I think it's not just kidding. I know I think I think it'd be interesting because because this article that she wrote is so old to hear if people are found updated stuff and maybe get a good list. So I think it's a great idea. All right, awesome. Thank you. Yeah.

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Don't forget there are a ton more defining diabetes episodes right there in your podcast player. And at juicebox podcast.com. You can also find the diabetes Pro Tip series and many of the other series. All right, wherever you listen, you might want to check out the private Facebook group for the Juicebox Podcast. It's called Juicebox Podcast type one diabetes. And please consider taking the T one D exchange survey AT T one D exchange.org. Forward slash juicebox right back to the episode now. Maybe I'm going to read people's suggestions in different voices. Each suggestion gets a different voice. I'm a man of 1000 voices are you ready

so I put a post on the private Facebook group after Jenny and I recorded this. The post was simple it said barrier wipes creams and patches. If you have a recommendation, please leave it here. Your product or methods may be used in an upcoming episode. Now I'm going to get through this as well as I can, there were 187 responses, I'm quite certain I won't be reading all of them to you. Alright, I'm sorry, there's not going to be any attribution to the people who left these because it'll make it'll just make me crazy to try to add the names. So you're ready. Smith and Nephew skin prep, which is a protective barrier wipe available on Amazon. In the past, we've used that company's version of adhesive to put overtop of Ardens CGM. Currently we're just using the overlay that Dexcom provides. Somebody here says they use expression med patches. This person says what works best for them before a pod they put on kavalan spray as a barrier. And for removing the pod Lift Spray and then lift wipes. They say they work amazingly well. They use dream cream from Lush on the site where the pod was afterwards and then somebody came in and said I love dream cream. I don't know what dream cream is. But two people here think is pretty cool. Someone here says they're using baby oil to help the devices come off to loosen up the adhesive and they're using a adhesive called HyperFlex which they say is available on Amazon. This person says they use two layers of Flo neighs base and then skin tack that works well for them. Here is a person that says wipe site with alcohol wipe. Spray Flo neighs. Dab one skin tag placed x comma on the pod. Then they put on Alexa cam patch for Dexcom or a pod pal for Omni pod. When they have a skin reaction, they use hydrocortisone to clear it up. Brandy Johnson here to make a good point. I'm going to read it for you. She said the one thing I'm seeing here is that there are two different issues some people in the thread have a typical mild allergic reaction and they can get away with less prep, but others have major reactions that are almost like chemical burns. She said hers was the ladder and the only thing that worked for her was to completely cover the device adhesive. Bandaid brand extra large size, Hydra colorectal bandage on the skin and then the device on top of that this next person says that when you're dealing with type one and eczema, a cloth feel adhesive patch works better than a latex feel adhesive patch. There go to is something called simp patch or sim patch Excuse me. And they also use the Smith and Nephew remover wipes which is a good company and I've used some of their products in the past as well. Becky says that she cleans sites after the device comes off with something called my cellular my seller water M IC e ll AR to remove the residue. This person is suggesting something called LaRoche Posey Lipikar balm. Wow for the rashes says that their child gets horrendous dry cracked skin in the winter. LaRoche Posey Lipikar balm AP plus intense repair body lotion sounds like I'm doing an ad for it. I don't even know if it works. Here's a vote for skin tack for a barrier and then they use a stay put adhesive for Dexcom they've bought peels for fun but they don't last as long they say not as long as the stay put brand

here's another person says floaties is a barrier for preventing a rash but you really have to let it dry out where the adhesive won't work well. They also like skin tack wipes and tech away wipes as a person here talking about how hype effects comes in a two inch roll. That looks like another Amazon thing. Here's someone talking about a wipe they use to prep the skin. They say it's like alcohol more portable than soap and water dries quicker they don't need Flonase brava skin barrier spray is what they're talking about brava skin barrier spray they're also talking about something called BZ K antiseptic, antiseptic tablets but you guys use a whole bunch of stuff. I have to be honest I just wipe it off with some warm water boom we slap that thing right on there I'm starting to feel lucky that we can do that. Um Let's see what we got here. Smith and Nephew tincture of benzos pump spread A liquid bandaid spray and it worked really well they said and they've added the Smith and Nephew but haven't tried it yet. Some people said they use googan for removal. I didn't know that was for people. Is it here's one for next care mmm 11803 spray liquid bandage. This person says they remove the adhesive afterwards with an alcohol wipe hmm I personally don't like using alcohol but to each his own. This next person says kavalan spray is the best. There are T one is elite allergic excuse me to all adhesives. Even breaks out from skin tack Flonase helps them but they prefer the calculon spray. This person says for for a barrier they use try my Jesus Lord Tria, MCI n o l o n e spray. Creams these baby oil Aqua four and Vanicream patches they love expression med patches and for removing adhesive they like baby oil. Sometimes yunusov But they don't like the chemical smell. I'll tell you what that yunusov works really well but it does stink. Stinky stinky stinky. Like after you use it you almost have to wash and wash the area so you don't smell it. But it is what we use here yunusov When we use it I don't really don't really use that often. Someone here is talking about a liquid adhesive called Marisol three M kavalan wipes for tea slim antibiotic cream for after the change. This person says they've tried several different brands of over patches. By far the most sticky and long lasting has been Lex cam adhesive waterproof looks like they make a Dexcom G six adhesive this Lex cam company another Amazon item wow there's so much here you guys are pretty cool to answer these questions like this person says they're allergic to expression med patches. And they go through a whole thing here skin tack is a possibility currently they're doing a clean slate with hypoallergenic soap dry Flonase times to dry Smith and Nephew dry hype effects sugar under patch then the Dexcom and hype effects on top and acute sugar patch for design so Alright, well that's nice. Wow, this she put a picture of her kid's arm here. It's really terrible. It he said he's uh, allergies are just nasty sometimes for people. Okay, Cavalia and cream tegaderm. Alright, I'm getting pretty far down the list here starting to see a lot of duplicates. Although here's a new one. All care protective barrier wipes. That's a ll kare. That one's from Isabel Isabel. Look at you helping out. What's next? This person says the sugar patch best patches the sugar patch.

Let's see. Let's do another sugar patch skin prep. Alright, we're getting down to it here. I think it's a great thread by the way. I'm going to leave it up for a little while in the private group. If you go to the top and go to featured I'm going to leave this thread in there so you can really go pick through it. Yeah, I think I'm down to I think I'm down to some repetition here. I'm just I'm scrolling real quick to be sure. Oh Goo Gone does make a bandage remover so they make one for your skin as well. Here's a vote for not just a patch calm tegaderm Fixi see adhesive patches for G sixes fixie see if i x i see on Amazon expression met against they put medical again. Sensi care barrier wipes and Cincy care adhesive remover spray have been awesome, says Julie. Sugar patch they put medical Flonase What's this one? This one's different. colo past barrier wipes to protect the skin COLOPL A S T. This one first person says I have to be honest what we use. It's hard to beat the free Dexcom over patches. They'll send you 10 of them every month if he asked for them. I agree we use them. They're terrific. Arden of course isn't allergic to anything so we don't have to worry about a lot of this but they are great if you don't have any allergies to adhesive. Here's one from Josh he says freedom band for Dexcom G six Benadryl, Some people use Benadryl spray underneath a barrier to prevent adhesive reactions. This person says not to use alcohol I have to agree. Alright guys, I think that's it. We've, we've, as they say, done it. I'm still scrolling. By the way, there's so many lovely people. Here's one safe and simple skin barrier on Amazon. I haven't seen that one yet. So another vote for fix IQ. Let's see. And we've done all right. Wow, I'm looking at some people's pictures of the reactions to adhesives and they're just terrible. Okay, guys, that's it. 187 replies, I've done a good job of picking through them and getting you everyone that was in there. None of these people are sponsors. I did not take any money to say anybody's the product I just thought this would be something for you. That might be helpful just to hear what everybody else is doing. Again, if you go to Juicebox Podcast, type one diabetes on facebook and join the private Facebook group. Right there in the featured tab at the top. You'll find this post which I will leave up there for absolutely as long as it is popular and people are commenting on it. Last thing I want to say is that for a great many of you, if not for most of you, and he's problems like this will never be an issue. But for the people for whom it is an issue. It is a serious one. And I hope something here today helped you.

A huge thank you to one of today's sponsors, G voc glucagon find out more about Chivo Kibo pen at G Vogue glucagon.com Ford slash juicebox you spell that? G v o OKEGL. You see ag o n.com forward slash juicebox. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. If you're enjoying the show, please share it with someone who you think might also enjoy it.