Wednesday, September 28, 2011

Fire Arms

As we returned from Boston last Saturday morning on a very early flight, I was still hoping to make it to our local north Dallas JDRF Walk. In anticipation of chatting up folks at the Omnipod table, I placed a brand new pod on the back of my right arm where it would be visible to anyone interested. A conversation starter, I thought.

By the time we arrived in Dallas, were bussed to our car in the remote parking, picked up our other car so we could go separate directions, etc, etc, I had missed the walk entirely. Oh well, second missed year in a row. Last year to rain. This year to travel delays.

But I had a brand new pod on that should take me through to Tuesday morning.

By Monday morning, however, it was clear that my blood sugars were being obstinant. No matter how I bolused, I hovered between 160 and 210 on my Dexcom CGMS. I bolused over 13 units for lunch and decided to wait to eat until I was trending downward. An hour later, I was still in the same place. Weird, I thought.

By Monday afternoon around 2pm as I began my afternoon music lessons, I felt a little pinch in the back of my arm.

By 6:30pm, as my last student headed out the door, I yanked the unbearably painful pod out and felt horribly sick. It hurt to move or touch my arm. The pod blurped out a few drops of insulin. Hmm. It's not supposed to do that when you remove it, I thought to myself. I popped open a new vial of insulin and inserted a new pod elsewhere on my body.

Checked urine for ketones. Got the horrible end-of-the-spectrum dark purple color. Oh no.

And my arm? A picture is worth a thousand words.

It was on fire. Ice packs did nothing (except for quickly warm to room temperature). A hard lump larger than a half dollar rested below the insertion wound. Lying on my arm or even lifting my arm above my head sent a shock of pain through my whole body.

Two days later? No change.

I called my GP's office and went in for an exam this afternoon. I held an ice pack on it with one hand as I handled the steering wheel with the other hand the whole way there. Got to the office and the ice pack was warm. My arm felt hot to the touch still.

He removed a tiny scab I hadn't even seen and inspected the insertion point with tweezers to make sure that there were no cannula remnants, he lanced it to check for fluid, but neither effort resulted in an answer. He prescribed oral antibiotics, encouraged me to keep icing it, and said he'll see my back on Friday to see if I'm responding to the antibiotic.

When I left there, I started making a lot of phone calls to people I trust at the local level who work for Insulet - the company that makes the Omnipod. They were nearly as baffled. Site infections don't normally hurt. And the redness in the picture above, though not streaking, was certainly spreading across the back of my arm - which is also out of the ordinary. The GP measured it at well over 10cm across.

But the two clinical specialists from Insulet were in complete agreement that it was a site infection, possibly staph related (particularly since I had a staph infection with another brand of pump four years ago), and that oral antibiotics were critical. They also pointed out that if you have staph once, you are  at risk as a carrier forever, and that if I am not doing any significant skin preparation pre-insertion, I'm posing extra risks to myself by exposing the insertion site to whatever happens to be on my skin. Point well-taken. Guilty as charged.

I filled my scrip, tied an ice pack onto my arm with a dish towel, and went about the rest of my evening. Hoping to see it start to subside soon.


  1. It looks like an allergic reaction to the adhesive to me. If the antibiotics aren't working, maybe something to consider. Hope it works it for you.

  2. I've worn pumps and cgms for 11 years with no adhesive reaction. It's not possible that it's a topical reaction. This is internal, under the skin and inside my arm. The redness and heat are just byproducts of whatever is going on underneath. If it were topical, a topical ointment would have provided relief. Adhesive reactions don't cause hard lumps and pain beneath the skin.

  3. ugh. i had cellulitis from a cgm site over the summer, but it wasn't nearly as severe as yours. mine hurt like heck, so i can't even imagine how yours feels. ouch! :(