Swimming with an insulin pump requires careful planning to ensure insulin delivery remains uninterrupted. The main challenge is protecting the infusion site, where the cannula enters the skin, from water exposure. Water can weaken the adhesive and compromise the integrity of the insulin delivery, potentially leading to high blood glucose levels. Therefore, proper preparation, including site protection or temporary disconnection, is crucial for any water activity.
Understanding Pump Water Resistance Ratings
The ability of an insulin pump to withstand water is quantified by its Ingress Protection (IP) rating, where the second digit indicates resistance to liquids. Pumps rated IPX7 can be submerged in up to one meter of water for 30 minutes, while IPX8 signifies protection against continuous submersion, with limits specified by the manufacturer. Many tubed pumps, such as the Tandem t:slim X2, are classified as water-resistant (often IPX7) but should generally be disconnected for prolonged swimming. Tubeless patch pumps, like the Omnipod, often carry an IP28 rating, allowing for submersion for a specific depth and duration, making them better suited for water activities while connected.
The pump’s rating only applies to the device itself, not the infusion set where the tubing connects to the body. The cannula and the adhesive securing the infusion set remain the most vulnerable points for water intrusion and adhesive failure. Water exposure, especially from chlorinated pools or saltwater, can quickly loosen the adhesive patch, potentially leading to a failed site. Therefore, even with a water-resistant pump, the infusion site requires additional protection to maintain its seal and prevent dislodgement.
Waterproofing Materials and Application Techniques
Physically covering the infusion site with specialized materials provides a barrier against water and reinforces the existing adhesive. The process begins with applying a liquid adhesive barrier, such as Skin Tac or Mastisol, directly to the clean skin surrounding the infusion set patch. This creates a tacky surface that improves the grip of subsequent coverings, helping to prevent the site from peeling away during water exposure. Allow this liquid barrier to become completely dry before proceeding for maximum adhesion.
The most effective physical barrier is a medical-grade transparent film dressing, often referred to by brand names like Tegaderm or Opsite Flexifix. These large, thin, waterproof patches should be applied directly over the entire infusion set, including the cannula insertion point and the tubing connection. The film must extend at least one to two inches beyond the edges of the original adhesive to ensure a wide, secure, and wrinkle-free seal on the skin. Carefully smoothing out any air bubbles or wrinkles from the center outwards is crucial, as a small crease can act as a channel for water to seep underneath.
For tubed pumps, apply a second piece of film dressing or durable medical tape to secure the tubing connection point, which is a common area for water entry. This protects the sensitive area where the cannula enters the skin from direct water contact. Applying a secondary, heavy-duty sports tape patch over the film dressing provides extra mechanical protection against dislodgement during vigorous activity. The combined use of a liquid adhesive and a large film dressing is the most reliable method to maintain site integrity while swimming.
Temporary Disconnection Procedures
When a pump lacks sufficient water resistance or the activity involves prolonged water exposure, temporary disconnection from the infusion site is the alternative strategy. This involves safely separating the pump and tubing from the infusion set base, which remains securely attached to the skin. Since basal insulin delivery is suspended during the disconnection, managing blood glucose levels is a primary concern to prevent hyperglycemia.
Before disconnecting, a temporary bolus of insulin may be necessary to cover the basal insulin that will be missed, especially if the activity is less intense. It is recommended to limit the disconnection time to 60 minutes or less, although some individuals may safely extend this if they monitor blood glucose frequently. Upon safely disconnecting the pump and tubing, the pump should be stored in a dry, safe location away from the water.
Upon exiting the water and reconnecting the pump, steps must be taken to restore insulin delivery effectively. The tubing should be checked for air bubbles, and a small prime or bolus may be required to fill any empty space that developed during the disconnection. Monitor blood glucose levels closely in the hours following reconnection, as the increased insulin sensitivity from exercise interacts with the resumption of insulin delivery.
Site Preparation and Post-Swim Care
Effective site protection begins with meticulous site preparation before entering the water. The skin area where the adhesive will be placed must be thoroughly cleaned with an alcohol swab and allowed to dry completely before applying any patches or dressings. The skin should be entirely free of lotions, sunscreens, or natural oils, as these substances severely inhibit adhesion. Ensuring the skin is dry maximizes the stickiness and longevity of the waterproofing materials.
After swimming, check the infusion site for any signs of moisture intrusion. If the outer patch is damp, gently pat the area dry with a clean towel and inspect the edges of the original infusion set adhesive. Prolonged moisture trapped under any patch can soften the skin and lead to irritation or potential infection, so monitor the area for redness or discomfort. Due to the increased insulin sensitivity that follows physical activity, blood glucose levels should also be checked frequently in the hours after swimming to prevent hypoglycemia.