Insulin pump therapy provides a continuous supply of rapid-acting insulin through a cannula inserted under the skin and held in place by an adhesive patch. The insertion point, known as the infusion site, remains in the body for two to three days before being changed. A pump site infection occurs when bacteria, most commonly Staphylococcus species, enter this point and cause inflammation and growth within the subcutaneous tissue. While these infections are relatively uncommon, a prompt and informed response is important for anyone managing diabetes.
Recognizing the Signs of Site Infection
Differentiating between simple skin irritation and a true infection is the first step toward effective treatment. Skin irritation, often caused by adhesive allergy or friction, typically presents as mild, localized redness and may feel itchy. This reaction is usually confined to the area under the adhesive patch and rarely involves systemic symptoms.
An infection is characterized by spreading inflammation that extends beyond the immediate insertion point. Look for redness that is expanding in diameter and may be warm or hot when touched. The site will feel tender or painful, particularly when pressure is applied.
Infections can also manifest as localized swelling or the formation of a hard, painful lump beneath the skin, which may signal an abscess. The appearance of pus or cloudy drainage from the insertion hole is a clear indication of a bacterial infection. If you observe any of these symptoms, the infusion set must be removed immediately.
Immediate At-Home Steps for Treatment
The single most important step upon suspecting an infection is the immediate removal of the entire infusion set, including the cannula and adhesive patch. Leaving the cannula in place provides a direct pathway for bacteria to travel deeper into the tissue, potentially worsening the condition. After removal, a new infusion set must be placed in a completely different, healthy location, ideally several inches away from the compromised area.
Once the set is removed, the infected area should be cleaned gently with mild soap and warm water to wash away any residual adhesive or surface bacteria. Avoid harsh scrubbing, which can further irritate the inflamed skin. If the skin is broken but the infection appears localized and mild, apply a thin layer of over-the-counter antibiotic ointment, followed by a sterile bandage.
To monitor the spread of redness, use a pen to draw a circle around the outer edge of the inflamed area, noting the time and date. If the redness expands outside this circle over the next 12 to 24 hours, or if the pain intensifies, it indicates the infection is progressing and requires professional attention. Applying a warm compress several times a day can help promote local blood flow and comfort.
Assessing Severity and Professional Medical Intervention
While mild, localized infections may resolve with immediate site removal and at-home care, a rapid escalation of symptoms requires immediate contact with a healthcare provider or a trip to an urgent care facility. Systemic symptoms signal that the infection is spreading beyond the insertion site and into the bloodstream, a condition known as cellulitis. Severe signs include developing a fever, experiencing chills, body aches, or observing a red streak extending away from the site.
An infection places significant physical stress on the body, triggering the release of counter-regulatory hormones that cause severe insulin resistance. This resistance leads to stubborn, uncorrectable hyperglycemia, where blood glucose levels remain high (often above 250 mg/dL) despite correction boluses and a site change. Uncontrolled high blood sugar, especially when combined with infection, increases the risk of Diabetic Ketoacidosis (DKA), a life-threatening complication that requires emergency care.
Professional medical treatment typically involves a course of oral antibiotics, often targeting common skin bacteria like Staphylococcus. For more severe cases or if systemic symptoms are present, intravenous (IV) antibiotics may be necessary. If an abscess has formed, a doctor may need to perform an incision and drainage (I&D) procedure to release the pus and allow the area to heal. It is important to check for ketones if blood glucose is persistently high and to maintain close communication with the diabetes care team for temporary adjustments to basal and bolus rates until the infection clears.
Strategies for Preventing Future Infections
Preventing pump site infections relies heavily on meticulous hygiene and proper site management. The most effective preventative measures include:
- Diligent site rotation, ensuring no single area is used more than once every few weeks. Repeated use can lead to lipodystrophy, which impairs insulin absorption and increases infection risk.
- Thoroughly cleaning the chosen site before every insertion with an antiseptic solution, such as an alcohol wipe or chlorhexidine. Allow the area to air-dry completely.
- Washing hands with soap and water before handling any infusion set components. Proper skin preparation reduces the bacterial load on the skin’s surface.
- Changing infusion sets every two to three days, as recommended by the manufacturer. Leaving a set in longer increases bacterial exposure time and can lead to skin barrier breakdown.
Regularly inspecting the site for early signs of redness or tenderness upon removal allows for prompt action before a minor irritation progresses to a full infection.