A child's treatment can falter when the device stops working properly
Over half of insulin pump users and nearly a third of glucose sensor users developed skin issues including eczema, scars, and lipodystrophy in a 1,719-child study. These technologies remain gold-standard care for type 1 diabetes, improving glucose control and quality of life, but access remains unequal in Brazil's public health system.
- 52% of insulin pump users and 30% of glucose sensor users developed skin problems in a 1,719-child study across 22 centers
- Eczema appeared in 9% of participants; lipodystrophy, scars, and sores also documented
- Type 1 diabetes accounts for 95% of cases in the study; insulin pumps remain largely inaccessible through Brazil's public health system
- Children with dry skin or keratosis pilaris faced 2-5 times higher risk of dermatological complications
A multinational study finds that 52% of children using insulin pumps and 30% using glucose sensors experience skin problems, though benefits for diabetes control generally outweigh risks.
When a child has type 1 diabetes, their body stops making insulin—the hormone that keeps blood sugar in check. That means constant monitoring, daily injections, and a lifetime of careful management. Over the past decade, two technologies have transformed how these children live: glucose sensors that stick to the skin and read blood sugar continuously, and insulin pumps that deliver medication through a small tube placed under the skin. They work. They give kids freedom. They let families sleep at night. But a new study of nearly 1,800 children across 22 medical centers worldwide, including researchers at the State University of Campinas in São Paulo, has found something troubling: these same devices are causing skin problems in more than half the children who use them.
The research, published in Hormone Research in Paediatrics, tracked 1,719 children and adolescents for four weeks. Among those using insulin pumps, 52 percent developed skin complications. Among those using glucose sensors, the number was 30 percent. The problems ranged from simple redness to eczema—an inflammatory condition that appeared in 9 percent of all participants—to scars, open sores, and lipodystrophy, a breakdown of the fatty tissue beneath the skin. About 95 percent of the children studied had type 1 diabetes, the form that dominates in childhood and adolescence, though type 2 is rising among young people due to obesity and sedentary habits.
The irony is sharp. These devices are considered the gold standard of care. They allow for precise blood sugar control, fewer dangerous drops in glucose, and a quality of life that older treatments simply cannot match. Mariana Zorron, a pediatric endocrinologist at Unicamp's Hospital de Clínicas and one of the study's authors, put it plainly: these technologies reduce the risk of long-term complications from diabetes itself. They let children avoid dozens of needle pricks each day. They make treatment something kids will actually stick with. "But the decision to use them must always be individualized," Zorron cautioned, "considering the child's age, their medical profile, access to the technology, and family support."
The skin damage, however, is real. Lindiane Gomes Crisostomo, a pediatric endocrinologist at Hospital Israelita Einstein, explained the mechanics: insulin is a medication with a different pH than skin. When injected repeatedly in the same spots, it triggers inflammation. Add to that the adhesive tape holding the device in place, the repeated insertion of the needle or sensor, and the presence of a foreign object—and you have a recipe for trouble, especially in children whose skin is already dry or prone to keratosis pilaris, a condition that makes skin rougher and more fragile. Those children faced two to five times higher risk of developing dermatological complications.
Most of these skin problems are reversible and do not lead to serious infection. But they matter more than they might seem. When the skin around a pump or sensor becomes inflamed or scarred, the device may not stick properly. If it does not stick, the insulin may not deliver correctly, or the sensor may not read glucose accurately. A child's treatment can falter. Some patients have had to rotate where they place their devices, moving them to different body sites while damaged skin heals. The standard approach involves intensive moisturizing, protective barriers, and careful rotation of insertion sites. Doctors watch for warning signs: persistent redness, intense itching, open wounds, discharge, or hardened skin. If these appear, medical attention is needed.
There is another layer to this story, one that speaks to inequality in Brazil. These technologies are not fully covered by the public health system. Glucose sensors have begun to be incorporated into some specialized public services, but insulin pumps remain largely dependent on court orders or special programs—meaning that access depends on money, legal resources, or luck. A child in a wealthy family can get a pump. A child in a poor family may not, even though both have the same disease and the same need. The study's findings, then, carry a double weight: not only do these devices carry a dermatological cost that must be managed carefully, but access to them remains unequal. For the children who do have them, the skin problems are a trade-off worth making—but it is a trade-off that should not be made lightly, and it should not be made alone.
Citas Notables
These technologies are considered gold-standard care for type 1 diabetes, allowing precise blood sugar control and fewer dangerous glucose drops, but the decision to use them must always be individualized, considering the child's age, medical profile, access, and family support.— Mariana Zorron, pediatric endocrinologist, Unicamp
Skin problems are not caused by the technology itself, but by the adhesive, repeated insertion, and the presence of a foreign object on already fragile skin.— Lindiane Gomes Crisostomo, pediatric endocrinologist, Hospital Israelita Einstein
La Conversación del Hearth Otra perspectiva de la historia
Why does insulin itself cause skin problems? Isn't it supposed to be safe?
It is safe to inject—it keeps children alive. But insulin has a different chemical balance than skin does. When you inject it repeatedly in the same spot, the skin reacts with inflammation. It's not the insulin failing; it's the skin defending itself against something foreign.
So the device itself is the problem, not the medicine?
Both. The adhesive tape, the repeated needle insertions, the constant presence of a foreign object—these all stress the skin. But children with naturally dry or fragile skin are hit hardest. Their skin is already compromised, so the device becomes a much bigger problem.
If skin problems happen in half of pump users, why do doctors still recommend them?
Because the alternative is worse. Without these devices, children face dozens of needle pricks daily, less precise control of their blood sugar, and a much higher risk of serious complications from diabetes itself. A skin rash is reversible. Kidney damage or blindness from poorly controlled diabetes is not.
Can the skin problems stop kids from using the devices?
Not usually. But they can make the device stop working properly. If the skin is too inflamed, the pump won't stick, or the sensor won't read accurately. That's when treatment breaks down—not because the child refuses, but because the device fails them.
What about the children who can't afford these devices at all?
That's the harder question. In Brazil, most families can't buy pumps without going to court. So the skin problems are a problem only for the children wealthy enough to have access. The others face a different problem: no device at all.