Who doesn't sometimes need help navigating life with diabetes? That's why we offer Ask D'Mine, our weekly advice column, hosted by veteran type 1, diabetes author and educator Wil Dubois.

This week, Wil addresses a universal question that many insulin-dependent PWDs (people with diabetes) face: How do I seriously wear all these gadgets -- especially when I also need an extra device not related to diabetes? Of course, Wil has some insight here, from his own personal experience... His answer may just strike you as da bomb.

{Got your own questions? Email us at AskDMine@diabetesmine.com}


Liz, type 1 from the UK, writes: I have a Medtronic MiniMed pump, a CGM, and a frozen shoulder. The last one gives me impossible pain and makes it hard to shoot in the sensors for the second one. So I bought a TENS machine, read instructions, and started having misgivings as to whether it's compatible with my gear. You seem to have used them all, but have you used them all at the same time?!

Wil@Ask D'Mine answers: I have indeed used all three at once and there's only one environment in the world where you can't use them together. More on that in a minute, but first let me get the rest of our readers up to speed on what TENS machines are in the first place.

TENS stands for Transcutaneous Electrical Nerve Stimulator. It's a controversial pain therapy system that suffers from some of the most conflicting scientific evidence surrounding any medical therapy on the planet. Some very good studies show that TENS systems are the best thing since Saran Wrap, while other equally good studies show the gear is pathetically ineffective junk. And like all areas in which science and commerce meet, there are also a ton of crappy studies and sham research intended to support one view or the other. But before we try to sort that out, just what is the gear in question?

TENS systems are made up of battery-powered controllers about the size of two iPhones that somehow got super-glued together face-to-face. Hey, it could happen. The boxes have a pair of double wires that lead to sticky pad electrodes that can be placed on your skin. These pads come in a dizzying array of sizes and shapes. When you turn the controlleTENS unitr on, electricity jumps from one pad to another, traveling through your skin—hence the "transcutaneous" in the system's name. The controller lets you change just how much juice is delivered, and just how it's delivered. Some TENS units can send "pulses," while others can create bizarre Morse Code patterns of electricity of varying amplitude, duration, pulse rate, and pulse width that dance across your skin.

These blasts of electricity seem to greatly reduce some kinds of pain for some people, while having no effect whatsoever on other kinds of pain in other people.


Well there are more problems than a bucket full of octopi when it comes to studying pain. First up, choose your pain: muscle, joint, nerve... Next, choose your body part: back, hip, wrist, foot... And then there's the real fly in the ointment: The pain with pain research is that you cannot scientifically quantify it. Pain is inherently subjective, which makes it impossible to study it in a truly scientific fashion. There is no pain meter. Pain can't be weighed, measured, or computed.

Still, many people report TENS are highly effective for them. Assuming that we're not dealing with the infamous placebo effect, how might TENS systems block pain? There are several theories about how they might work. One is connected to the 1960's Gate Theory of pain, which, in a nutshell, suggests that by distracting the nerves close to the site of pain, they don't relay pain signals on to the brain. Another theory is that stimulating nerves with electricity causes endorphins to be released, which would be like having your body produce its own endogenous morphine, but without leaving you stoned or having all those nasty addiction side effects that lead you to burglary and prostitution. Or it may be that the electricity from TENS are more like a blast of static from a radio between stations: There's so much scattered background noise that the brain can't hear the pain over the din. Still others hold it may be the hammer effect: Dropping a hammer on your foot distracts you from the headache. New and different pain can be better than the old bothersome pain.

Wait a minute, you say, did you say pain?! Do these things hurt?

Well, sure. They can. Depending on how high you crank it, the sensation of the electricity coursing through your skin can range from a mild tingling sensation, to what it feels like to get a tattoo, to what I can only presume it feels like to have your skin stripped off with a blow torch. Yes. On "high," TENS units can be quite painful. I'm sure the CIA used TENS units during those dark torture days in recent history. So why would anyone subject themselves to what amounts to junior-grade electrocution?

Because it hurts less than the pain it's treating. Or least it hurts differently. That's what I found. For me, the back pain I was suffering was so bad that I couldn't function. Period. The tattoo-gun like TENS sensation was easier for me to shut out. It was actually bizarrely comforting after a bit, and it kept me going until my back healed.

Did the TENS help that healing process? No. Probably not. There's not really any good evidence that TENS units are therapeutic in the healing sense of the word. But for me anyway, I found it damn good medicine to mask pain until the natural healing process ran its course.

In the medical world, TENS units, once the darlings of pain docs, had fallen out of favor over the last decade; the low point probably being when the Washington State Health Technology Assessment (HTA) program torpedoed the technology in 2009. Today, at this point in time, most insurance plans won't cover TENS systems or their supplies.

But clinical faith in the gear is on the rise again. According to a recent article at Medscape (the doctor side of WebMD), there "is an overall consensus favoring" the use of TENS. The same article quoted studies showing that as many as 80% of people who use the systems report excellent results in the first several months, although this drops significantly over time. Only a quarter of people stick with them beyond three months. This suggests that TENS systems might be better suited to treating acute pain than chronic pain with one very important exception for us PWDs: the American Academy of Neurology gives TENS a thumbs up for treating diabetic neuropathy pain (although they are less enthusiastic on its use long-term for back pain therapy).

So that's the scoop on TENS. Now to your actual question. I first wore a TENS back in 2010 when I jacked up my back, and I wore it 24-7 for months. And I wore it again last year during another health crisis. And throughout both of those misadventures, I wore TENS, pump, and CGM together. They all played nice together in the sandbox that is my wrecked body except for the time I had to get an MRI. Then they all had to go. But none of your other gear would work in there either. Off came the pads and wires. Off came the pump. Out came the expensive (day old) sensor. Damn it.

But other than in MRI machines—and I base this on my own experience—you can wear the trio of devices together with no problems. With the TENS zapping my skin, I had no pump problems, and my CGM was as accurate as always, which is to say good enough to keep me out of the grave, but not good enough to drive an artificial pancreas.Photo Vest

Oh, wait. I just remembered something. There is a second place you can't wear them all together: At Walmart. When my back was out, I stopped wearing my gear on my belt or carrying it in my pants pockets. I adopted a photo vest to keep all the controls of all my gadgets handy. Of course, that left me brisling with wires and tubes for all the world to see. Buying groceries at Walmart one day, a young cashier with a presumed IQ of 82 asked me (wide-eyed and terrified) if I was wearing a bomb.


Yes. I'm the diabetic Uni-bomber here to blow you up. You and your small-town Walmart cash register. With all my explosive gear in plain view... Give me a friggin' break.

Still, short of MRIs and Walmarts, I don't think you'll have any trouble with your new trio, and I hope your new TENS helps that frozen shoulder of yours!


This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.