Got questions about navigating life with diabetes? You've come to the right place! You know... it's Ask D'Mine, our weekly advice column, hosted by veteran type 1, diabetes author and educator Wil Dubois. This week, Wil's offering some advice about new pumps and their little-read instruction manuals, as well as insights about wrist-style blood pressure cuffs and what they mean for people with diabetes who are prone to circulation concerns.

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Jody, type 1 from California, writes: I was reading the manual for my shiny new t:slim insulin pump and came across the following: "Always dispose of used cartridges and infusion sets following your community's regulations. Insulin can be absorbed through the skin, so wash your hands thoroughly after handling any insulin-holding device." Is this true? The part about the insulin and skin, I mean, not the part about the disposal regs.

Wil@Ask D'Mine answers: Get outta' town! You actually read the manual? Hell, I don't even remember getting a manual with my shiny new t:slim. (Alert for readers living under a rock: All t:slims are new. All t:slims are shiny.)

Oh... wait a sec. Here it is! The manual is on one of those funky hi-tech USB business cards. Appropriate for the hi-tech Applesque pump, I suppose. Let me check. Hold on a sec while I plug in my User Guide... Oh how fun! You can turn the pages just like a real book. But better, because it's searchable, and you are right. On page 15 they warn us to wash our paws if we happen spill insulin on them.

What? You didn't know I had returned to pumping? Oh yes, and look for an in-the-trenches review of the t:slim right here at the 'Mine in the coming weeks. I just want to get a little time under my belt... well, on my belt... before writing about it. But I'll tease you by saying my first impression was that all the things I thought I wouldn't like about it are non-issues, and that it's great for getting attention from the ladies—at least the ones with diabetes. I've never had so many women want to press my buttons before. :-)

Life is good. But we've gotten off track.

Can insulin be absorbed directly through skin? To be honest, I'd never heard that before. Nor could I find any reliable sources that mention this possibility. After all, skin is a really tough barrier. Its job is to keep stuff outside of your body. Wait a sec, you say, what about all those medicine patches? They deliver meds through the skin, right?

True, all kinds of small-molecule meds can be delivered through the skin, what's called transdermally, via patches. The best example is the nicotine patch for those of you having trouble with your New Year's quit-smoking resolution. There are also patches for hypertension, Alzheimer's, ADHD, depression, and motion sickness. Vitamin B-12 can be had in a patch, as can the powerful opioid pain killer Fentanyl.

And there's a testosterone patch, too. I only mention this because, like insulin, testosterone is a hormone. Will we someday see an insulin patch? Maybe. The problem is that insulin is a pretty big-ass molecule. Most transdermal drugs have a molecular weight (a.k.a. "size") of less than 500 Daltons (a unit of atomic weight). Insulin has a whopping weight of 6,000 Daltons.

Getting insulin through the skin is kinda like trying to thread a rope through the eye of a needle.

But there would be a lot of money to be made if you could figure out how to do it, so the Pharma folks are working on it day and night. One of the insulin patches in development is really more of a skin-worn reservoir that requires a "blast" from a sonic applicator to open up skin pores. Sounds like a tool right out the the Brit Sci-Fi program Dr. Who. Another company has developed a different approach that works on pigs to piggy-back (pardon the pun) large molecules through the skin by hiding the insulin inside a specialized form of vitamin E—but this is some serious scientific black magic. It's a far cry from spilling some Novolog on your palm.

Now, if you had a fresh, open wound, and poured insulin into it, that would be a horse of another color. It would be an extremely crude way of taking intravenous insulin. I bet it would sure as hell lower your blood sugar, but I don't think this will become the standard of care anytime soon.

So I have no idea what the Tandem folks were thinking when they put that into their slick, hi-tech manual. Maybe it was written by the same folks who wrote the originalreturn policy. Serves you right for reading the manual in the first place, Jody. Hopefully, the rest of the advice in it is better.

Anyway, it would seem that the worst thing that will happen if you get insulin on your hands is that you'll smell like Band-Aids for the rest of the day. But, of course, you should still wash your hands before checking your blood sugar, for accuracy reasons.

Moving up the body to the wrist, I found this question in my inbox at the clinic from one of the nurses other day:

Kristy, nurse type from New Mexico, writes: I read somewhere that we shouldn't use the wrist-style blood pressure cuffs for diabetes patients because reduced peripheral circulation will throw off the results. Is that true?

Wil@Ask D'Mine answers: For God's sake, we don't all have complications! And even if we did, how much reduction in circulation could there possibly be between the upper arm and the wrist?

I couldn't find the place she read that, and she didn't remember where she'd seen it, either. I scoured the Internet until I ran out of caffeine, and then scoured some more until I drank too much whiskey and fell asleep at my keyboard. I didn't find much.

But here's what I learned: Blood pressure machines in general are suspect when it comes to accuracy, compared to the manual method done well, and wrist machines even more so. Apparently, the real key to an accurate reading on a wrist unit is to get the damn thing right at heart level, something historically difficult to do with wrist models. The newer ones have a sensor that lets you know when you've got it in just the right position, and this is said to do much to up the accuracy of the wrist-style design.

As for the arm type auto-cuff, it's important to use this kind correctly, too, and most people apparently don't, as getting it onto the arm correctly is a challenge. I could see where a so-so wrist unit used correctly could easily trump the accuracy an arm unit used poorly.

Now you might have noticed above that I said "when done well," when I was talking about the Gold Standard of manual blood pressure reading. You know, the kind using a stethoscope, a good old-fashioned dial, and done by a person wearing scrubs. But guess what? Between equipment errors, mistakes made by the person taking the blood pressure, wrong cuff sizes, and white coat syndrome—a great percentage of blood pressure readings in clinical environments are just plain wrong.

In fact, the only place I found anything that even came close to being about us D-folk and wrist blood pressure cuffs was in the manual for one of the more hi-tech wrist monitors, the Omrom Series 7. It states, "If you have a condition that may compromise circulation, you may get an inaccurate reading with this device." Of course, on the same page it says, "If battery fluid should get in your eyes, immediately rinse with plenty of clean water. Contact a physician immediately." Ya think?

At the same time, these kinds of systems are sold by American Diabetes Wholesale, Diabetic Care Services, Typefree Diabetes Superstore, and everyone else who makes money off us. An outfit called Diabetic Supply of Suncoast, Inc., even makes a wrist unit.

So what does all of this mean? Like so many other things in diabetes, it's all quicksand. If you are going to use a wrist model, spend a little extra and get a really good one, read the manual, then use it "right."

In the end, I think that frequency trumps accuracy. You'll learn more at home from frequent readings that are less than perfect, than you will from a perfect reading four times a year at the doctor's office.

“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.”