Type 1 diabetes and skin health

Skin issues can be related to type 1 itself or can be conditions that people with type 1 are more likely to develop. Technology for type 1 management, like continuous glucose monitors and insulin pumps can also cause skin changes.

If you notice changes in your skin, talk to your Type 1 Healthcare Team. They can provide advice and may refer you to a skin specialist (a dermatologist) if needed.

Type 1 technology and skin

Devices like continuous glucose monitors and insulin pumps can help you manage type 1 but can affect your skin where they attach to you.

Make sure your skin is clean and dry before applying any device because this will allow a more secure seal. Avoid using moisturisers on the area where you attach the device.

The adhesives used by these devices can sometimes cause small, inflamed bumps around hairs when removed. This usually resolves on its own. Rotating the placement of devices can help your skin recover.

Rarely, you might be allergic to the device’s adhesive because of the chemicals used in the adhesive or stickers. This can cause a raised discoloured, itchy rash around the device or sticker. If this happens, speak to your Diabetes Healthcare Team for help and information about protective patches, sprays and wipes to use on the skin before applying devices.

Skin conditions that can be caused by type 1

Living with type 1 can cause rashes or skin changes. These conditions are rare and often linked to having high blood glucose levels over a long time. Working with your Diabetes Healthcare Team to manage your blood glucose levels can help reduce these issues.

Here is information about some common skin conditions related to type 1. If you have any of these symptoms or any concerns about your skin, see your GP or Diabetes Healthcare Team.

Psoriasis

People with type 1 are twice as likely to develop psoriasis, which affects 1-2% of the population. It appears as a discoloured, scaly rash, often on the scalp, elbows, knees and genitals. Treatments are available so speak to your GP or Diabetes Healthcare Team.

Vitiligo

This condition causes loss of skin pigment, resulting in pale patches. It is an autoimmune disorder, which is more common in people with type 1.

Infections

Type 1 affects the immune system which makes skin infections more likely. Common infections include:

• Impetigo: A bacterial infection that causes golden crusting or ooze.
• Candida (thrush): A yeast infection that can affect the genitals, mouth, and skin folds such as armpits, groins, stomach folds.

Diabetic dermopathy

This is a skin condition that may affect about one third of people with type 1, often many years (10 – 20) after diagnosis. Diabetic dermopathy appears as flat, discoloured spots on the skin, often on the shins. It can look and feel slightly dimpled. It might occur after a trauma to the area, like an injury or getting too hot or cold and is usually associated with high HbA1c levels.

These spots are harmless and usually go away on their own after a few years. If you can, increasing your time in range and trying to lower your HbA1c levels can help this condition.

Necrobiosis lipoidica

This condition is rare and affects 1 in 300 people with type 1, often in young and middle-aged adults. It appears as shiny, discoloured (red-brown, dark or yellow patches) often on the shins with visible blood vessels on the skin. It is associated with type 1 but people without type 1 can get it too.

The skin on top of Necrobiosis Lipoidica can be very thin and break (known as ulceration) quite easily. If that happens it can take some time to fully heal. There are several treatments available. Early treatment is recommended because it can help prevent scarring, so speak to your GP or Diabetes Healthcare Team as soon as you can.

Diabetic bullae

These are blisters that appear without any obvious cause, usually on the hands and feet. It is rare and more likely to develop in men and people with long-term raised blood glucose levels. They should be left to heal naturally to prevent scarring but speak to your Diabetes Healthcare Team if you have concerns.

Diabetic stiff skin (diabetic cheiroarthropathy)

This a rare condition that causes the skin to become stiff, waxy, and thickened. It develops over many years. It can make it difficult to fully flatten your fingers when making a ‘prayer sign’ with your hands.

If you have diabetic stiff skin, there are exercises that can help with joint mobility. You can discuss this with your Diabetes Healthcare Team who may refer you to a physiotherapist.

Acanthosis nigricans

This is a rare condition that causes dark patches in skin folds like the neck, groin, or armpits. They can have a velvety feel to them. In women it can occur on the nipples or genitals. It is more common in people with type 2 diabetes, but rarely it can affect people with type 1 of any age. It’s more common if you have black or brown skin.

There are treatments to improve the appearance of the area so speak to your GP or Diabetes Healthcare Team.

Reactive perforating collagenosis

This is a relatively rare condition where intensely itchy areas appear on skin. They may develop into raised, crusted areas which heal with an area of scarring. It can be caused by having raised blood glucose levels over a period of time.

Granuloma annulare

This is a rare condition which is more common in people with type 1 and can occur at any age. It causes an itchy, ring-shaped rash. Treatments are available so speak to your GP or Diabetes Healthcare Team if this is affecting you.

This content was developed by Dr David Middleton, Consultant Dermatologist.