Table 1.

Device Placement Considerations

General considerations
• Assess skin in candidate area: Avoid broken skin, unhealed irritation, and close proximity to another infusion set/sensor (1–2 inches)
• Previous insertion sites should be given a minimum of 1 week to heal before new tape/adhesive agents are placed over sites
• Rotate through multiple sites for preservation of long-term skin integrity32,38 (ideally 6–10 placement sites)
• Angled CGM sensors and IIS provide more flexibility with placement in leaner areas on the body due to the depth of insertion
• Although lipohypertrophy may worsen with persistent use of CSII, lipohypertrophic tissue will likely not adversely affect pump or sensor performance2,3
• Consider volume of subcutaneous tissue as well as underlying musculature and collagen,33 sleep position (e.g., back vs. side sleeper), sports/sports equipment, activity, and clothing preferences
• Place IIS with tubing oriented strategically (e.g., if placed on arm, position tubing origin toward the axilla so tubing can be threaded under clothes; if placed on buttock, position tubing origin upwards to allow for easy disconnection)
• Some individuals may have a strong preference for discrete placement (e.g., not on arms where it might be more visible to others)16

Location	Advantages	Professional tips
Upper buttocks	—FDA approved area for CGM and IIS insertion —Relatively flat surface for children, not likely to crease Children should be toilet trained before using16 —Good for side sleepers —Good option for lean children	—Avoid waistline/pantline to prevent discomfort, irritation, or unintended removal —Place tape footprint or tubing horizontally to follow contour of gluteal muscles and minimize dislodging with clothing changesa —May cause PISA in lean individuals or back sleepers —Steel cannulas may pop out with gluteus flexiona —Difficult for self-insertion
Abdomen	—FDA approved area for CGM and IIS insertion —Large surface, with possible sites below and above umbilicus	—Avoid placement in areas where skin creases (e.g., hunch over to see where skin folds and avoid these areas) —For lean individuals, placement may be better while sitting/hunchinga —Insert 1–2 inches away from umbilicus —Angled cannula may allow for placement in leaner abdominal tissue —If too lean, cannula/sensor may abut muscle causing discomfort or PISA (CGM) —Sensitive skin more vulnerable to injury by mechanical injury
Upper hip	—Above pantline, less likely to catch on clothes —May be a good choice if other areas too lean (must be able to pinch tissue)	—Possible sites may extend from side of body to middle of backb —Stay away from pantline to prevent discomfort or irritation (placement too low) —Place tape footprint or tubing horizontally, away from the midline, to minimize dislodging with clothing changesa —Can cause discomfort if placed along a clothing or sports equipment line —May dislodge more easily with sports
Upper thigh	—Discrete, concealed under clothes —Relatively flat surface	—High variability with individual tolerance and subcutaneous volume —If too lean, cannula/sensor may hit muscle causing discomfort or PISA (CGM). Less likely to hit muscle if placed on outer or inner thigh compared to frontb —May chafe more on inner thighb —Place pump tubing origin toward torso for ease of tubing placementa
Upper arm	—Good adhesion for longer footprint of sensors —Good for back/front sleepers —Good option for CGM in lean children using buttock exclusively for IIS —Comparable CGM accuracy to buttocks and abdomen36	—Avoid placement too close to axilla which risks skin irritation with taping —For CSII, position tubing origin toward axilla so tubing can be threaded through sleeve of clothinga —Less discrete, visible to others with short sleeves16 —If too lean, cannula/sensor may hit muscle causing discomfort or PISA (CGM)
Forearm	—Easier for self–insertion than upper arm —Occasionally used for sensor insertions, unknown if people use for IISb	—Alternative site to add to rotation if primary sites have damaged skin or other insertionsb —High variability with individual tolerance and subcutaneous volumeb —Not recommended by our center, but is occasionally used for CGMb

Recommendations based on literature (cited), expert opinion, manufacturer's indication, or common clinical practice unless otherwise indicated.

^aUsed within our institution or support in public commentary, online articles, diabetes blogs, and social media.

^bUnclear support, requires additional studies.

CGM, continuous glucose monitor; CSII, continuous subcutaneous insulin infusion; IIS, insulin infusion sets.