Several years ago, I had a 70-year-old patient who was starting on an insulin pump.
She was given individual training with frequent phone follow-up and weekly clinic visits for the first four weeks. She did beautifully and soon had well controlled BG’s. About two months later she called and explained her BG’s were “all over the place.” She came in, pump and meter were downloaded, and the data showed daily hyper and hypoglycemic excursions. She had had no change in health status or medication adjustments. Pump settings were correct. Then I asked her to change her infusion set so we could evaluate her technique.
When she detached her pump and took out the reservoir, it was obvious that she had changed insulins as hers was cloudy. I questioned what she had used. She said she had been using the short-acting analog that was prescribed. However, the previous week she had come across an unopened bottle of a Humulin mix which she did not want to waste so decided to use it in her pump. We reviewed her previous education about the types of insulin and their actions and then she labeled her short acting analogue “For Pump” so that it would not be mixed up with the back-up analog basal which she also had on hand.
It’s important to review procedures and keep educating patients, and especially so for the elderly.
Bonnie A Stone, RD, CDE
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