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Once A Pump, Always a Pump? Wrong Again!

Jun 12, 2018
 

This is a follow-up to the patient who was under the impression he would always need an insulin pump as written here — http://www.diabetesincontrol.com/once-a-pump-always-a-pump-wrong/

It was a “rocky” start at first. The patient had some early morning highs and some unexpected lows, but likes being off the pump. He wears his Dexcom, which he plans to continue with. This has been extremely helpful with alarms during the adjustments to his long-acting and rapid-acting insulins. The endocrinologist knew the patient was extremely sensitive to insulin, so his rapid-acting insulin has gone from using 1-unit increments to 0.5-unit increments instead and is doing well. At this time, the patient wants to stay off the pump, continue with MDI and the sensor. We’re still making minor changes, but getting close to goal.

Another patient came in last week to tell me that she wore an insulin pump for almost 20 years. She too thought once a pump, always a pump. Again, WRONG! She worked closely with her endo, and is now on MDI. She looked at me and said, “I feel freer!” Yes, she wears a sensor too. And oh,by the way, the patient’s A1C has been as it was when she was on a pump, in the 6.3-6.5% range.

Lessons Learned:

  • Diabetes management has, can, and will change. With new knowledge about diabetes, newer medications — including insulins — and new technology, what was in the past does not necessarily need to be what is today.
  • Health care providers need to stay abreast of the new treatments and give patients a choice, then work with them knowing it will take time to make the changes and make them safely.

Stay up to date and learn more at diabetesincontrol.com.

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Joy Pape, FNP-C, CDE
Medical Editor
Diabetes In Control

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