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A man, lean and muscular, with type 1 for over 25 years, has been pumping for 15 years and wearing a sensor for the past five years. Glucose levels have been very erratic. We checked his sites and were concerned that the erratic glucose levels were mostly related to lack of subcutaneous fat and scar tissue, so he was actually getting insulin into his muscle, scar tissue, or subcutaneous tissue at various times. Also, the patient wears an OmniPod and thought it could only be in one particular direction.
We offered the patient the opportunity to go back to multiple daily injections (MDI) and continue with the sensor and directions of optimal places for sensor placement. The patient looked up and said, “Oh, I didn’t know I could go back to injections. I thought once I used a pump, I would always have to use a pump. My last endocrinologist told me pumps are better and left me with the impression I’d be wearing a pump for life.”
We informed him that that is not true. It’s his choice and it’s fine to go back to MDI if he’d like to. We informed him of the newer insulins, how they could work, and where and how to inject. We also explained that his understanding of the particular position he thought he had to use was incorrect. He could change the direction of the OmniPod if he chooses to stay with it, which could help him find areas.
We also informed the patient that if he wants to give the pump a rest for some time, then go back to it, he could. He was very excited and relieved to hear this news. At this time, he is considering his options and will let us know his decision. Stay tuned.
Lessons Learned:
- When there is great variability, think about the possibility of sites being the problem.
- Always check injection/pump/sensor sites during patient visits. You may be surprised what you see, feel, and hear from patient.
- Teach new treatments and options for patients. Remember shared decision making; it is not just up to the health care provider but most important are the patients’ informed decisions. They are the ones who live with their diabetes every day, not us.
- Clarify misunderstandings without being judgmental. There’s a lot to learn and remember. We don’t know what the patient heard/remembers or what they have actually been taught in the past. Listen to their story.
Joy Pape, FNP-C, CDE
Medical Editor, Diabetes In Control
| Help! Tell Us How To Avoid Disasters Using CGM
Many of you have and have not had experience with the Continuous Glucose Monitors (CGMs) now available. We would like you to share with your colleagues the top 5 tips you think are important for health care professionals and for your patients to know. See below for how to submit your tips. Sometimes the best way to learn is from real life experience from each other. Thank you! Joy Pape, FNP-C, CDE |
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