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Create Safe Environment for Your Patients to Tell You the Truth

Feb 9, 2016
 

A teenage type 1 on an insulin pump was seen in our office for follow up.  The download on her pump revealed some interesting numbers.  First off, her glucose levels were out of target range and secondly her I:CHO ratio and her insulin sensitivity looked more like the numbers of a type 2 diabetic vs a type 1. Her I:CHO was 1:16 and her insulin sensitivity was 1:30.  In my experience, I’m used to seeing a lower I:CHO and a higher insulin sensitivity in type 1 vs type 2.

Almost certain that the pt was feeding the pump some misinformation and wanting to ensure the pt felt safe to reveal what was really going on, the teen was asked, “Do you often enter incorrect information in the pump to avoid lows?”  Pt responded with, “Yes,  I enter 15-25 less carbs in the pump because I always go low 2-3 hours after a bolus if I don’t.”

 

Settings on the pump were changed to ones very conservative (avoiding lows) and the pt was instructed to feed the pump real numbers.  We would adjust settings as needed.  Once again, the basics on how the pump determines insulin needs was reviewed.

Lessons Learned:

  • Pt’s have to understand that the pump must be fed real numbers in order to achieve optimal care and if for any reason the pt is not comfortable with the settings or feel they have to feed the pump different numbers, we need to teach them to let us know this.
  • Fear of hypoglycemia is real.
  • Match what you see with what experience has taught you.  I can’t remember anyone telling me that type 1’s usually have a lower I:CHO and higher insulin sensitivity but I have found it to be true the majority of the time in working with type 1’s.  Seeing type 2 settings on a pump for a type 1 pt sent up some red flags.
  • Most of the time, patients want to be honest with their care provider and that is why creating a safe environment to share information is so important.

Anonymous

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