Support vital when transitioning to new technology

Transition from insulin injections to pump therapy can involve a few months of ongoing support even with the best preparation, the Australasian Diabetes Congress was told.

Ms Sally Double, a credentialed diabetes educator in private practice and at the Baker Heart and Diabetes Institute, told the Congress that people with diabetes required time to become familiar with their new technology.

“I find what generally works most effectively when transitioning from MDI to pump therapy is daily contact for at least a week, and that can be remote, a face-to-face review within a week, another face-to-face review within four weeks and then ongoing remote support for probably at least 12 weeks.”

“If their list of expectations are married correctly at the beginning, people would transition well within 3-4 months. The people who don’t transition well are the people who haven’t accessed enough support or been given enough support.”

Presenting in the ADEA Case Study session, Ms Double said one of her clients with type 1 diabetes had been using multiple daily injections for nearly 40 years before deciding to change to pump therapy.

“And the main rationale was she was unable to control her glucose levels overnight and was hence at risk of nocturnal hypoglycaemia.”

Ms Double said introducing flash glucose monitoring at the same time worked well to help the client gain more confidence in how she was delivering her insulin.

“We thought she needed more insight into her 24/7 glucose variability to understand what it was like to work with one type of insulin.”

“You have to almost readjust your thinking and understanding related to a system where you are only working with one rapid acting insulin versus MDI where she had two or three insulins to work with.”

“It is a different concept they have to get their head around so it is a process. They need appreciation that it is going to change and preparation to trust that change.”

“Anybody with type 1 diabetes gets clever with how they manage it and when you make a choice to change the way you deliver your insulin, you have to almost relearn how your body responds.”

She said many patients transition to a pump without CGM or flash glucose monitoring but the additional information it provided compared to a point in time reading was invaluable.

“Flash glucose monitoring gives them that information of directional change; of where their levels are going. I think the insight from that is much more valuable than even the number itself to be honest.”

However the amount of data available could in itself be daunting without adequate support.

“And that is why many people need to be able to discuss the data with someone else; to be able to step back and interpret it correctly and constructively make the changes.”

She said her client had transitioned well to pump therapy, was enjoying more flexibility and had a reduction in hypoglycaemic events.

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