New Insulin Pump Training Idea For Adults
INNOVATION IN EDUCATION:
HOW LENNY THE LION IS MAKING NEW FRIENDS... AND THEY AREN’T JUST KIDS
BY REBECCA RAY, MSN, APRN, FNP-CAs a family nurse practitioner (NP) who specializes in endocrinology, my primary focus is adults and adolescents with type 1 and 2 diabetes (T1D and T2D). I believe in continuity of care and have a special interest in diabetes education, so I enjoy providing insulin pump training for my patients. I have experienced a tremendous amount of success with patient outcomes because of this. Often I train patients who have been referred by my collaborating physician or another NP.
PUTTING THE PATIENT AT EASEWhen Shirley came to the office for her initial pump training appointment, she brought her daughters to observe and for moral support. She still seemed to be hesitant about starting IPT. I reassured Shirley and her daughters that we would take things as slowly as she needed—and if we didn't think the pump would work for her, we would try something different. At the same time, I knew that IPT was an excellent therapeutic option for Shirley, and I was motivated to tailor my education and training approach so that we could make it work while alleviating any reservations that she might have. I started by teaching Shirley and her daughters about the pump features and showed her the Bolus Wizard®. By the time she left the training, Shirley was entering her carbohydrate counts and blood glucose (BG) levels into the pump. She remained on multiple daily injection (MDI) therapy for the time-being and only used the pump to record that information.
A LITTLE HELP FROM SOME FRIENDSWhen we met the next week, I uploaded Shirley’s CareLink® data from the pump and found that she did everything almost perfectly. When I saw how well she did entering her BGs and carbs, I became more and more confident she would be successful on IPT. At this training, I also asked our Medtronic clinical educator to meet with Shirley to assess her as a pump candidate. She agreed that the patient was positioned to do well. At the same time, Shirley said that she still did not feel ready to start on the pump. I reassured her, letting her know that was okay and that I would teach her something else that day and have her return for more training. Then it hit me. I knew Shirley needed to be taught how to use her infusion set, so I came up with the novel idea of using Medtronic’s Lenny® the Lion, an education and training tool usually reserved for pediatric patients. Using one of several of the stuffed animal Lennys I had in my office, I taught Shirley how to change an infusion set. We filled the reservoir and walked through several set changes on Lenny. I could see Shirley become more and more at ease as the training progressed.
BONDING WITH LENNY—AND WARMING UP TO IPTI sent Shirley home with a box of Quick-set® infusion sets, reservoirs, and samples of insulin. I instructed her to change Lenny's infusion set on a daily basis, to increase her comfort level with doing her own infusion set changes. During this time, Shirley remained on MDI, but she and Lenny went everywhere together for the next week. Lenny wore the pump, and Shirley continued to use the Bolus Wizard, entering all of her information. One week later, we met and I uploaded Shirley’s CareLink data from the pump. Again, Shirley did everything nearly perfectly. I observed her putting her infusion set in and saw how confident she was. We decided Shirley would remain on MDI for 2 weeks while she practiced wearing the pump and performing all of the appropriate pump behaviors. Since Shirley had developed a bond with Lenny, I decided she should to keep him.
READY TO ROLLWhen Shirley came back 2 weeks later; I uploaded her data from CareLink and felt confident about starting her on IPT. She was ready and confident—and so were her daughters. Shirley was doing well when I did 24-hour and 3-day follow-up calls with her. When I saw her in the office 1 week later, Shirley’s CareLink data looked great, and she was following all of the appropriate pump behaviors. Shirley is now a model IPT patient and is doing very well clinically. In particular, her BG control has improved drastically. Prior to IPT, Shirley was taking varying amounts of short- and long-acting insulin at different times of the day, which led to widely fluctuating BG with multiple episodes of hyper- and hypoglycemia. She now has less variability in her BG and understands how her carbohydrate intake and activity affect her insulin needs. Shirley and I are able to look at CareLink to see exactly what is going on with her clinically in order to make optimal adjustments. I also am able to see that she has been adherent with her therapy, which gives me peace of mind. Shirley’s daughters are happy with her outcomes, because she is able to remain safe at home due to having better diabetes control. We have come a long way—with Lenny’s help, of course. By making Lenny part of Shirley’s training and taking things at her pace, the patient, her family, and I felt comfortable with IPT—and she was positioned for success. This experience changed the way I view patients who may benefit from IPT and reminded me how each training must be individualized. I hope that by sharing my experience, I have given you a new pump training idea to think about. I would love to hear about your innovative strategies, too. *The patient’s name and other identifying details have been changed to protect her privacy.
Settings & features: Changing your Bolus Wizard settings. Medtronic Diabetes. Accessed May 20, 2015.
Lenny® the Lion. Medtronic Diabetes. Accessed May 19, 2015.