Hi all, I found this article in my Google News Type 1 Diabetes page.
EMS Treatment of the Type 1 Diabetic Insulin Pump User
While it is not a perfect description of insulin pumps, and it is very MM (Paradigm)-centric, it is good to know that articles like this are out there to help educate our emergency responders.
I would have a few quibbles, yeah, but it was a really interesting read–fascinating to see it all from the EMT’s perspective. I thought the part about EMTs unfamiliar with pumps being afraid to touch anything lest they accidentally deliver a bolus was particularly unexpected:
A common fear among first responders is that a mere touch of any button will activate the pump’s insulin delivery system. However, most pumps have built-in safeguards that prevent an unwanted action from occurring with just one button push. They require you to acknowledge the request and then submit it once more prior to the insulin being injected.
I definitely want any emergency personnel who deal with me (god forbid) to know they can click through to “SUSPEND” rather than using their trauma shears to cut my tubing.
It’s good to see that emergency responders are at least exposed to the basic concept of insulin pump operation. It would be even better if writers of articles like this would reach out to someone who has lived with a pump for a long time so that the communication effort could be strengthened and refined.
The writer confused the concept of sliding scale insulin dosing with the insulin to carbohydrate ratio. It’s a shame that the sliding scale dosing lingo is even remembered, it’s such an archaic and gross method to manage blood glucose.
I would have counseled the writer of this article to emphasize how to disconnect the pump when responding to apparent hypoglycemia. When paramedics found me unconscious they removed my pump reservoir from my pump but did not disconnect the infusion set from the site. When I regained consciousness, the pump reservoir dangled at the end of my infusion set and left me completely vulnerable to an accidental massive overdose.
Why is it that doctors, nurses, and EMTs do not see people with diabetes as a resource?
I just reviewed the article again. The writer is an EMT and a T1D. What can I say?!!
Edit: I didn’t mean to respond to @DrBB but to the original post.
Given that, the amount of MISinformation is even more appalling.
This one in particular stands out - “Just five years ago most pumps could only dispense insulin in 1-unit measurements. Today, most pumps are able to dispense as little as 0.10 units, and they’ve had a dramatic redesign.” I had to double check the date on the article - because this is just proof that the person who wrote it is an idiot.
I’ve had my Animas Ping for 6+ years (and it wasn’t super new technology when I got it), and it can dose a bolus in 0.05u and basal in 0.025u increments. The ancient MM508 was limited to 0.1 increments… but the Paradigm came out in 2002 (13 years ago!!!) and that one definitely had 0.05 basal increments.
It amazes me that medical personnel are so poorly educated in diabetes care. I have dealt with EMT’s twice in my diabetic lifetime but neither time was it diabetes related, thank the gods. But I have been hospitalized many times for and not for diabetes related things and the care is so, so poor.
I have only been using a pump and CGM for a few months now and haven’t had to deal with EMT’s or hospitals since I’ve been using them but I am scared of when I will have to because most likely they will try to force me to remove them during my care and I will threaten to sue if they do. I am in control of my diabetes care, no matter what I’m in the hospital for. Of course there are exceptions…but few.
I used to work for the San Diego Fire Rescue Dept (JEMS is pyblished in San Diego County). I tried to train the EMT/Paramedics with our dept on pumps. I provided printouts of the owners manuauls for the current pumps at the time. I said that using suspend was better than pulling out an infusion set or cutting the tubing. Infusion sets aren’t cheap, most hospitals (if the ptient is transported) don’t have spare sets, and if it happens on a Fri or Sat night during a full moon (yes the rumpur is true) it could be awhile before the patient had their bg control back. Disconnecting at the infusion site is easy and so is suspending. The benefit of suspending is the alerts that most pumps sound so the patient - when aware - can take action,. test their bg, resume insulin and not have to deal with the skyrocketing bg’s.
The paramedic supervisors and RN’s in our dept were all for the training. Unfortunately, the MD who was the medical director said it was to complicated for the EMT’s and Paramedics. I just rolled my eyes and said children and their parents (who aren’t MD’s etc) learn and it is far better for the patient. Good to see better info, even for some of the old jargon.
I wear a medic alert that says: T1 diabetic Insulin Pump CGM See wallet card.
Wallet card includes contact info for my ICE, med list, insulin type and pump type, as well as a small quick reference card with pump instructions for suspending, clearing alerts, what alerts mean, etc. I have given it to docs performing surgery, and dentists during long procedures…
I have only been to the ER/hospital a couple times, not diabetic related as well. I was very appalled at the lack of knowledge by EMTs in the ambulance, nurses and doctors regarding diabetes and my pump. I have to preface this by saying that I was conscious- as in awake so if I wasn’t this strategy wouldn’t necessarily work. I have observed through my own experiences and others’ experiences when at the ER/hospital/in an ambulance, you have to take the upper hand about your own health/healthcare history. You have to be assertive! You have to fake it until you make it real for them so they know who is in charge of your health most of the time- YOU. If you aren’t assertive, they will walk all over you with their medical jargon and try to unintentiallly intimadate you. Its not meant to intentionally intimadate you its that you are in an emergency situation, adrenaline is high and your life could be on the line. These people are responsible for you so they need to do their best to treat you. This is why the whole situation is intimadating naturally. My husband is an EMT and has learned a great many things about treating diabetics just from being, living around me.
The best strategy is to be assertive and show them how you do things because you know more than they do about your diabetes on a regular basis. I’ve had nurses try to tell me what do with my pump and they don’t have a clue. I make sure I know what they are giving me and how much and grill them on how it affect my blood sugar. I have a pump so no one gives me any insulin except me. In the end, medical personnel will respect you for this even if they see you as being difficult. You care just as much about your life and as they do but mistakes (fatal ones) can happen and do- due to misunderstandings, miscommunications, and misinformation on their part.
Our protocol states that we NEVER remove any medical device from a patient. ER staff do that. We merely transport the equipment with the patient. Protocols differ region to region, but I think that’s best practice. Someone should write JEMS.
When I have been transported, it wasn’t EMS I worried about, it was hospital staff. During hospitalization for conditions unrelated to diabetes, my mom snuck in insulin because the hospital was running me at BG=350 for days. They were afraid to let it get lower than that, so I just quit eating and didn’t feel well. One of the Docs said that if they found insulin in the room, I would be restricted from having visitors. They were pissed. Hospital staff often lack the software for downloading data from a pump or from a sensor. They are going to collect their own data, manually.