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Nikki Blankenship, a licensed practical nurse, and Dr. Tracy Mathena demonstrate various functions on their insulin pumps Thursday afternoon. Photo by Jean Farley

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Doctor, nurse test glucose monitoring system

By NATE HUBBARD/Staff

Dr. Tracy Mathena of Wythe Medical Associates can’t put himself in his patients’ pancreases, but when he had a chance to put himself in their shoes he seized the opportunity.
From April 16-19, Mathena and licensed practical nurse Nikki Blankenship wore Medtronic insulin pumps (filled with saline in their case) and continuous glucose monitoring systems to get a first-hand understanding of a process they recommend for many of their diabetic patients.
“It was a very humbling experience,” Mathena said. “We came in and I think we both looked at each other and said, ‘Diabetes is hard.’”
Mathena, who is certified in both family practice and internal medicine, said he began working with Medtronic representatives a few months ago to learn more about the insulin pumps and blood sugar monitors.
More and more of his patients were showing an interest in replacing their daily insulin shots regimen with a pump, and he said he felt he needed a better grasp of the way the devices worked.
“I didn’t know much about insulin pumps so I was trying to learn,” he said. “Who can get a pump has kind of changed. Five years ago it used to be that the only people who could get pumps were people who had type 1 diabetes…now Medicare and most of the insurance companies recognize that as type 2 diabetes, which is the adult-onset type of diabetes, progresses and gets worse and worse those people usually wind up having to need multiple insulin shots a day, too.”
Blankenship said she and Mathena have dozens of patients who take five to six insulin shots each day and a few who already use an insulin pump.
The insulin pump and CGMS can be worn in tandem or as separate entities.
The CGMS is a quarter-size device that patients wear on their stomachs for 72 hours. The gadget records blood sugar levels every five minutes, giving Mathena a graph showing a detailed look at a patient’s blood sugar fluctuations throughout an entire day instead of just four specific moments as is commonly provided by finger-prick measurements.
When worn together with an insulin pump, a three-hour graph and a patient’s current blood sugar level are displayed on the pump’s small screen.
“You don’t check your sugar a 100 times a day and you can see that this person may be missing fluctuations going all the way up into the 300s, dropping down into the 50s,” Mathena said as he showed the readings on a sample CGMS graph.
“I can look and I can say, ‘Yeah, you’re checking your sugar here and here and here, but you’re missing the fact that you’re not giving yourself enough insulin in the morning, you’re giving yourself too much in the afternoon and you’re missing all these skyrocketings and all these plummetings and everything like that.”
About 10 of Blankenship and Mathena’s patients have worn the blood sugar monitor and Mathena said the results have been extremely valuable in helping patients better manage their blood sugar levels, which ideally should stay in the 70-110 range throughout the day.
“It is a beneficial thing for people who have really fragile diabetes, whose blood sugars go up very quickly and down very quickly, for people who may be passing out and having seizures from low blood sugars who don’t know it,” he said.
Medtronic loaned the office two extra CGMS gadgets for Blankenship and Mathena’s experience, but the office also has one CGMS of its own that it rotates among patients doing the three-day tests.
If patient demand warrants it, Mathena said he’ll look into purchasing more of the monitors in the coming months. He added that he has three or four patients on a waiting list to wear the device.
Although Blankenship and Mathena wore both an insulin pump and a CGMS, their patients who have worn a CGMS have been people who take shots or pills to regulate their blood sugar.
“We’ve had some really eye-opening things,” Mathena said. “It’s just been pretty fantastic.”
Although CGMS devices provide data electronically, patients still have to do four finger-prick readings to calibrate the results.
Mathena said the finger-pricking process especially made him realize why some of his patients may be reluctant to check their blood sugar the recommended four times each day.
“It’s definitely a burden,” Blankenship agreed. “It’s a life-changing – a big alteration that they have to make.”
In addition to giving them more empathy for their patients, personally wearing the insulin pumps allowed Blankenship and Mathena to become more adept at using all the different functions of the device.
“You really get used to pushing the buttons and you know your way around it,” Mathena said. “If you’re going to try to sell your patients on wearing this thing for the rest of their lives, you should try it for a couple of days to see how much work it really is.”
Mathena has a trip to a Medtronic facility in Northbridge, Calif., planned for next month to learn more about the latest technologies in insulin pumps and blood sugar monitoring systems. Blankenship will also make the trip to California later this summer.
While spending a few days living the lifestyle of a diabetic wasn’t an easy task, Blankenship and Mathena said they did receive the tangible benefit of some peace of mind that their own bodies are managing blood sugar properly.
Mathena said Blankenship’s graph showed her glucose levels as “rock-solid stable,” while his also remained consistently in a safe range.
“It was pretty reassuring to see that my pancreas actually works,” he said.
Nate Hubbard can be reached at 228-6611 or .