A Highly Prevalent Condition

Like millions of others, my husband is diabetic. He was diagnosed with Type 1 Diabetes Mellitus (DM) more than three decades ago. He was in and out of the doctor’s office and hospital the first few years as he learned to manage his DM. At that time, every dose of insulin was delivered via a needle which provided limited flexibility. If he injected insulin and didn’t eat in a timely manner, his blood sugar level would go low. If he had a bigger meal and didn’t give himself enough pre-meal insulin, it would go high.

More than a decade later, he obtained his first insulin pump. It was a God-send. With the insertion of a small canula (changed every few days), he had more control. Insulin could be delivered at a basal rate similar to the body’s natural production. He could also bolus at mealtimes. If needed, the pump could be paused if his blood sugar started to go too low. Later, he would add a continuous blood glucose monitor (CGM) to his toolkit which identifies if blood sugar levels are creeping up or declining.

A CASE OF LOW BLOOD SUGAR

Working in tandem, the combined pump and CGM technology, has generally eliminated major episodes of hyperglycemia or hypoglycemia. So, when my husband accepted a new role working out of town during the week, I wasn't overly concerned. My concern was heightened a bit a few months ago.

My husband works 4/10’s and would be returning Thursday evening. I hadn't slept well the night before and decided to turn in early. I was deep asleep when the phone rang. “Honey, I’m in trouble.” Before I could even process my husband’s sentence, a paramedic came on the line. My husband had been driving erratically, been pulled over by the police and was being treated for low blood sugar. As context, pre-meal blood sugar levels generally run between ~80-120. My husband was hovering around 25. They asked me to come pick him up as he could not be released to drive. It took about 35 minutes to reach his location. After a quick conversation with the EMTs, we returned home.

I would learn the next day that my husband’s CGM had not been “communicating” with the insulin pump. He had changed insets before his drive. Occasionally, an inset doesn't work due to a one-off poor sensor or human error. In either case, the pump didn't know he was going low and kept delivering insulin, eventually causing disorientation and confusion. As a result, he missed his usual turn-off. It was good fortune. He drove through a town that had police and EMT services (his normal route would have taken him through winding roads and the countryside).

PATIENT EXPERIENCE

Let’s drill into this story from two angles this month. First, let’s look at technology from the lens of our values. Even with a Six Sigma level of quality, there will always be some small percentage of error/failure. Technology Outcomes are critical. While it might not be top of mind for computer-programmers, there is absolutely Human-Centered impact of healthcare technology work. Lives literally can hang in the balance. If tech is rushed to market and there is “bad press” from a lack of testing/QA, it can raise questions of Integrity in the mind of the consumer. In turn, this can impact company market share, or worst case, the complete demise of an organization. To be clear, there were no bad technology actors in this story. My husband's overall experience with the equipment has been wonderful. This was simply a case of two separate pieces of equipment not talking to each other - which occasionally happens. Going forward, he plans to change insets sooner and allow time to ensure the technology is working as expected before he drives home.

The second angle is our Mission of achieving the Quadruple Aim. The EMTs that treated my husband receive high praise for: 1) patient experience, and 2) reducing costs. Dropping my husband at the ER would have meant hours of wait time and additional cost. Quickly diagnosing the issue and providing a couple doses of glucose were an effective stop-gap until my husband could eat a full meal and recheck his CGM and pump. I’m extremely grateful they were able to stay with him and provide effective care until I arrived. ?