Insulin Pump for the Elderly?

Although we are living in a high tech world, when it comes to the elderly, we often think to simplify regimens and use low tech products. This is especially true when an elderly person has a cognitive impairment. However, there are times in which high tech devices, such as insulin pumps, are particularly useful in an older population. With the assistance of another person (family, friends, home health nurse, etc.), I have seen dozens of cognitively impaired older adults (both type 1 and type 2) benefit from the use of insulin pump therapy. In a few cases, I have seen mildly impaired older adults learn to manage their pump independently (with exception of adjusting settings in which family members assist), after multiple in-home trainings.

As someone who has ordered a fair number of insulin pumps for older adults in the state of Utah, here are a few recommendations.

1. Do a pump trial using saline. Make sure the older adult won’t become confused by the pump and pull the pump site out. I have found that waist bands are sometimes helpful in keeping the pump discreet.

2. Plan for multiple pump trainings. If you are relying on others to assist with button pushing to navigate the pump, you will need to train back-up individuals that can manage the pump if the primary caregiver(s) are away.

3. Plan a dosing schedule. Assure that it is realistic for the family member, friend, or home health nurse to assist with bolusing and pump site changes.

Is it worth all the work? Yes! When blood sugars become more stable, older adults often feel much better. Clinically, I have witnessed some cognitive improvement in older adults who started insulin pump therapy. I believe this is directly related to fewer episodes of hypoglycemia and overall excursions. Insulin pumps for the cognitively impaired elderly is possible, but it does take work!

(photo above retrieved from http://bloximages.chicago2.vip.townnews.com/santamariatimes.com/content/tncms/assets/editorial/2/f2/467/2f24670a-2f66-11e0-a50b-001cc4c03286-revisions/4d4a576b2a849.image.jpg)

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4 thoughts on “Insulin Pump for the Elderly?

  1. My 72-year-old mother has been type I diabetic for 48 years. She has escaped any major complications, although she has had some severe hypoglycemic episodes that required intervention by paramedics. She lives alone, which is why we wanted to get her the pump. We’re hoping that once she begins using the ‘sensor’ feature, she is not likely to experience the dangerous hypoglycemic episodes she’s suffered in the past. She no longer has a husband at home who can seek emergency treatment, which is what happened before. She lives entirely on her own.

    I attended the insulin pump training with her for the past few days and realize that it’s a bit of a struggle for her to understand the ‘gadgetry.’ She took the pump home last night and did the blood test, entered the carbs, etc. but she neglected to ‘accept’ the recommended bolus and didn’t realize that the device did not administer it. Neither did she recognize, understand or respond to the bolus reminder alarm. Had she really been on the pump and not just ‘practising,’ she would not have had any bolus prior to bed!

    She is 72, but very active and youthful. She’s also quite intelligent, but woefully inexperienced when it comes to using technology like computers or cellphones. I intend to spend the weekend with her and help her become familiar with the device, but since I am a neophyte myself, I’m a little concerned about whether this is the right option for my mom.

    Can you tell me what are some of pitfalls of being on the device? Forewarned is forearmed, and perhaps if we can anticipate problems before she has to experience them, we can prepare her. For example, until the process becomes more familiar, I’m encouraging her to make it part of her routine to go back and check the event history to make sure she did in fact, receive the bolus.

    What might be some mistakes she could make?

    • Deborah,

      Your active mother sounds lovely! When training an older adult, who isn’t used to technology/gadgets, on an insulin pump it is important to take things one step at a time. She may need supplemental training. You may need to provide her with some of the skills (changing pump sites, adjusting pump settings) until she can master things. The most important step is knowing how to bolus. The fact that she is able to go back to check the event history to assure she has bolused is great! The second thing to master would be to change pump sites. Third would be adjusting pump settings.

      One of the major mistakes would be not accepting a bolus, as you mentioned in your messsage. Another would be not entering in the correct blood sugar or amount of carbohydrates, as this would result in an inappropriate bolus. She will need to know how to trouble shoot a high blood sugar, is it because she forgot to bolus? Under bolused for carbohydrates? Or has a pump site that is occluded and needs to be changed out? She will also need to know how to trouble shoot a low blood sugar. Make sure she has resources, she will need to be able to contact someone quickly during this period of training if she has any questions or needs assistance.

      I wish you and your mom the best of luck. Please keep me posted on her progress!
      Michelle

  2. Having read this I thought it was extremely informative.
    I appreciate you taking the time and effort to put this
    information together. I once again find myself spending
    a lot of time both reading and leaving comments. But
    so what, it was still worth it!

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