May 23, 2025

Leads:

Carol Levy – Mt. Sinai (Adult)

Emily Coppedge – Cornell (Peds)

Dr. Grace Nelson (University of Tennessee) Discussed hybrid closed loop systems and sick day rules for pumps

Discussion on key takeaways, research findings, and implications for clinical practice
Q&A with Dr. Grace Nelson

Background on Sick Day Rule Changes

Grace initiated a discussion several months ago regarding sick day rules and pumps, seeking input from others due to the lack of clear guidance.
Changes were initiated based on instances of DKA related to pump failure.
Data was collected over a year and nine months (2023 and part of 2024) regarding admissions of patients with and without pumps to analyze reasons for DKA in pump users.

New Sick Day Rules

The old sick day rules advised patients to inject insulin or bolus through the pump and wait one to two hours before changing the site if blood sugar didn’t improve.
The team felt this advice was no longer suitable for patients in auto mode.
They developed a nurse triage system to ensure patients changed their site as the first step.
The team created more comprehensive sick day rules, specifically for pump users.
Many patients on Omnipod receive more basal insulin in auto mode than they have programmed in manual mode.
Patients continued with injections while letting the pump run.
They provide patients with a dosing sheet to avoid relying on memory or pump calculations.
Patients are instructed to give themselves injections every two hours.

QI Projects

A QI project is in progress regarding technology access and earlier pump starts.
A second project is ongoing to increase access to insulin pumps to public insured patients.
Initially was, you know, there’s different interventions and we’re able to increase from the 30% to almost 70%, but there’s still a cohort of patients that take much longer to get their hands on the pump than others.
Trying to decrease the amount of time that those patients take to actually start on a pump.

CGM and Infusion Sets

Some Tandem patients reported difficulty obtaining True Steel infusion sets.
Tandem reps said True Steel access is limited to those with skin irritations or cannula issues.
Tandem is educating on using the 31 infusion set and addressing cannula kinking issues related to adhesive removal from the autosoft.
There are concerns about disparity if patients can’t access True Steel.
Patients with kinking issues should contact Tandem Support before switching to True Steel.

Discussions on Current QI Projects and Best Practices

Upcoming Meetings

The next meeting is scheduled for June 27th but will be canceled due to its proximity to ADA.
Rayon Lal will speak on DIY Systems during the next meeting.
Next meeting Friday, July 25 at 2:00 PM EST.