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World Diabetes Day (WDD) was created in 1991 by the International Diabetes Federation (IDF) and the World Health Organization in response to growing concerns about the escalating health threat posed by diabetes. It is marked every year on November 14, the birthday of Sir Frederick Banting, who co-discovered insulin along with Charles Best in 1921.
The theme for World Diabetes Day 2020 is The Nurse and Diabetes, and it aims to raise awareness around the crucial role that nurses play in supporting people living with diabetes. As the number of people with diabetes continues to rise across the world, the role of nurses and other health professional support staff becomes increasingly important in managing the impact of the condition.
In recognition of WDD 2020 – and its specific focus on the role nurses play – Glytec’s Director of Clinical Practice, Betsy Kubacka, MSN, AGPCNP-BC, RDN, CDCES, is conducting a three-part interview series with nursing professionals that have clinical expertise in treating patients with diabetes and glycemic management issues. Click here for part one of our series, “Diabetes and the Nurse” with Debra Dudley. For part two, “Glycemic Management in the ICU” with Barbara McLean, click here.
The final installment of our series is a conversation with our very own Lori Weiss, BSN, RN, CPN, CDCES. After spending more than 27 years on the frontlines as a nurse at health systems in Wisconsin and Dallas, Lori is now applying her field expertise as the Clinical Project Lead with Glytec. Lori understands the complex processes, risks and challenges providers face titrating insulin for all patients – pediatric and adult – across the continuum of care.
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Betsy Kubacka: Over the course of your career, from your work in the hospital setting to your current role with Glytec, how has the role of the nurse evolved in treating people with diabetes? What are some of your observations now that you serve as a Clinical Project Lead?
Lori Weiss: Caring for patients with diabetes has been woven into my nursing career from the beginning. After starting in a large unit that housed a diabetes treatment center, I transitioned to a large children’s hospital in the unit where all diabetes patients were admitted. I began as a bedside nurse, counseling many patients and their families in diabetes education, before becoming the hospital’s outpatient Clinical Diabetes Care and Education Specialist (CDCES) in 1999.
At that time, our choices for medications and therapies were extremely limited. Insulin lispro was available for bolus and correction doses but we were still using NPH and Lente as basal insulins. The approval of insulin glargine in early 2000 was a significant improvement in the process because it dramatically enhanced our ability to effectively manage a patient’s blood glucose values while also preventing hypoglycemia. As this new form of insulin was being introduced, Medtronic received the first FDA approval for a continuous glucose monitoring (CGM) system. This provided us with another tool to gather information about a patient’s blood glucose patterns, but the system was brand new and not widely used. Similarly, insulin pumps were available but not widely used in the pediatric population. Despite these advancements, our health system and our patients relied on intermittent blood glucose checks to guide insulin dose adjustments.
After transitioning to other nursing roles, I returned as a CDCES at another large pediatric hospital in 2014. While many of the foundational concepts and approaches to diabetes education and support remained the same, the tools and resources at our disposal changed tremendously. Personal and professional CGMs were available for patients, insulin pumps were widely used and came in a variety of options to suit patient needs, and there was an explosion of blood glucose meter options that included apps and other types of digital solutions. As a CDCES, you needed to understand the intricacies of all these new tools and learn as much as you could about them in a dynamic manner. This was necessary in order to educate patients and providers on the most effective solutions available. Patients also had more access to this information through television, the internet, and social media, and there were times I learned of a new app from my patients.
Although the outpatient setting has been most affected by all these technological advancements, the inpatient setting has the opportunity to leverage technology as well. If it is challenging for a CDCES to stay up to date with all the changes in diabetes care, then it is nearly impossible to keep track as a busy bedside nurse. Bedside nurses need a way to effectively and easily care for their patients with diabetes in the safest manner possible. This is where the eGMS insulin dosing software system can help, and why I was drawn to working as a Clinical Project Lead at Glytec. In my role at Glytec, I help guide clients in making all the necessary clinical decisions to integrate Glucommander in their hospital(s).
At times, it amazes me how little nurses understand about diabetes, diabetes medications and the available tools to care for people with diabetes. But, when I pause to consider how much information I have learned over the years, it makes sense. The bedside nurse lacks this specialized clinical knowledge because they are required to have a general understanding of a wide range of topics, where I have been focused solely on diabetes.
BK: How valuable has your previous experience in the role of the Clinical Diabetes Educator been in guiding nurses through this evolution as a Clinical Project Lead?
LW: Nurses want to do what is best for their patients and they are often at a disadvantage because of hospitals still using the outdated and inefficient method of sliding scale insulin dosing. It is invaluable to leverage my expertise as a CDCES to help guide these practice changes because bedside nurses need a way to easily, effectively and safely care for their patients with diabetes. Glucommander utilizes basal/Bolus + correction dosing that is individualized for specific patient needs – which can be a large shift in practice for health systems still using one-size-fits-all protocols.
This practice change encompasses many areas of the hospital and ultimately impacts providers, pharmacists, bedside nurses, nutritionists and patient care techs. I assist clients by providing suggestions based on my experience as a bedside nurse, a CDCES and a Clinical Project Lead.
BK: What are some of the most significant challenges you see nurses facing in your role as a Clinical Project Lead? What are the greatest concerns you are hearing from the health facilities you partner with?
LW: Time! Time remains the most significant challenge because nurses are busy, they have more patients to attend to and those patients have a higher level of acuity. They need ways to do their job efficiently and in the safest way possible. Patient safety is the primary focus, and nurses are in desperate need of processes that improve their workflows and simplify the ability to do the right thing.
The health facilities we partner with continue to express their desire to increase patient safety while also reducing the burden on their nurses. Leadership teams want to lower the number of hypoglycemic events and the adverse outcomes associated with them, and they also want to decrease any risk of transcription errors. Once they begin using Glucommander, they see an immediate increase in nursing workflow efficiency and patient safety, a reduction of incidences of hypoglycemia, and far fewer errors because the algorithm will automatically calculate insulin adjustments in real time.
BK: How has technology helped in overcoming these challenges? How has Glytec taken customer feedback into account when providing them with clinical solutions?
LW: Since Glucommander calculates the insulin dose based on how the patient has responded to the insulin, this eliminates any calculations by the nurse. It saves precious nursing time while simultaneously increasing safety because the nurse is not required to do any math. It interfaces with the EMR to pull in the patient demographic information, labs, and charting elements to further reduce nurse burden and increase patient safety. Glucommander redirects insulin dosing in a responsive manner, and as a result, our studies have shown its use can lower hypoglycemic events by as much as 97%.
We take our client’s suggestions for improvement seriously, and we work to integrate their feedback into product updates. In the past, clients have asked for the provider’s Glucommander orders to be integrated so the nurse does not need to transcribe these. Clients have also requested Medication Administration Record (MAR) integration so the nurse no longer needs to chart their dose of insulin on the MAR in addition to Glucommander. This input from our clients has become our top priority and these new features will be released in the coming months.
BK: How would you describe your feelings towards World Diabetes Day 2020 focusing on the role of nurses in the prevention and management of diabetes?
LW: I feel incredibly proud to be part of the nursing profession as a Certified Diabetes Care and Education Specialist. The CDCES works with patients to help them live a healthy and high-quality life while preventing illness and managing their diabetes on a daily basis. They help patients navigate all the advancements, information and challenges of living with diabetes, and I would not change a thing about the career I choose.
