Pump Talk with Virginia Valentine

Virginia Valentine is a veteran nurse and CDE (certified diabetes educator) who’s established herself as a prime source of information on all things related to insulin pumping.  (I’ve always thought she had one of the most interesting names in the industry, btw; the first time I met her she was deckedValentinelow08 out in all-red.)

She’s served on the board of the American Association of Diabetes Educators (AADE) and chairs the Advanced Practice Specialty Practice Group for AADE. She writes numerous professional and patient articles. And she’s CEO and Co-owner of Diabetes Network, Inc., a private healthcare practice in New Mexico that is recognized by the ADA.

As part of my crusade to learn as much as possible about my new lifestyle — insulin pumping — I asked Virginia to enlighten us here at DiabetesMine.com.  You may recognize some of the same questions recently posed to CDE and author Gary Scheiner (I always value a second opinion.)

Ooh, and did I mention that Virginia is Type 2 since 1980 and was an insulin pumper herself for several years?  She’s now off insulin entirely and has managed to shed 70 lbs in the past four years.  She’s now using 10 mcg Byetta daily, plus glipizide at bedtime, and says her current A1c is 4.9 (wow!).  She also exercises regularly at Curves.

Here’s her perspective on D-industry and the world of pumping in particular:

DM) What do you believe was the most important advancement in diabetes care made in 2006?

VV) Im my view, the most important advancement is the continued development of gut hormones such as Byetta, Symlin, and Januvia. This area will continue to develop over the next few years and I believe has great promise for medications that truly address the defects in diabetes.  Continuous glucose monitoring (CGM) also holds great promise but in current iterations still difficult to use — and with very limited insurance reimbursement at this time.

DM) Do you think CGM will really change diabetes care in the “mainstream,” or will it mostly be applied to only the most motivated or most challenged patients?

VV) I think it can change the care of all patients who are able to use it… for many people, it can be useful as a learning tool for a few weeks now and then to identify the effectiveness of their current regimen.

DM) And how will patients and doctors share and utilize all the CGM data?

VV) I think the patient has to be prepared to utilize the data themselves, or they cannot opitimize the value of continuous monitoring.  Health Care Plans will need to invest in data management tools to help with data analysis.

DM) You specialize in insulin pumping strategies.  Are there some patients who are better off remaining on injections?

For type 2’s using only basal insulin, a pump would be a waste of effort. Some patients who don’t have the sophistication to manage a pump or are unwilling to test BGs regularly are not candidates for pumps.

DM) You do a lot of work advising patients on insulin dosing strategies as well.  What are some of the most common mistakes or pain points?

VV) Not testing is by far and away the biggest mistake anyone can make. I know it is a hassle, but it has been shown clearly that the more you test, the lower your A1c.

DM) What would you say is the single most important thing a Type 1 diabetic can do to achieve optimal glucose control?

VV) Using the best tools available: an insulin pump, and also continuous monitoring if money is no object.

DM) And a Type 2 diabetic?

VV) If they require substantial insulin, then the answer’s the same: using a pump and continuous monitoring if possible.  If substantial insulin is not required, use Byetta… and of course regular exercise for everyone.

DM) What do you think is the most exciting thing happening in insulin pumping right now? Powerful new “smart pump” features? Wireless models like the OmniPod? Or something else?Roche_pump_1

VV) I think combo pump-continuous monitors will be extremely helpful as soon as the CGM systems are improved in terms of accuracy and reliability.

DM) What do you think the world of insulin pumping (subcutaneous insulin delivery) will look like in 5 years?  In 10 years?

VV) I think the features will be very advanced so that they are completely customizable and very smart and will get smaller and easier to wear.  I think we will have higher concentrated forms of insulin so that the pump can be smaller but also so that pumps can be more effective for type 2’s who are very insulin resistant.

Thank you, Virginia, for your very down-to-earth insights.  Now more than ever, you are my Valentine :)


8 Responses

  1. Scott
    Scott March 5, 2007 at 7:15 am | | Reply

    Interesting perspective, although I’m troubled by her view that “the most important advancement in diabetes care made in 2006″ are gut hormone development since most of these drugs are completely irrelevant to those of us with type 1 diabetes (Symlin, incidentally, is an endocrine hormone also made by the beta cells, not a “gut hormone” akin to Byetta or Januvia). :(

  2. AmyT
    AmyT March 5, 2007 at 8:43 am | | Reply

    Ah yes, Scott, but let us not forget that 90+% of the people in this country with diabetes have Type 2. So what is important for them is… well, important.

  3. Megan
    Megan March 5, 2007 at 11:05 am | | Reply

    Is Januvia even a hormone?

  4. Hannah
    Hannah March 5, 2007 at 12:13 pm | | Reply

    Very interesting. Also, I hope the promise of more concentrated insulin becomes a reality for everyone with diabetes, including those of us type 1′s who are insulin resistant!

  5. Bernard Farrell
    Bernard Farrell March 5, 2007 at 5:36 pm | | Reply

    What I think will be critical (and I argue this in my recent journal article) is to provide tools so that both health care providers AND patients can easily interpret their blood glucose readings.

    CGMs are not the answer without the supporting tools. There will provide way too much data for longer term use. Yes, they’ll help folks with highs and lows. But we won’t be able to improve the long term trends without better analysis software.

    And the key to better software is better data standards for all the device creators. Make the data format uniform. Standardize the physical interface (USB please, not some serial cable alternative).

    Ok, I’m stepping off my soapbox now.

  6. Scott
    Scott March 5, 2007 at 6:20 pm | | Reply

    Thanks for your feedback. I don’t deny the size or importance of the type 2 market, but I do think that when we refer to what is important to diabetes, it must be important to all people with this condition. Marginalizing the needs of one group because there are fewer of them does not render their needs any less important!

  7. Sunil S Chiplunkar
    Sunil S Chiplunkar March 5, 2007 at 8:15 pm | | Reply

    This website is truly a gold mine for the d-patients. We get some excellent perspectives and inspiration. (I am a diabetic myself.)

    Generally speaking, it is unfortunate that we see a lack of appreciation for natural herbal support products in diabetes management. We need some threadbare discussions on this aspect as much as the ‘mainstream’ medicines.

    There is for eg. Karela ie bittergourd for prediabetes and Type 2 diabetes management.

    In Yoga for eg. there are some types of pranayama that help reduce blood sugar levels and have a rejuvenative effect.

    I would love to see Amy’s scholarship and focus on these offbeat aspects too.

  8. Jane
    Jane April 4, 2008 at 6:28 am | | Reply

    I had the pleasure of attending a 2 day seminar presented by you over the last 2 days. As a provider I wanted to thank you for your clarity and for sharing some of your profound diabetes management pearls.

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