AsktheExpertAsk the Expert: Adena Goldstein, R.N., B.S.N, C.D.E

Living with diabetes can sometimes be overwhelming.  This section focuses on practical information about diabetes. Experts in various fields related to diabetes will give advice about day-to-day living. These topics will change regularly, so check back often to meet our new experts!


Questions & Answers with Clinical Diabetes Nurse, Adena Goldstein

1. What is an insulin pump and how does it work?

An insulin pump is a small device that gives insulin continuously and also on-demand when directed by the pump user. The pump only has fast acting insulin in it and gives a little bit of insulin every few minutes to mimic a body’s normal pancreas functioning. That basal insulin that’s given continuously replaces a person’s long acting insulin that may be been previously part of his or her diabetes regimen. The pump is programmed with a person’s ratios, targets and settings so when the pump wearer enters the total carbs to be eaten and blood sugar it will calculate the insulin to be given (bolus). A traditional pump is connected with a small tube attached to an infusion set that is inserted under the skin that has a small canula that delivers the insulin. There is a tubeless pump option available as an alternative way to give insulin. The insulin and pump site are changed every 3 days.

2. What are some benefits of a pump?
  • It replaces insulin injections given by a syringe or pen
  • It offers more precise dosing options, with as little as 0.001 unit adjustments
  • Since the basal insulin is given every few minutes, the rate can be adjusted by time of day to help minimize out highs and lows
  • If you count carbs and check your blood sugar regularly, the pump can help you with the math to figure out how much insulin to take
  • It is a tool that can help lower your Hemoglobin A1C
  • It can help avoid low blood sugars

If you’d like to learn more about insulin pump therapy, talk to your diabetes care provider at your next visit to see if pump therapy is a good option for you.

3. I see advertisements for different insulin pumps, how do I pick one?

As the technology continues to evolve and new pumps become available, picking an insulin pump can be tricky. I like to compare picking out a pump to buying a new car. You can’t have all the features you want in one car, but you look for what is most important to you. Some things to compare are the following:

  • Tubes versus no tubes
  • Integration with a continuous glucose monitor
  • Automated insulin delivery
  • Remote bolusing options
  • Rechargeable battery vs. disposable batteries
  • Amount of insulin it can hold at one time
  • Mobile app compatibility
4. I don’t like pricking my finger, are there any alternative ways to test my blood sugar?

With advances in technology over the last decade, there are now ways for people with diabetes to monitor their blood sugar without pricking their fingers. A continuous glucose monitor consists of 3 parts: the sensor, the transmitter, and the receiver. The small sensor with a thin filament inserted under the skin is worn 10-14 days with the transmitter attached to the sensor. The transmitter sends the blood sugar data to either a receiver or a smart phone. Some insurances may have requirements as to who is eligible to get a continuous glucose monitor, but sensors are becoming more and more accessible to people with diabetes.

5. What are some advantages of a Continuous glucose meter?

One of the biggest advantages of the CGM is data. I like to tell my patients who are considering a CGM that wearing a CGM is like treating diabetes with your eyes open vs. your eyes closed. A CGM is a great tool to learn about what certain foods and activities do to your blood sugar. You can also clearly see how the timing of when you give your mealtime insulin affects your blood sugars. The trend arrows are also a big advantage help you make more informed decision about food, activity and medication. Finger-sticks capture only a point in time and you only know the direction of the blood sugar in retrospect. With a CGM, nothing is a surprise. The alarms are a great comfort to many patients and their loves one and allow them to get a good nights sleep.

6. What are some of the difference between the Libre and the Dexcom?

The Libre is worn on the back of the arm and changed every 14 days. A person scans the sensor with a reader or a smart phone (depending on the model) and a blood sugar and trend arrow appears on the screen. The sensor should be scanned at least every 8 hours so there are no gaps in the data. The newer Libre 2 has optional alarms, that will alert a person if his or her glucose is out of range and then the person scans to see the glucose. The sensor and transmitter are inserted together and are both disposable. There is a 60 minute warm up period when the system is getting to know you after putting in a new sensor and there are no readings available.

The Dexcom is typically worn on the abdomen or upper buttocks for 10 days. The transmitter is reusable for 90 days and is clicked into each sensor. The blood sugars automatically go to the receiver or phone as long as they are within 20 feet of the reader/phone. There is a 2 hours warm up period at the beginning of each new sensor session.

7. When is an ideal time to start a pump or sensor?

Whether you have had diabetes for 2 week or 40 years, whenever you add a new piece of technology to your diabetes regimen, you need to give yourself time to learn and adapt. If you are looking to transition to a sensor or insulin pump or upgrade to a newer version, start it when you have time to invest into learning the device. If possible I would avoid starting something new when you are starting a new job, moving or going on vacation. Whenever you have a change in your life, you need to be patient as you learn and adapt to your new routine. This is particularly true when it comes to diabetes technology.

8. What is a smart pen?

A smart pen is an insulin delivery device that is paired with a mobile app on your phone. The app has your personal insulin settings that help you calculate your insulin doses. It also calculates how much insulin on board you still have working in your body and will help you avoid giving too much insulin. Since the pen device and app communicate, the app records all insulin injections. The smart pens uses fast acting insulin cartridges and insulin can be dosed in half units.

9. What features are important to consider when looking for a new glucometer?
  • Screen size
  • Small blood sample size
  • Accuracy
  • Insurance coverage
  • App compatibility
  • Memory storage
  • Downloading capabilities
10. What devices are available for visually impaired people to test their blood sugar?

There are some meters available that “speak” the blood sugar after a person test, such as the Prodigy meter. When a CGM is used with the phone, there are also options for the glucose value and trend arrow to be read out loud.

Meet Adena Goldstein, RN, BSN, CDCES, our diabetes nurse and expert of the month!

Adena Goldstein is a clinical diabetes nurse and certified diabetes care and education specialist at the Johns Hopkins Outpatient Diabetes Center in Baltimore, MD.  Adena received her nursing degree from Villanova University in Philadelphia, PA and became a certified diabetes educator in 2012.  She has experience with both pediatric and adult diabetes and has a strong interest in diabetes technology and using it to improve the lives of people with diabetes. 

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