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 decked 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.
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 :)