Virtual doctor visits - because time is a precious thing

By Peter Nerothin, MA

Efficiency is a big deal for me. I am a full-time graduate student with deadline reminders plastered all over my house. I am also the type of distance runner who logs miles and cycles through a new pair of shoes every eight weeks. Then of course there is my life life—kitchen duties, household errands, tracking deductibles, and such. So when it comes to health appointments, I have an extremely low threshold of patience.

Visiting the endocrinologist usually requires a half day of my time, plus the negative downstream effects of breaking from my routine. I have to deal with angry freeway traffic, confusing one-way streets, parking meters, long lines of sick people, and the same frustrating stack of paperwork I feel like I’ve filled out a thousand times. If there is bloodwork to do, I have also been fasting on these appointment days. This means I will probably eat junk food on the way home, compounding the consequences of missing my morning workout.

Telehealth would seem like the perfect solution for a person like me. But I am suspicious of new technologies for the same reason I dislike visiting the doctor. New gadgets and software can end up wasting more time than they save. It’s all stuff I’m going to forget to pack, update, or charge. Or it’s a platform I will need to learn, then abandon once something better comes along, leaving me exposed to a lifetime of alerts, notifications, forgotten passwords, and email marketing.

Enter COVID-19, the pandemic that squashed all lifestyle preferences. It doesn’t matter how I feel about things like commutes or technology these days. I am required now by my healthcare provider to schedule virtual appointments. And that’s that.

Fortunately, I am not an orthodox Luddite (a person opposed to new technology or ways of doing things). I do sometimes adopt new tools if I’ve had a chance to think through their unintended consequences. Control-IQ® technology from Tandem Diabetes Care is one example. The benefits of near-perfect overnight BG control far outweighed any foreseeable downside, so I updated my t:slim X2 insulin pump almost immediately once the software was released. What I didn’t anticipate was a hidden benefit of the update, which motivated me to re-engage with the t:connect® web application, the data upload feature that makes virtual doctor visits a snap. Not only has it saved me time, but it made for one the most productive appointments I’ve had in 19 years living with type 1 diabetes.

Compared to half-day excursions in the olden days, my first virtual appointment took—all said and done—approximately 37 minutes. This included digital “paperwork” via my patient portal (10 min), an initial download of video conferencing software (5 min), uploading pump and CGM data via my t:connect desktop app (1 min), fielding a reminder call from my doctor’s office (30 sec) and finally, the actual visit with my doctor (20 min).

The meeting itself was highly purposeful and extremely effective. Sure, there were predictable challenges—spotty internet signals, dimly lit corners of a crammed quarantine house, my cat walking across the keyboard, etc. All easily surmountable. The substance of the interaction with my endocrinologist is what mattered. And with 24-hour up-to-date data at our fingertips, including insulin dosing and CGM trends, my doctor and I were able to accomplish far more than we ever had in the past (at times when we were just looking at hemoglobin a1C test results and a collection of random BG values). Although my sensor time in range had improved overall (especially overnight), we were able to identify that there was still work to be done around mealtime pre-bolusing and afternoon exercise. For the first time I can remember, I ended my appointment with a clear idea of what was discussed, and with a concrete plan for me to make improvements.

Like most people these days, I spend a lot of time wondering how the world will be different after this coronavirus thing is finally over. Hopefully we can keep with the virtual doctor visits because time is a precious thing.

Note: Peter Nerothin was compensated by Tandem Diabetes Care for his contribution on this topic. However, he created the content and it is based on his personal knowledge, experiences, and observations.

From time to time, we may pass along: suggestions, tips, or information about other Tandem Insulin Pump user experiences or approaches to the management of diabetes. However, please note individual symptoms, situations, circumstances and results may vary. Please consult your physician or qualified health care provider regarding your condition and appropriate medical treatment. Please read the Important Safety Information linked below before using a Tandem Diabetes Care product.

Responsible Use Statement

Even with advanced systems such as the t:slim X2 insulin pump with Control-IQ technology, you are still responsible for actively managing your diabetes. Control-IQ technology does not prevent all high and low blood glucose events. The system is designed to help reduce glucose variability, but it requires your accurate input of information, such as meals and periods of sleep or exercise. Control-IQ technology will not function as intended unless you use all system components, including your CGM, infusion sets and pump cartridges, as instructed. Importantly, the system cannot adjust your insulin dosing if the pump is not receiving CGM readings. Since there are situations and emergencies that the system may not be capable of identifying or addressing, always pay attention to your symptoms and treat according to your healthcare provider’s recommendations.

Important Safety Information

RX ONLY.

Indications for Use:

t:slim X2 insulin pump
The t:slim X2 insulin pump with interoperable technology is an alternate controller enabled (ACE) pump that is intended for the subcutaneous delivery of insulin, at set and variable rates, for the management of diabetes mellitus in people requiring insulin. The pump is able to reliably and securely communicate with compatible, digitally connected devices, including automated insulin dosing software, to receive, execute, and confirm commands from these devices. The pump is indicated for use in individuals six years of age and greater. The pump is intended for single patient, home use and requires a prescription. The pump is indicated for use with NovoLog or Humalog U-100 insulin.

Control-IQ technology
Control-IQ technology is intended for use with a compatible integrated continuous glucose monitor (iCGM, sold separately) and ACE pump to automatically increase, decrease, and suspend delivery of basal insulin based on iCGM readings and predicted glucose values. It can also deliver correction boluses when the glucose value is predicted to exceed a predefined threshold. Control-IQ technology is intended for the management of Type 1 diabetes mellitus in persons six years of age and greater. Control-IQ technology is intended for single patient use. Control-IQ technology is indicated for use with NovoLog or Humalog U-100 insulin.

Contraindications and Warnings:

Control-IQ technology is not indicated for use in pregnant women, people on dialysis, or critically ill patients. Do not use Control-IQ technology if using hydroxyurea.

Users of the t:slim X2 pump and Control-IQ technology must:

• be able and willing to use the insulin pump, CGM, and all other system components in accordance with their respective instructions for use;
• test blood glucose levels as recommended by their healthcare provider;
• demonstrate adequate carb-counting skills;
• maintain sufficient diabetes self-care skills;
• see healthcare provider(s) regularly; and
• have adequate vision and/or hearing to recognize all functions of the pump, including alerts, alarms, and reminders;

The t:slim X2 pump and the CGM transmitter and sensor must be removed before MRI, CT, or diathermy treatment. Visit tandemdiabetes.com/safetyinfo for additional important safety information.