Changing the clock twice a year for daylight saving time can pose real hazards for people with diabetes who use insulin pumps.

Says Saleh Aldasouqi, associate professor of medicine at Michigan State University:

“Forgetting to change the time can result in insulin dosing errors that can be harmful.”

Dosing errors could cause too little or too much insulin being delivered at the right time for these patients. Too much insulin produces hypoglycemia, which could be severe and trigger seizures, fainting spells, or coma.

Hyperglycemia is a result of too little insulin being delivered and in the short term isn’t as harmful as hypoglycemia. Early effects of hyperglycemia may include tiredness and frequent urination, yet longer-term effects could cause the body to become acidic, known as diabetic ketoacidosis, and could also produce life-threatening complications.

Aldasouqi says he’s had a number of patients come into his office who have forgotten to make the time change or in other cases, haven’t adjusted the clock after changing the pump battery.

“At this point, I haven’t seen a fatal error occur, but why wait?” he says. “That’s why it’s important to raise awareness about this issue now and encourage physicians and patients alike to make sure these clocks are set up correctly at all times.”

Pump Technology Lags Behind

There are two forms of insulin delivery methods, basal and bolus. Basal insulin therapy helps patients with diabetes control blood sugar in steady amounts throughout the day and night, while bolus therapy releases insulin in bursts around meals.

A major concern is those receiving the bolus therapy may be affected more significantly if timing is off.

“Since this delivery method is timed around meals, if a patient eats lunch around noon, they’ll get their burst of insulin at the wrong time,” he says. “If it’s too much or too little, it could send them to the hospital or worse.”

Currently, insulin pump technology lags behind and doesn’t have clocks that automatically adjust. GPS technology could be used to help solve this problem, but is considered controversial due to privacy concerns.

For now, Aldasouqi says the responsibility is on the patient and also on the medical community to educate patients and make sure pumps are set correctly.

“The implications of remembering to change the clock in these devices means so much more than just remembering to adjust the alarm clock for that extra hour of sleep,” he adds. “As a physician, I’m going to do what I can to make sure patients are safe.”

Saleh A. Aldasouqi and Amy J. Reed Pitfalls of Insulin Pump Clocks: Technical Glitches That May Potentially Affect Medical Care in Patients With Diabetes J Diabetes Sci Technol November 2014 8: 1215-1220,  doi:10.1177/1932296814541811

Photo: Brian J. Matis/Flickr

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