Glytec’s Chief Medical Officer, Jordan Messler, introduces Patricia Neely, RN, CDCES —a valued customer who shares her personal journey as someone living with type 1 diabetes and how that inspired her career in inpatient glycemic management.



Jordan Messler:
Welcome to time to Target 2023. I'm Jordan Messler, the Chief Medical Officer here at Glytec. We are so pleased that so many of you could join us today. The theme of our third annual Time to Target conference is the glycemic management journey. We recognize that everyone is at different stages of their glycemic journey, both personally and at their respective hospital systems.

We've designed the agenda to be helpful regardless of your experience level, your stage of journey, or your organization's current practices. The first day of the conference is focused on ‘the why’. Why we must take action now. Why we must prioritize improving glycemic management. More and more organizations are recognizing the urgency to act, both because it's the right thing to do, but also due to the increasing emphasis placed on glycemic management by regulators.

While the reporting on CMS's hyperglycemia and hypoglycemia quality metrics is currently optional, everyone realizes that this is just CMS's first step, and that other regulatory actions by CMS and the CDC, as well as the Joint Commission, are aligned with CMS's focus. Glytec is supportive of these regulations.

It's encouraging a higher standard of care. We are working tirelessly with our customers to help them respond and improve, while at the same time building a better, more intuitive product solution that further enables glycemic excellence. Tomorrow, on the second day of the conference, we will talk about ‘the how’.

We'll discuss how people, process, and technology can be leveraged to improve patient safety. For example, Betsy Kubaka, a Glytec Vice President of Clinical Partner Solutions, will present on the best practices of glycemic management committees. But today it's about ‘the why’, and someone who knows the why better than most is Trish Neely.

Trish is an RN and CDCES who serves as the lead inpatient diabetes educator at AnMed in South Carolina. More than that, she's been living with type 1 diabetes since she was 11 years old. This has inspired her to become a nurse and help teach others how to care for themselves. A true Glucommander champion, she provides patient, family, and staff glycemic management education and serves as a subject matter expert on AnMed’s Glycemic Management Council to drive best practices.

I'm honored that Trish has agreed to join me today. So let's please give a warm welcome to Trish Neely.

Patricia Neely: It's an honor to be here. That was a very warm welcome. Thank you.

Jordan Messler: As you know, Trish, the theme of the conference is the journey, the glycemic management journey. Can you speak to your journey a little bit from when you first learned you're living with diabetes to today as a passionate inpatient specialist?

How did you get here from there?

Patricia Neely: That's been a long journey. I was diagnosed when I was 11 years old. That was, um, I'm telling my age, it was 1974. Pig insulin and beef insulin was actually on the market then. We did not have glucometers at home. It was doing a urine dipstick to check if you were spilling glucose.

The insulins had peaks. You had ups and downs, so you really had to live a very regimented life. And luckily I had parents who wanted the best for me. They took me to an endocrinologist that was more than an hour away. Endocrinologists weren't very common back then, and the endocrinologist said you'll be blind by the time you're 30 and dead by the time you're 40.

You know, and I, over the years of living with diabetes, I think I learned to be a little hard headed and headstrong, and I thought, you know what, I'm not going to let these odds get me. So over the years, I learned, I set goals in life. To, you know, one day I wanted to get married, have children, you know, watch my child grow up.

So as I, as I've lived with diabetes all these years, for more than, a little more than 49 years now, I've accomplished some things, but when I think back from going to what I call my farm days of controlling my diabetes with pig and beef insulin to what it is today with the advances in medicine and the advances in diabetes research and how far that's brought us, I am so thankful for what technology has done over the years for the care of diabetes.

Jordan Messler: Thanks so much for sharing, Trish. It's a very heartbreaking story, you know, shared by so many that have type 1 diabetes. Really appreciate you sharing your story with us, Trish. What technologies have you used over the years, given what you've been through, you've seen a lot of change, what has that transition been like for you?

Was it easy? Was it nerve wracking to learn to trust new technology?

Patricia Neely: So, you know, learning early in life and growing up with diabetes, you know, I went from learning how to kind of adjust my insulin, what's the meters, the blood glucose monitors were on the market, and I could kind of adjust my insulin to give me a little bit more freedom because I participated in sports and things like that, but as the years past there was a co-worker of mine who said, Trish, you have got to get you an insulin pump.

I'm like, no way. Because if any of you have seen the picture of the insulin pump, the first insulin pump that the guy wore as a backpack, I'm like, no way. I am not wearing that. So, her daughter had an insulin pump. And was getting good control. And I thought, you know, I want better control. I want to live longer.

I want to see my child grow up. By this time, I had had my child. He's 27 now, and I started, I asked my internal medicine doctor to please send me to an endocrinologist who could get me on pump therapy. And I did. And it was a pump that I actually set your basal rates, but you had the mathematical knowledge of knowing how to figure your carbohydrates and your correction doses, of insulin. 

Pumps came this thing called a bolus wizard that was going to figure it for you. And as I would go to my appointments with my endocrinologist, she'd say, Tricia, you're not using your bolus wizard. I'm like, why should I trust a wizard when I've done this for years myself? So she kept encouraging me, encouraging me.

Finally, I did use my bolus wizard. And then in years to come, I got a CGM and started trusting in those readings and then I advanced onto an automated pump. So I have an automated delivery pump system now with both CGM and the pump, and it gives me so much freedom and I feel so much better without the excursions that I once lived with.

Jordan Messler: Trish, that's terrific. Very similar to some of the processes that we go through on the inpatient side when we deploy Glucommander. We're constantly re-educating and retraining clinicians, basal bolus, standard of care, Glucommander software solution. So just curious, as you reflect on your own personal experience and as you've now transitioned for years on the inpatient side, you know, how is that similar?

Does that carry over in terms of the lessons learned on how to think about that process change?

Patricia Neely: Absolutely. When I first heard about, I had, when I became a nurse, I started out in neurointensive care and, you know, of course I saw a lot of stroke and things with those high a1Cs, you know, which can be a complication of hyperglycemia.

And then I had patients with DKA and I would try and try my best to teach them the job came open as a diabetes educator and I thought that is, I want that job. So after quite a few years in neurointensive I became a diabetes educator and later became certified. Well, through those years, looking at the glycemic management and some, we have a glucose management screen that we look at and it kind of records, the insulin given, what kind, if they've had steroids, nutritional supplements, but some of those glycemic management screens looked literally like a roller coaster.

The ups and downs, the excursions that I talked about, and those excursions to a person living with diabetes, you got to think that those numbers, they're not just glucose numbers. You got to think about what's going on in the background, too, with the changes of those sodium and potassium levels, and how those highs can give you the worst headache and just feeling sluggish.

And then, as I was looking at, someone had told me about Glytec, and I was looking at Glytec Glucommander system, I thought, hmm, that works about like my automated insulin pump. It's taking what that person's reaction to the insulin therapy given and adjusting it on a daily basis because diabetes is not cookie cutter.

The same person's not going to use the same thing day in and day out. So I think that's one of the things that really, really interests me at first in Glucommander and also that it would adjust whenever we give the D50 or the D10. You know, we had a, we had a policy that, you know, you do a half amp or a whole amp, but it's so precise with, with Glytec knowing that patient sensitivity that it can give the perfect amount to correct any hypoglycemic event.

Jordan Messler: Trish, that is great. Thank you so much for that. There is a lot of it. It's very analogous, like you're saying, on your journey, what you've gone through personally, on the outpatient side, taking care of yourself. And also the journey on the inpatient side that we're really focused on to help all of our clients.

Really appreciate that. I know you believe strongly and we do as well that a great inpatient glycemic management program is more than just technology. It needs the people, it needs the processes, in addition to the technology. You're really focused on it, and did a terrific job building it up at AnMed. Can you share some, how you brought all that together, how you continue to bring that together at AnMed?

Patricia Neely: Well, at AnMed, when we first started our go-live, and, and starting with Glucommander in the hospital, you know, we discovered some things. When you start this new system, it will uncover… We did not have a DKA protocol, which, we have one now. There were a lot of things that we needed. To work on, and one of those was the education of nurses and physicians.

So we started a glucose management council that is our quality physician, some other physicians, pharmacy is involved with that, and they meet, or we meet monthly. To talk about any case reviews that we need to look at and things like that. And also, I have a Diabetes Management Committee that the nurses will, we have representatives from our nursing units.

And actually, I use a lot of the Glycomander data to look at different patients and different scenarios that nurses can learn from in their day to day bedside treatment of these patients.

Jordan Messler: That's great, Trish. Thanks so much for sharing that. What are some of the challenges? I'm sure this was a difficult change to go from where you were, just from even some of the things you've shared with us about uncovering areas you need to improve.

What are some of those challenges you faced and how did you overcome them?

Patricia Neely: Well, one of the, I think one of the biggest challenges was,physicians saying, I'll just use sliding scale. Sliding scale is so reactive instead of proactive.

Getting the education out there has been a tremendous challenge that we continue, right now we have boxes out on each unit, any diabetes questions, please submit and we're going to address those in the month of November to get more and more education out there. Getting physicians champions on board.

We've had physicians tell me in the hallway, you know, they're just gonna use sliding scale. And then, I just kind of share with them what the ADA recommends. And it is not sliding scale insulin that we use. They have these targets that we should be aiming, our blood glucose control, and then those CMS guidelines.

We actually placed those CMS guidelines, what the copy of those, we have a little newspaper, we call it our Sweet News, and we posted that on every unit so that we could get the word out because what I found was a lot of physicians did not know about the ADA guidelines, standards of care, and they also did not know about the CMS guidelines.

So, reaching some physician champions and getting them to go with their peers and, help guide them. And let them know that Glucommander does not take away the physician control. Because they're going to choose that multiplier and that target range for that specific patient. And it's going to help us achieve the goals that are set forth for us to achieve. 

Jordan Messler: Yeah, that's so terrific Trish, certainly recognizing the importance of physician champions, really letting them know that Glucommander doesn't take away some of that physician control. And we know some of the challenges that physicians, others are just resistant to change.

We get used to doing what we're doing. There's a perception of... Current state. Before I change something, it's easier. That easier is not always the right thing though. You also discussed the use of data, glucometrics data, in your meetings. Do providers or clinicians, I have to think that they respond very well to the data.

I'm sure you've been using data. Has that been a key tool for you to overcome any of the resistance?

Patricia Neely: Matter of fact, the first thing I do every morning when I get to work is look at our Glucommander dashboard. I like to look at the IV and SubQ. I look, and those patient details to see if there's any issues or any problems that they go and then it also in our dashboard, it can identify those who have potential to be placed on Glucommander.

And, even today, this morning, there was a particular patient whose glucose, I looked at his glucose management screen and it was, it was not meeting those guidelines, so I put a sticky note in the decision.

Jordan Messler: So despite all these challenges, has this all been worth it for you? 

Patricia Neely: Absolutely. You know, one of the things that I talked about, the treatment of the hypo being so specific, that was one of the things, you talk about technology coming forth, that was one of the things that I struggled with as a person with diabetes.

EMS is… my husband went to wake me up one morning to come to work, and this was before I had a CGM, and I was unconscious, and my child, who was approximately 2 years old at that time, saw EMS have to come in there and work with me, and I just, you know, I've always had that fear of hypo, but I have learned with technology to overcome that, and that's why I like Glucommander because it's so adjust and can, once the physician sets that target range, that's what Glucommander is working toward to keep that patient in that target range.

Jordan Messler: Thanks so much for that, Trish. Everyone out there listening, wherever they are in their glycemic management journey. Any last words to share to the audience? 

Patricia Neely: Go for Glucommander.

Jordan Messler: Thank you, Trish. Very much appreciate, appreciate your assistance, your feedback as a valued customer. It's always so important to us so we can improve the product.

Really appreciate your support, Trish. You're a passionate advocate for Glucommander, for your patients, for your health system. Together we're making a difference and we're not alone. We're joined by over a thousand people right here today at Time to Target. We're just as committed to moving the needle on inpatient glycemic care.

Thank you all for being here. Thank you to all our presenters who are sharing their time and expertise with us today and tomorrow. I know all of us at Time to Target, all of us live at the conference, participants are on a clinical mission to improve patient safety. That's what's most important to all of us.

Thank you so much, Trish, what you shared with us. This work really matters. Thank you again, and enjoy the conference.

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