BLOG: My colleague experienced real-life consequence of daylight savings time change
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This year is the first that I did not write a post on the weekend of the biannual daylight savings time change since the launch of this blog. In each earlier post, I aimed to raise awareness about health risks due to the time change.
My reason for not writing again this spring is perhaps a bit of frustration and feeling of helplessness, because what I have been calling for since a 2014 review article was never achieved. There is still a health risk related to technologic glitches in the time settings in insulin pumps — what I refer to as the internal clocks of the insulin pumps. An incorrect time setting, different from the ambient time, is a risk for incorrect insulin dosing, with potential risk of hyper- or hypoglycemia.
To my knowledge, time settings (internal clocks) of insulin pumps are still not automated. That is, they are not linked with GPS, and they do not have the function of automatically updating the time settings during DST changes. Most other technologic devices, such as cell phones, have this function. Insulin pumps still lag in this technologic area.
Unfortunately, I found myself obliged to write this post, after all: This spring’s DST change has caused a glitch that was encountered by one of my colleagues and associates.
Katie Sullivan, NP, is a provider in our MSU endocrinology clinic. She has volunteered to share her personal experience with the public for the purpose of public health awareness and education. Katie has type 1 diabetes and uses an insulin pump. She also uses her cell phone which pairs with her CGM.
Katie made the latest “spring forward” DST change on Sunday morning, March 10. But several hours later, in late evening, she became concerned because her sugars during the day were higher than usual. She could not figure out what the problem was. Also, she got puzzled because her pump showed “sleep mode” during the day!
Katie then realized that by mistake she had flipped the AM-PM setting while making the DST change on the pump settings. Her insulin dosing settings were quite different between the day and night, and so she was getting less insulin during the day and more insulin at night. Fortunately, Katie discovered the glitch in the evening before going to bed, and so she escaped a potential occurrence of hypoglycemia at night, from the higher insulin amounts which were set for the day (due to the AM-MP flip).
As an endocrinology nurse practitioner and as a patient, here is Katie’s perspective about her personal experience, in her own words:
“I have had type 1 diabetes since 2015. I have been using an insulin pump since 2016. Most of the time when a time change is required for my pump, like when I am traveling to a different time zone, or if it is daylight savings time, I am able to remember to manually change the time. This past daylight savings time change was no different, and I remembered to change the time on my insulin pump. However, when I changed the time this past Sunday, I accidentally switched AM to PM. This made a big difference for me as my AM settings differ greatly from my PM settings. It wasn’t until evening when I was experiencing more hyperglycemia than normal that I realized what happened. I am grateful that my pump will send a notification to my phone if the time on my phone does not match the time on my pump, but I would prefer having a way for it to automatically switch.”
Katie and I wished to share her personal experience for the purpose of public health education and awareness. We reached out to our local TV station WILX Lansing, and they aired this story on the evening News cast https://www.wilx.com/2024/03/14/is-daylight-savings-dangerous-diabetics/ . In that interview, Katie and I emphasized that while we are health care providers, practicing diabetes care, we are just humans after all. If such an IT glitch has occurred to Katie, who is as a provider and patient herself, it is presumably happening to more patients using insulin pumps — but these glitches go unreported.
Katie and I are really hoping that the DST gets eliminated in Michigan and perhaps nationwide. As I stated in the TV interview, I am in full support of a new bill in Michigan’s legislature that was just announced, calling for elimination of DST in Michigan.
To reach out to larger audiences, I have utilized all possible venues: presenting abstracts at national meetings, as well as writing about this in this very blog every March and November marking the DST changes. Locally, I have also been reaching out to media outlets to spread this message in the evening news casts, such as this news report from 2018 https://www.wilx.com/content/news/Insulin-pumps-could-be-affected-by-Daylight-Saving-Time-499439481.html.
And, regarding educating our own patients about this health concern, I would always check the time setting every time I see a patient with insulin pump. It has become a kind of obsession for me to first glance at the time on the pump screen before I review or edit pumps’ insulin settings. I also always teach students, residents and fellows, as well as reminding colleagues and nurses, about this safety health concern.
Often, we detected incorrect time settings for our patients, especially following the DST change in the fall and spring. And, occasionally, we detected cases of incorrect insulin dosing, resulting in hyper- or hypoglycemia. Fortunately, no related serious harm was encountered in our practice; but the question is: Is this really a low-risk probability or a matter of underestimation and that such harm occurs but we and other providers are not aware of it?
For the purpose of broader reach to our local community, our health organization, MSU Health Care, routinely posts a message on its Facebook page to remind patients with diabetes who use insulin pumps to remember to make the DST change https://www.facebook.com/photo/?fbid=844560257685150&set=pb.100063935494939.-2207520000.
Reference:
Aldasouqi S and Reed A. Pitfalls of insulin pump clocks: Technical glitches that may potentially affect patient care in patient with diabetes. Journal of Diabetes Science and Technology 2014; 6:1215-20.
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