Information given to patient starting insulin

Effective education of patients is essential since insulin therapy is self managed and it helps to minimise the impact of their condition on their everyday life and also helps in dealing with problems or complications which may arise due to insulin therapy (1)

During the first appointment patients should be informed about the following:

• insulin regimen
  • which insulin preparation e.g. - isophane insulin, biphasic insulin
  • about the correct dose and when to administer it
  • titration of the dose
• how to administer insulin:
  • teaching the correct injection technique, disposing of sharps
  • injection sites which can be used to administer insulin
  • importance of rotating the injection site
• about how to store insulin correctly e.g. - additional insulin should be kept in the fridge between 4 and 8 celsius
• having adequate supplies of insulin
• managing hypoglycaemia
• dietary and lifestyle advice e.g. - regular intake of starchy carbohydrates to stabilize the glucose levels
• driving - patients put on insulin should be informed about the dangers of hypoglycaemia while driving and they should also inform the DVLA and their insurance company
• information about a routine contact and an emergency contact number

During the first few weeks of starting insulin therapy:

• go through the advice given during the first appointment with the patient
• show the effects of food, exercise and insulin on blood glucose levels using patient's personal experience
• teach how to titrate the dose according to the blood glucose levels
• advice regarding management during
  • illness - blood glucose should be measured more frequently since higher doses of insulin are oftennecessary
  • alcohol - there is increased risk of delayed hypoglycaemia with alcohol and therefore should be advised to eat while consuming alcohol o eating out - adjust the dose and timing according to the occasion

Ongoing education should be provided after starting insulin treatment includes:

• missed injections - occasional missed dose will not cause any problems
• advise on managing insulin treatment during travel, holiday and religious festivals involving fasting (such as Ramadan)
• about the long-term complications of diabetes
• contraception and pregnancy, if appropriate
• reviewing the treatment regimen due to the progressive nature of type 2 diabetes (1)

Reference:

• 1. Royal College of Nursing 2006. Starting insulin treatment in adults with type 2 diabetes