I believe we have all progressed beyond the concept of “if you are not a good diabetic, you will have to go on insulin.” If I ever hear that again, I will storm up to the provider that is uttering those words and scream! I’m hoping providers are developing an understanding of the importance of insulin as a powerful and effective drug for many patients with type 2 diabetes. With that insulin prescription we, as educators, SHOULD become an important part of the teaching process for taking insulin.
Too often a patient is sent off with a prescription for an insulin pen, or vials and syringes, without proper education on the use of the tools. In addition, the Rx can be written for needles that are too long, and syringes that do not match the dose. The September/October 2012 issue of The Diabetes Educator has a great review article on insulin injection technique. An important focus is the fact that small needles (4-5 mm) are just as effective for the thin or overweight patient. We no longer have to pull out our 12 mm needles and recommend they just get used to them! According to recent research, most individuals do not remember getting trained on insulin delivery technique. Not surprising considering the few that ever get referred for even basic diabetes education!
In addition to working with the technique of insulin injection, it is so very important for the patient to understand how insulin works, and why the choice was made to start them on insulin. The peaks and valleys of insulin and duration of action should be clearly defined for the patient. If someone understands that basal insulin is a dribble over time, they will understand they need to always take their long-acting insulin, even when they are not eating much. I have experienced a number of phone calls from patients asking if they should “go off all insulin” for a morning procedure. It is a case-by- case basis, but rarely would that be beneficial (in fact, I can’t think of one time) and often they could end up with dangerously high BG levels by morning (I have even had several type 1 diabetes pump patients told by providers to remove their pump the night before a procedure!). So if the patient understands the peaks and valleys of the types of insulin they are using, and why they are using it, hopefully they will be able to understand when it makes sense not to take insulin.
Diabetes educators need to be an integral part of the insulin delivery education team. Wouldn’t it be wonderful if every initial prescription for insulin required an education session with a CDE? Hopefully you are out front and center, telling primary care physicians how important you are to the health of their patient in the area of teaching about medication, as well as about healthy eating and exercise.