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Insulin injections: promoting insulin and teaching techniques

Nov 13, 2012

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.

5 comments

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  1. Dec 03, 2012

    I don't think I write a prescription for new insulin without ordering diabetes education, but I have a great team of diabetes educators. I did appreciate that article in the Diabetes Educator, and plan to have all my colleagues read it for their practice and education too. Like someone said it can be a great resource. I too wonder how many people aren't injecting correctly, or never received the education they deserve. I plan to get that information out to primary care providers who may be ordering supplies and starting insulin in our area. I could also relate to the information of the before morning procedures people with type 1 diabetes taking their pump off because the surgeon told them too at midnight and they didn't want to "mess up" their surgery. We do a lot of education with everyone when that occurs. It still always shocks me though.
  2. Nov 16, 2012

    You are so right! I can't tell you how many diabetic patients that have been on insulin for years are not using proper technique. They are surprised when I start asking them to demonstrate how and where they give their insulin injections. Over the years they develop their own bad habits without understanding the effects. If they are not given the knowledge they are not going to ask I feel it should be mandated that all diabetics are seen by a CDE or at least a properly trained nurse when being started on insulin for proper education then followed on a regular basis for support and reassurance.
  3. Nov 14, 2012

    We provide insulin instruction for patients in the hospital and for outpatients IF they are referred. During group class, patients on insulin frequently comment that they learned something about injection that they hadn't been doing. Makes me wonder how many aren't doing it correctly.
  4. Nov 13, 2012

    I met a patient's caregiver today who cried after finding out that she had been administering her husband's dose incorrectly; she was turning the pen dial instead of pressing the button!!
  5. Nov 13, 2012

    I agree with you totally, I work mostly with self referrals, diabetic patients who feel they are not getting much from their regular health team and decide on their own to seek deeper understanding of their condition and management ...the problem is they feel guilty about being disloyal to theirprimary health care provider and so are in the middle of two disconnected service providers, its shameful how little they actually understand their meds and condition....we do our best and reward comes from a stable confident patient introducing another for self management training. It would be so much more effective if seeing a Diabetic Educator was the norm for all diabetics.

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