preparing the patient for insulinshort

International Diabetes Center International Diabetes Center Preparing the Patient for Insulin Therapy International Diabetes Center International Diabetes Center Preparing the Patient for Insulin Therapy • Understand natural history of diabetes Understand natural history of diabetes and treatment options (SDM) and treatment options (SDM) International Diabetes Center International Diabetes Center Preparing the Patient for Insulin Therapy • Understand natural history of diabetes and treatment Understand natural history of diabetes and treatment options (SDM) options (SDM) • Review targets for blood glucose and Review targets for blood glucose and HbA1c HbA1c Treat to Target HbA1c HbA1c < 7% < 7% Fasting and Pre meal glucose Fasting and Pre meal glucose 70-140 mg/dL (3.9-7.7 mmol/L) 70-140 mg/dL (3.9-7.7 mmol/L) Postprandial glucose Postprandial glucose <160 mg/dL (8.8 mmol/L) <160 mg/dL (8.8 mmol/L) ( ( Two hours after the start of a meal the BG should Two hours after the start of a meal the BG should be no more than 20 to 40 mg/dL or 1.1 to 2.2 mmol/L be no more than 20 to 40 mg/dL or 1.1 to 2.2 mmol/L above the pre-meal BG above the pre-meal BG ) ) Bedtime glucose Bedtime glucose 100-160 mg/dL (5.5-8.9 mmol/L) 100-160 mg/dL (5.5-8.9 mmol/L) International Diabetes Center International Diabetes Center International Diabetes Center International Diabetes Center Preparing the Patient for Insulin Therapy • Understand natural history of diabetes and treatment Understand natural history of diabetes and treatment options (SDM) options (SDM) • Review targets for blood glucose and HbA1c Review targets for blood glucose and HbA1c • Review insulin therapy options: Review insulin therapy options: physiologic vs. conventional physiologic vs. conventional International Diabetes Center International Diabetes Center 0 10 20 30 40 50 0 2 4 6 8 10 12 14 16 18 20 22 24 Normal Insulin Secretion: Basal and Bolus Patterns Serum insulin (mU/L) Serum insulin (mU/L) Time (Hours) Meal Meal Meal Meal Meal Meal Basal Insulin Needs Basal Insulin Needs Bolus insulin needs Bolus insulin needs International Diabetes Center International Diabetes Center Preparing the Patient for Insulin Therapy • Understand natural history of diabetes and treatment Understand natural history of diabetes and treatment options (SDM) options (SDM) • Review targets for blood glucose and HbA1c Review targets for blood glucose and HbA1c • Review insulin therapy options: physiologic vs. Review insulin therapy options: physiologic vs. conventional conventional • Review benefits and potential side Review benefits and potential side effects of insulin therapy effects of insulin therapy International Diabetes Center International Diabetes Center Benefits and Potential Side Effects of Insulin Therapy Benefits: Benefits: • Improved well-being; increased energy; decreased Improved well-being; increased energy; decreased fatigue fatigue • Improved glucose control Improved glucose control • Reduction in risk of complications Reduction in risk of complications Side effects: Side effects: • Weight gain Weight gain • Hypoglycemia Hypoglycemia International Diabetes Center International Diabetes Center Preparing the Patient for Insulin Therapy • Understand natural history of diabetes and treatment Understand natural history of diabetes and treatment options (SDM) options (SDM) • Review targets for blood glucose and HbA1c Review targets for blood glucose and HbA1c • Review insulin therapy options: physiologic vs. Review insulin therapy options: physiologic vs. conventional conventional • Review benefits and potential side effects of insulin Review benefits and potential side effects of insulin therapy therapy • If patient resistant to insulin or needle If patient resistant to insulin or needle phobia, demonstrate insulin injection phobia, demonstrate insulin injection using sterile normal saline using sterile normal saline International Diabetes Center International Diabetes Center Preparing the Patient for Insulin Overcoming Patient Resistance Overcoming Patient Resistance Misinformation Misinformation • Insulin means I have “serious” diabetes • Insulin causes hypoglycemia • Insulin causes the complications of diabetes (heart disease, blindness, kidney failure) • Insulin makes you gain weight • Injections cause infection [...]... Monitoring • • • • • • To improve clinical decision-making To adjust insulin therapy To evaluate efficacy of the therapy To pin point problems To support adherence to regimen Feedback for the patient International Diabetes Center Testing Frequency Patients on Insulin • • • Four times/day recommended Testing before each meal and before bedtime May also test pre-meal and 2 hours post meal to evaluate effect.. .Preparing the Patient for Insulin Overcoming Patient Resistance Behavioral issues • Taking insulin is inconvenient • Taking insulin is embarrassing • Taking insulin is painful • Why should I take insulin when I feel well • I would rather take a pill than take insulin International Diabetes Center Overcoming Patient Barriers to Insulin Barriers Solutions • Fear of injections • Improved comfort... pumps) • Severe hypoglycemia rare in type 2 DM (< 3 %) • Explain that weight gain is seen with most effective therapies (not insulin alone) • Glucose lowering is the KEY • Fear of hypoglycemia • Fear of weight gain • Insulin = “Severe diabetes” Starting the Patient on Insulin • Determine insulin therapy and starting dose – Physiologic vs conventional • Teach insulin administration – Syringe and vial –... Diabetes Center Starting the Patient on Insulin • Determine insulin therapy and starting dose – Physiologic vs conventional • Teach insulin administration – Syringe and vial – Insulin pen • Review/teach blood glucose monitoring • Reinforce meal planning using carbohydrate counting International Diabetes Center Carbohydrate Counting • Emphasizes total amount of carbohydrate not the source • Sources of... International Diabetes Center Sites for Insulin Administration From My Insulin Plan, International Diabetes Center, 2001 International Diabetes Center Insulin Injection Technique: Abdomen International Diabetes Center Insulin Pens International Diabetes Center Insulin Pen Injection Technique International Diabetes Center Starting the Patient on Insulin • Determine insulin therapy and starting dose – Physiologic... blood glucose pre/post-meal to assess impact International Diabetes Center Starting the Patient on Insulin • Determine insulin therapy and starting dose – Physiologic vs conventional – (0.3 u/kg recommended) • Teach insulin administration – Syringe and vial – Insulin pen • Review/teach blood glucose monitoring • Reinforce meal planning using carbohydrate counting • Prevention and treatment of hypoglycemia... another person • Standard doses – 0.5 mg for children/1.0 mg for adults May be given IM or SC • May cause nausea/vomiting/headache • Increase fluids following injection • Call physician International Diabetes Center Moderate to Severe Hypoglycemia International Diabetes Center Hypoglycemia Prevention • Preventing hypoglycemia is a delicate balancing act of food, medications and insulin • Instruct patients... Hypoglycemia Prevention • Preventing hypoglycemia is a delicate balancing act of food, medications and insulin • Instruct patients to – Carry carbohydrate at all times – Test before driving (if possible) – Wear medical identification – Teach others how to inject glucagon International Diabetes Center ... recommended Testing before each meal and before bedtime May also test pre-meal and 2 hours post meal to evaluate effect of insulin on post-meal glucose • Modify frequency of monitoring if necessary • Encourage patients to record values in a record book International Diabetes Center Blood Glucose Monitoring Current Technology International Diabetes Center Glycosylated HbA1c and Average Blood Glucose Correlation... intake without food – Physical activity without insulin/food adjustment International Diabetes Center Hypoglycemia Symptoms Mild to Moderate – – – – – – – Shaking/trembling Sweating Hunger Dizziness/lightheaded Nervous/anxious Rapid heartbeat Numb or tingling lips/hands/feet – Blurry vision Severe – – – – – – – – Difficulty thinking Tired/drowsy Yawning Difficulty speaking Poor coordination Odd behavior/giddy . Center International Diabetes Center Preparing the Patient for Insulin Therapy International Diabetes Center International Diabetes Center Preparing the Patient for Insulin Therapy • Understand natural. Diabetes Center International Diabetes Center Preparing the Patient for Insulin Overcoming Patient Resistance Overcoming Patient Resistance Misinformation Misinformation • Insulin means I have “serious”. infection International Diabetes Center International Diabetes Center Preparing the Patient for Insulin Overcoming Patient Resistance Overcoming Patient Resistance Behavioral issues Behavioral issues • Taking