People with type 1 diabetes are often unwell at diagnosis and are started on insulin at the onset of treatment.
People with type 2 diabetes usually only switch to insulin after a varying amount of time on diet and anti-diabetic agents. They are the largest group of people switching to insulin. An initial appointment is arranged to discuss the need and benefits of insulin treatment. Referrals are taken from GPs or practice nurses. The following describes the entire educational package for starting insulin.
Initial consultation for starting insulin
- explore patients existing knowledge of diabetes and insulin
- explore the patients health and cultural beliefs
- social implications of starting insulin
- the need for insulin
- the benefits of insulin
- how insulin works
- demonstration of injection devices
- dummy injection
- goal setting. Short and long term aims of treatment
- teach self blood glucose monitoring, if appropriate.
- demonstration of injection technique
- self inject with support
- discuss injection and meal times, storage of insulin, disposal of sharps, sites for injection and rotation
- hypoglycaemia: signs, treatment and management
- driving, insurance and employment implications
- importance of carrying diabetes identification
- telephone contact numbers.
- assess current control
- establish any problems and discuss possible solutions
- revise any areas or topics
- review insulin doses and discuss principles of how to adjust doses
- discuss inter current illness advice
It may take many more appointments for the majority of patients to achieve an understanding of the above topics and issues and feel confident to manage their condition. The average number of appointments needed for most patients to become confident in using inuslin and sucessful dose adjustment is between six and eight.
Group insulin conversions
In response to the increasing number of patients with type 2 diabetes switching to insulin, small group sessions have been developed which have successfully reduced waiting times. The sessions have been well received by patients as they have gained support from each other.