How i introduce insulin in type 2 diabetes mellitus
Download
1 / 18

How I Introduce Insulin in Type 2 Diabetes Mellitus - PowerPoint PPT Presentation


  • 157 Views
  • Uploaded on

How I Introduce Insulin in Type 2 Diabetes Mellitus. Sheena Duffus Diabetes Specialist Nurse Norma Alexander Sister Diabetes Clinic. Points to ponder. Time of diagnosis to insulin therapy Oral therapy at maximum combination tolerated by the patient Patient compliance

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' How I Introduce Insulin in Type 2 Diabetes Mellitus' - caleb-stokes


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
How i introduce insulin in type 2 diabetes mellitus

How I Introduce Insulin in Type 2 Diabetes Mellitus

Sheena Duffus

Diabetes Specialist Nurse

Norma Alexander

Sister Diabetes Clinic


Points to ponder
Points to ponder

  • Time of diagnosis to insulin therapy

  • Oral therapy at maximum combination tolerated by the patient

  • Patient compliance

  • Weight loss clinics? Metabolic syndrome drugs

  • Glitazones not licensed for use with insulin


Patients perspective
Patients perspective

  • Patients resistance to insulin ‘v’ insulin resistance

  • Fear factor

  • Loss of employment / driving categories

  • Weight gain

  • Hypo’s (fear of)

  • ? Feel better


Who to target
Who to target?

  • Persistent hyperglycaemia HbA1c > 7% despite maximum dose OHAs

  • Symptomatic

  • Severe inter-recurrent illness

  • Diabetes complications present

  • Weight loss due to hyperglycaemia

  • Ketosis?! Honk


Grampian step 1
Grampian Step 1

  • Review the patient HbA1c , ? Symptomatic, ? Weight loss, Inter-recurrent illness or complication present Height / Weight BMI Waist circumference


Step 1
Step 1

  • Review the medication Compliant ? Dose increase possible Additional OHA Weight control clinic Metabolic insulin resistant drug


Step 11
Step 1

  • Knowledge of diabetes Start again ? – Have they had any formal diabetes education ?


Revisiting control step 1
Revisiting control Step 1

  • Review lifestyle Exercise – Do they do any ? – What could they do ?

  • Smoking

  • Psychological issues – What else is happening in their life ? stress

  • Motivation – How do they see it ?


Step 2
Step 2

  • Commence home blood glucose monitoring – An essential tool !

  • Refer patient to diabetes dietitian

  • Discuss with Consultant, DSN or GP


Step 3
Step 3

  • A. After 2 months if there is an improvement in HbA1c go back to Step 1

  • B. Negotiate commencement of insulin with the patient.


Next step
Next step

  • Be positive but address their fear factor

  • Seeing the needle!

  • Dry run – Sticking the needle in!

  • Relief factor


Preparation
Preparation

  • Consent

  • Discuss and agree change of treatment

  • Employment

  • Driving

  • Hypo’s

  • Lifestyle

  • Exercise

  • Sick day rules


Insulin regime options

Pre – mix and OHAs Novomix 30 via preloaded Flexpen or Novopen 3 Humalog 25 Mix via Humapen Luxura

Basal insulin and OHAs Lantus (Glargine) via pre loaded Optiset pen * must use Penfine needles or Autopen 24

Insulin regime options


Step 4
Step 4 Flexpen or Novopen 3 Humalog 25 Mix via Humapen Luxura

  • Discuss insulin regime options

  • Action of insulin - How insulin works

  • Choosing their pen device – dexterity – pen needle length


Step 41
Step 4 Flexpen or Novopen 3 Humalog 25 Mix via Humapen Luxura

  • Start doses - titration rates

  • Give clear verbal and written instructions of any OHA to be discontinued!

  • Written instructions of insulin dosage and titration rate


Step 42
Step 4 Flexpen or Novopen 3 Humalog 25 Mix via Humapen Luxura

  • Injection sites and rotation

  • Storage of insulin – expiry date

  • Sharps disposal

  • Repeat prescriptions


Start date and time
Start date and time Flexpen or Novopen 3 Humalog 25 Mix via Humapen Luxura

  • Venue – surgery – ward

  • Time – morning

  • Task – first injection – keep it simple

  • Injection site – where? – rotation

  • Praise – discuss fear & their technique

  • Oral medication – continue or stop – written instructions


Follow up support
Follow up support Flexpen or Novopen 3 Humalog 25 Mix via Humapen Luxura

  • Injections

  • Daily contact at surgery or phone

  • Who should initiate contact?

  • Dose adjust every few days with patient depending upon their BG results Titrate dose slowly to prevent severe hypo’s

  • Answer questions


ad