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How to Use Short Acting Insulin Patient Education Handout

How to Use Short Acting Insulin Patient Education Handout. John Brill, MD, MPH Primary Care Clerkship July 2009. The Patient. 72 yo Latina woman Patient of mine at St. Luke’s FPC, south side of Milwaukee DM x 8 years, with neuropathy Poor control with maximum PO Meds

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How to Use Short Acting Insulin Patient Education Handout

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  1. How to Use Short Acting InsulinPatient Education Handout John Brill, MD, MPH Primary Care Clerkship July 2009

  2. The Patient • 72 yo Latina woman • Patient of mine at St. Luke’s FPC, south side of Milwaukee • DM x 8 years, with neuropathy • Poor control with maximum PO Meds • Very resistant to idea of starting insulin

  3. The Patient (Cont) • Hospitalized with acute MI • Started on insulin, had teaching • Sent home with insulin prescriptions (lantus + humalog) • Called me 2 days later; not using short-acting insulin because unsure how

  4. DM2 • 17.6 million patients in US--7.8% of adults • Prevalence increased 13.5% last 3 years • One of top 10 reasons to see PCP • Total cost ~ $174 billion in 2007 ADA: http://www.diabetes.org/about-diabetes.jsp

  5. DM2 Treatment • 15% TLC* • 57% PO Meds • 12% PO +Insulin • 16% Insulin alone *Therapeutic LifestyleChanges Source: ADA

  6. Patient Education • Patient met with PharmD and RN to go over how to use insulin • Bilingual (not language barrier) • Very afraid of hypoglycemia • Needed a lot of repetition, reassurance, reinforcement

  7. Literature Search • Search for patient education materials • ADA • FamilyDoctor.org • Aurora ‘For Your Well-Being’ • Google search • TuOtroMedico

  8. Search results • Several websites (patient did not have internet access) • Some handouts on how to give insulin injection • No general handouts • Most sites written at high reading grade level (except FamilyDoctor)

  9. How to Use Short Acting Insulin Goals for handout: • Simple • Easy to remember: ‘TIE’ mnemonic • Visually attractive, simple pictures • Low reading level

  10. Process • Draft • Consulted with Pharm D • Tested readibility: 127.0 grade level • Polysyllabic words: hypoglycemia, injection, frequently, carbohydrates, administer • Piloted with 2 patients

  11. Challenges • Layout • Low reading level • How to integrate Sliding Scale concept • Pictures

  12. How this will be useful • Can be given to patients who are being started on insulin, or considering it • Might help improve care and decrease amount of time needed to teach • Could be especially helpful in sites with limited staff expertise • Patients felt the TIE mnemonic might be helpful for patients starting on insulin • A nice reference for patient’s dosages

  13. Limitations • Doesn’t cover long acting insulin • References other handout for injection • Only very simple sliding scale • Would have to change handout every time insulin dose is changed • Probably wouldn’t travel with patients

  14. Future Steps • Translate into Spanish, Hmong • More culturally diverse pictures • Create versions with other options for sliding scale • An electronic version that was stored on glucometer could be very helpful

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