DIABETES,  ENDOCRINE

starting Insulin and Insulin education

  1. Education on Insulin Action:
    • Explain the type of insulin being prescribed (rapid-acting, short-acting, intermediate-acting, long-acting) and how it works to control blood glucose levels.
  2. Injection Technique:
    • Demonstrate how to inject insulin properly, including site rotation (abdomen, thighs, buttocks, upper arms).
    • Inject at least 1 inch away from the previous site and avoid areas with scars or moles.
    • Ensure proper injection technique (needle length, angle of insertion).
    • Discuss the importance of proper needle disposal.
    • Inform about possible reactions at the injection site and how to manage them.
  3. Dosing and Timing:
    • Instruct on how to measure and adjust doses.
    • Explain the timing of insulin administration in relation to meals and daily activities.
    • Emphasize the importance of regular blood glucose monitoring and keeping a log of results to adjust insulin doses.
    • When to Monitor:
      • Typically, BGL should be checked
        • before meals
        • before bedtime
        • before exercising
        • when feeling unwell
        • before critical tasks like driving.
    • Target Levels:
      • Pre-prandial (Before Meals): Generally, the target is between 4-7 mmol/L.
      • Post-prandial (1-2 hours after starting a meal): The target is typically less than 10 mmol/L.
  4. Hypoglycemia Awareness and Management:
    • Educate about signs and symptoms of hypoglycemia (e.g., shakiness, sweating, confusion).
    • Discuss how to treat hypoglycemia promptly with fast-acting carbohydrates.
    • Mild to Moderate Hypoglycemia:
      • Consume 15-20 grams of fast-acting carbohydrates (e.g., glucose tablets, sugary drinks).
    • Recheck BGL after 15 minutes. If it remains low, repeat the treatment.
      • Once BGL stabilizes, eat a small snack if the next meal is more than an hour away.
  5. Hyperglycemia and Ketones:
    • Instruct on recognizing and managing high blood sugar and the importance of testing for ketones if blood glucose levels are consistently high.
  6. Sick Day Management:
    • During illness, BGL can fluctuate. It’s essential to continue taking insulin or diabetes medication.
    • Monitor BGL more frequently (e.g., every 2-4 hours).
    • Stay hydrated and if unable to eat, consume carbohydrate-rich liquids.
    • If ketones are present in urine or if BGL is consistently high, seek medical advice
  7. Diet and Exercise:
    • Discuss the impact of food choices and physical activity on blood glucose levels.
    • Highlight the need for carbohydrate counting or understanding the glycemic index of foods.
  8. Insulin Storage and Handling:
    • Instruct on proper storage of insulin (refrigeration of unused vials/pens, room temperature for in-use insulin).
    • Advise against using insulin past its expiration date or if it appears cloudy (for clear insulins).
  9. Travel and Lifestyle Considerations:
    • Discuss adjustments that might be needed for travel, time zone changes, or varying daily routines.
  10. Driver’s Licence Authority Notification/Other Relevant Licensing Notification:
    • If the patient is a driver, they may need to notify the driver’s licensing authority about their diabetes management, especially if they’re on insulin therapy.
    • The specific requirements vary by region, but typically include regular medical reviews and stringent BGL monitoring to ensure safe driving capabilities.
    • Failure to notify can have legal implications and might affect insurance coverage.
  11. Emergency Situations:
  • Educate about the need for a medical ID bracelet and carrying emergency contact information.
  • Advise on what to do in case of illness or emergencies when glucose levels may be harder to control.
  1. Regular Follow-Up and Support:
  • Stress the importance of regular follow-up appointments for dose adjustments and monitoring.
  • Provide information about diabetes education programs and support groups.
  1. Insulin Adjustment Factors:
  • Educate about factors that may necessitate insulin dose adjustments (e.g., changes in diet, activity level, stress, illness).

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