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starting Insulin and Insulin education
- 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.
- 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.
- 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.
- 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.
- 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.
- 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
- 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.
- 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).
- Travel and Lifestyle Considerations:
- Discuss adjustments that might be needed for travel, time zone changes, or varying daily routines.
- 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.
- 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.
- 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.
- 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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