Be Very Specific When Instructing Patients on Insulin
At the diabetes center I work at, we have group classes for exercise which some diabetes patients attend often and are known to all the educators at the center.
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One of these patients is a young man of slightly below average intelligence who had had his basal insulin adjusted by an endocrinologist over the phone. He told me that his FBS was now in the correct range and that he was starting prandial insulin. I had not worked with this man personally, but occasionally he relates how he is doing. Recently this man came over to me and told me he had had a low BS of 51 the previous afternoon which scared him, but he had treated it correctly.
I questioned him to determine the cause and, in the process, discovered that when he was instructed in taking the prandial insulin, he was told to "take it 3 times a day," and he decided to take the 3 shots at 1 pm, 2pm, and 3pm.
Needless to say I corrected his misconception and explained to him the action of prandial insulin, and that he must only take 1 shot right before eating a meal. I also told him not to take a shot if he was going to skip eating a meal. One can never be too specific.
Lesson Learned:
Write out very specific instructions for insulin administration when a person is new to insulin or if the regime is being changed or adjusted, and have the person explain back to you what to do.
Gloria Parker, RD, CDE
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