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Assessing Insulin Administration Technique

Dec 15, 2014

An 83-year-old woman who lived alone and was very active in her community was having wide swings in her glucose levels.

She reported sometimes waking up hours after dinner with her head in her dinner plate. She did not understand why.

She did not have family or caretakers nearby to check on her. Her physician was thinking of admitting her to a long-term facility, but before doing so, asked our home health agency to make a home visit to evaluate her and her safety at home. As the certified diabetes educator (CDE), I was asked to make the visit.

She told me she was mixing regular and NPH insulin from vials in a syringe. I asked her to demonstrate her technique. As I watched her, it was clear to me she couldn’t see well enough to get the correct doses of insulin, and she wasn’t mixing them properly. Her regular insulin, which should have been clear, was cloudy, which told me there was NPH in her regular insulin. Besides this, sometimes her syringes were half-filled with air, sometimes they were not. She was never getting the same amount of insulin.

Other than these “bouts” she functioned very well at home and in the community. She did not qualify for home health because she was not homebound, and she drove. She refused using an insulin pen. However, she was willing to pay out of pocket for a home health nurse to visit on a regular basis to draw up her insulin, and provide home assessments. She was fine after this. She was able to stay in her own home and remain active for years.

Lesson Learned:

  • When your patients have unexplained highs and lows, watch their technique. Teach and make recommendations as necessary.
  • Even if your patients seem to be doing well, it is a good idea to check your patient’s insulin administration technique. Teach and make recommendations as necessary.
  • Whether their technique is correct or not, find something good in what they are doing. Praise them for this. We can all benefit from encouragement!

Certified Foot Care Nurse
Associate Medical Editor, Diabetes In Control