I asked a patient with erratic glucose levels where he usually gave his insulin injections to which he responded, “In my arms.” I asked, “Could you show me where?” The patient promptly rolled up his sleeves and pointed to the vein in his antecubital space. As insulin action is determined mostly by its rate of disassociation in the subcutaneous (fat) space under the skin, injection directly into the blood stream would certainly, and possibly dangerously cause wide fluctuations in blood glucose.
- Use investigative and motivational interviewing techniques and teach-back when trouble-shooting problems with your patients.
- Always check (meaning…ask, look at and touch) injection sites during your visits.
- Include the above for all of your patients, even those who have had diabetes for many years, as you never know what you will discover.
- Never underestimate the value of sending your patients to a diabetes educator!
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