Recently a patient presented to our outpatient diabetes education center. His A1C had historically been elevated, despite the initiation of insulin therapy and increasing doses. The patient reported that he had taken all insulin doses as ordered, but was frustrated with his lack of progress.
On interview and on return demonstration, it was found that his injection technique was appropriate, except that he did not prime his insulin pen. His injection sites were free of lipohypertrophy. The educator asked him where he stored his insulin, and he reported, ‘In the refrigerator.’ The seasoned educator then asked, “Where in the refrigerator?” to which he responded, “In the butter dish.” As this seemed like a small area to store insulin, the educator pursued this response by asking how he fit all of his insulin in the butter dish when he received a new order, to which the patient replied, “I only keep the pen I am using in the refrigerator as it has been opened. I keep the rest of the pens in their box on the top of the fridge.” Of course, the lack of appropriate storage and the heat generated by the refrigerator would have decreased the effectiveness of all of his stored insulin in the matter of a few weeks.
- Use investigative and motivational interviewing techniques and teach-back when trouble-shooting problems with 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!