This problem seems to be the one that we see most often in our office. We had a patient who had been through our diabetes education classes and came to see me for a one to one visit. She came into my office complaining that her blood sugars were still high.
I downloaded her meter and sure enough all readings were over 600mg/dl, except one reading which registered low, and this was over a 2 week period. She was on a fairly large dose of basal insulin and was also to give mealtime insulin + correction scale with each meal. I checked her BG in the office and my meter read HI. She was fine, only complaint was that she was thirsty. After talking with the doctor we decided not to send her to the ER but to give her insulin here in the office and check her blood sugar every ½ hour….
She brought her insulin pens and other medications with her that day. I asked the patient to demonstrate administering her insulin, since she was on the insulin pens. Upon demonstrating, I found that she was not priming the pen, and was dialing up dosage and sticking herself but not pushing the injection button to administer the insulin. She thought that the pen administered the medication on its own. Needless to say, after giving her rapid-acting insulin and having her sit in the office for 2½ hours checking blood glucose, her blood glucose was down to 345 mg/dl before letting her go home. During this time, I allowed her to administer each dose of insulin using the insulin pen. Before going home she was able to demonstrate how to prime the pen, dial up her dose and administer the insulin. Everyone was happy and I’m sure her readings will be much better at her next visit.
When a patient complains about taking their insulin and that their blood glucoses are still high, have them demonstrate their injection technique. If using an insulin pen let them demonstrate priming, dialing up the dosage and administrating the medication. If they are using vials, have the patient also draw up their dosage from the vial.
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