Editor’s Desk, DCMS #140

I just finished a class this morning with seven patients in an endocrinologist’s office. They were seven of the most diverse patients I have ever had in a class; two patients on orals, an oral and basal insulin patient, a type 2 who was dependent on insulin, a type 1.5 patient, and two type 1 patients who had been on insulin for many years. One of these patients was on a mixed regimen three times a day with sliding scale correction and one was on a basal/bolus regimen with carb and correction ratios. Most of you have had days with these multiple types of patients and using a one-size-fits-all approach would never work here. To help you work through this kind of situation I recommend you check out this week’s Clinical Text from Elizabeth Blair, MSN, APRN, BC, CDE and Joslin’s Diabetes Deskbook.

If you have patients who use a lot of insulin then you may decide they should be on U500 regular insulin. You can probably figure out how to correctly dose this, but will your orders get carried out correctly? This week’s Disaster Averted looks at how easily U-500 errors can occur, and then be sure to check out Part 4 of our Homerun Slides on Core Defects of Type 2 Diabetes. Our Mastery In Minutes video featuring Mary Ann Hodorowicz has some terrific insight into the barriers which may not be what you expect clinicians face when setting up SMA’s (Shared Medical Appointments).