A patient came to us on reasonably high doses of basal bolus insulin, using Levemir and NovoLog flex pens. He stated that he had been using insulin for a few months and was referred for more management assistance from his provider. He was seen by a CDE to review his meal management and insulin regimen. Since he lived some distance away, we relied on telephonic support for patient-reported glucoses and protocol insulin adjustments. Blood glucoses continued to climb with further increases in insulin….
After substantial insulin increases, the patient was finally asked to bring all meds and supplies to his next DSME session. He demonstrated the use of his insulin pen by removing the outer cap on the pen needle but did not remove the needle protector when he injected resulting in no insulin delivery. This indicated that the entire time he was “on insulin” he had not, in fact, been actually getting any medication.
In spite of the fact that we met the patient well after his insulin was started by a different provider, we felt we were implicit for this lack of sufficient insulin pen instruction. As a CDE, my procedure now is to review the patient’s technique no matter how long their treatment plan has been in place, something I will never forget. Our patients are direct-marketed constantly on how they can “get a sample of blood without having to poke their finger” so it may stand to reason they would think a device for taking insulin that they are completely naïve to would work without poking into their skin.
Kristine Kilen, RD, CDE
Diabetes Education Program
Billings Clinic Miles City
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