Insulin Initiation - Dean Brown

Visit 1 Discuss need for Insulin , including barriers to overcomeHome BG testing for 2-4wk, glucose log bookVisit 2 Review log book. Discuss adjusting oral anti-diabeticsReview barriers. Discuss Insulin . Write 3 Review. Demonstrate/teach use of Insulin pen. on injection sites, dealing with low BS, diet, dosingVisit 4 Review injection technique, review log, advise re dosingDiscuss safety issues - handoutsVisit 5 Review log, discuss problems encounteredFollow up labsInsulin InitiationInsulin InitiationPhysicianInformationPatientInf ormationPrescribing InsulinIndications for Insulin InitiationStarting InsulinStep 1 - PreparationStarting InsulinStep 2 Option ABasal +/- BolusOption BPre-mixed InsulinTesting & Insulin AdjustmentTesting & Insulin AdjustmentShort-TermFollow-upShort-TermF ollow-upLong-TermFollow-upLong-TermFollo w-up Primarily fasting/pre-meal hyperglycemia +/- post-meal hyperglycemia Preference for fewer injections Consistent daily routine Unwilling to self monitor BG Limited cognitive function Limited healthcare supportStop TZDs1 4 wks3 monthsPatientInformationPhysicianInforma tion Insulin Initiation

Insulin Initiation Insulin may be used at almost any stage of diabetes In primary care, consider insulin if: Using 2 or more oral glucose lowering agents at or near

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