Insulin Management

Glucose Physiology

·     Explain how insulin works

·     Understand why insulin may be needed as a therapy option in type 2 diabetes

Management guidelines for type 2 diabetes

·     Understand the principles of the NICE¹ guidelines and ADA/EASD² consensus report for the treatment of type 2 diabetes

·     Understand how these principles are implemented in their local guidelines

·     Understand the need to tailor targets and treatment to the individual person with type 2 diabetes

Types of insulin

·     Explain what types of insulin and insulin regimens are available for people with type 2 diabetes

·     Describe the benefits and limitations of each type of insulin regimen

·     Be able to discuss Co Formulation therapy options available

Insulin and Lifestyle:

Diet

·       Work in partnership with the person with type 2 diabetes to identify realistic and achievable strategies to minimise weight gain or encourage weight loss

·       Explain why an awareness of calorie content and carbohydrate awareness is important with all insulin regimens

·       Understand the support required and available locally to assist the individual in achieving their personal targets

Insulin and lifestyle: Physical activity

·     Work in partnership with the person with type 2 diabetes to set specific activity targets and understand the benefits.

·     Explain how the insulin regimen or food intake may need altering when physical activity is planned

Insulin and Lifestyle: other considerations

·     Be able to discuss with the effects of smoking alcohol and recreational drugs in relation to diabetes

Blood glucose monitoring

·     Explain the need for blood glucose monitoring including frequency of testing and DVLA³ regulations regarding driving and insulin therapy

·     Explain Explain what HbA_1c⁴ is and how often it is measured

·     Be able to support the individual in setting clinical targets for monitoring the control of their diabetes

·     Agree with the individual appropriate timing and recording of blood glucose monitoring, according to their individual circumstances.

·     Discuss how someone with type 2 diabetes can interpret blood glucose results and use them to optimize their insulin therapy by taking the appropriate action

Optimising communication

The person centred approach, tips for communicating effectively

·     Understand and describe how the need for life-long self-management of diabetes can affect people with type 2 diabetes

·     Adopt a person-centred approach, which includes an understanding of each person’s perceptions as well as empowering communication and elaboration

·     Understand models of treatment decision making and ley listening skills

Insulin practicalities

·     Be able to fully demonstrate the correct injection technique and appropriate injection sites including the importance of rotation of injection sites and use of correct size needles

·     Identify areas of lipohypertrophy by examination of injection sites and advise on how to manage them

·     Propose solutions to common injection site problems

·     Provide practical information on insulin storage and disposal of sharps

Hypoglycaemia

·     Provide information to people with type 2 diabetes about hypoglycaemia including, signs and symptoms, management and DVLA regulations

·     Be able to advise on nocturnal hypoglycaemia, how to recognise and manage

Devices

·     Identify the most appropriate insulin delivery device for person with type 2 diabetes and be able to demonstrate how to use it

Altering the insulin regimen

·     Understand when a change in insulin regimen is required

·     Recommend a change in dose, regimen or type of insulin based on individual needs and blood glucose results  

·     Be able to advise on changing to a basal insulin, pre-mixed insulin, or a basal-bolus insulin regimen

·     Recognise potential barriers to intensification

1. NICE, National Institute for Health and Care Excellence

2. ADA/EASD, American Diabetes Association, European Association for the study of Diabetes

3. DVLA, Driver and Vehicle Licensing Agency

4. Hba1c, Glycated hemoglobin