How to Use Short Acting Insulin

Patient Education Handout

John Brill, MD, MPH

Primary Care Clerkship

July 2009

The Patient

72 yo Latina woman Patient of mine at St. Luke’s FPC, south side of

Milwaukee DM x 8 years, with neuropathy Poor control with maximum PO Meds Very resistant to idea of starting insulin

The Patient (Cont)

Hospitalized with acute MI Started on insulin, had teachingSent home with insulin prescriptions (lantus +

humalog) Called me 2 days later; not using short-

acting insulin because unsure how

DM2

17.6 million patients in US--7.8% of adults

Prevalence increased 13.5% last 3 years One of top 10 reasons to see PCP Total cost ~ $174 billion in 2007

ADA: http://www.diabetes.org/about-diabetes.jsp

DM2 Treatment

15% TLC* 57% PO Meds 12% PO +Insulin 16% Insulin alone

*Therapeutic LifestyleChanges

TLCPOPO + InsInsulin

Source: ADA

Patient Education

Patient met with PharmD and RN to go over how to use insulin

Bilingual (not language barrier) Very afraid of hypoglycemia Needed a lot of repetition, reassurance,

reinforcement

Literature Search Search for patient education materials

ADAFamilyDoctor.orgAurora ‘For Your Well-Being’Google searchTuOtroMedico

Search results

Several websites (patient did not have internet access)

Some handouts on how to give insulin injection

No general handouts Most sites written at high reading grade level

(except FamilyDoctor)

How to Use Short Acting Insulin

Goals for handout: Simple Easy to remember: ‘TIE’ mnemonic Visually attractive, simple pictures Low reading level

Process

Draft Consulted with Pharm D Tested readibility: 127.0 grade level

Polysyllabic words: hypoglycemia, injection, frequently, carbohydrates, administer

Piloted with 2 patients

Challenges

Layout Low reading level How to integrate Sliding Scale concept Pictures

How this will be useful Can be given to patients who are being started on

insulin, or considering it Might help improve care and decrease amount of

time needed to teach Could be especially helpful in sites with limited

staff expertise Patients felt the TIE mnemonic might be helpful

for patients starting on insulin A nice reference for patient’s dosages

Limitations

Doesn’t cover long acting insulin References other handout for injection Only very simple sliding scale Would have to change handout every

time insulin dose is changed Probably wouldn’t travel with patients

Future Steps

Translate into Spanish, Hmong More culturally diverse pictures Create versions with other options for

sliding scale An electronic version that was stored

on glucometer could be very helpful