Transcript How to Use Short Acting Insulin Patient Education Handout

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 teaching
 Sent home with insulin prescriptions (lantus +
humalog)
 Called
me 2 days later; not using shortacting 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

TLC
PO
PO + Ins
Insulin
*Therapeutic LifestyleChanges
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
 ADA
 FamilyDoctor.org
 Aurora
‘For Your Well-Being’
 Google search
 TuOtroMedico
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: 127.0 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