Suggest that insulin will help patients achieve glycemic targets and minimize the risk of long-term complications
Allow patients to actively participate in their insulin dose titration
Always praise patients on insulin at their visits for their efforts at achieving their glycemic targets
○ Remember, patients who are using insulin do not have normally functioning pancreases
○ They are performing their own insulin dose calculations, perhaps multiple times each day
○ Insulin prescribers should do everything possible to help patients become successful users of insulin
Individualize therapy to meet the needs of each patient
Emphasize the importance of lifestyle intervention
Consider group office visits to have patients meet with a certified diabetes educator diabetes educator
Provide each patient with an individualized, written insulin protocol to which they can refer
Prescribe insulin pen devices whenever possible
Teach patients how to identify and appropriately manage hypoglycemic events
When initiating basal insulin, use 0.4 U/kg/day as the starting dose
If patient requires > 60 U of basal insulin per day, and his or her A1C level is >7%, add a rapid-acting insulin analog at the largest meal of the day
If A1C level is not reduced to target after 3 months of basal plus bolus insulin, add a second injection at the next largest meal of the day
Patients on basal-bolus insulin therapy should consider modified paired glucose testing in order to fine-tune their treatment regimens
|