Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-64

Reassure the individual that it is not their fault that they need insulin: • Most people with type 2 diabetes will require insulin therapy to achieve blood glucose targets due to the progressive decline in beta- cell function. • Studies have shown that insulin may preserve pancreatic beta cell function when started early in the course of diabetes. Reassure the individual that advances in insulin administration devices have minimized the pain associated with insulin injections. There is increased comfort with needles that are finer, shorter (4-6 mm), laser- sharpened, and silicone-coated (155). • Insulin pens make it easier to administer insulin and ensure accurate dosing. • Address the fear of needles by demonstrating the use of pen needle/syringe and encourage the individual to try a ‘dry or saline’ injection so that they can see that there is minimal pain associated with an injection. Inform the individual that insulin therapy will be started at a low dose and titrated slowly in order to minimize their risk of hypoglycemia. • Newer insulin analogues are associated with less hypoglycemia. • The individual will be taught to recognize, prevent and treat hypoglycemia. It is imperative that the DHC team explore the individual’s fears, knowledge or personal experiences in order to clarify any misconceptions that insulin use causes complications. • Complications result from prolonged poor glycemic control and the delay in initiating insulin therapy. Instill confidence by reinforcing that insulin initiation education will consist of an overview of the treatment plan, a review/hands-on practice of the steps to giving an injection and prompt follow-up to ensure the individual’s success with insulin therapy. • The resultant improvement in glycemic levels can increase one’s confidence in their ability to self-manage their diabetes. • CDE to provide written information and instructions to the individual to reinforce information presented and learning.

Personal failure (38.4–58%) and increased severity of diabetes (38.1%).

Fear of injections and anticipated pain (34.7%).

Fear of hypoglycemia (40.6%).

Insulin associated with the onset of complications (10.1%).

Lack of confidence in ability to take insulin therapy (43.9%).