As a diabetes educator I’ve seen a lot of my patients come in with blood glucose not well controlled and have assisted them with management. One patient in particular stands out. She had been through our diabetes classes and came to see me for a 1:1 visit. She entered into my office complaining that her blood sugars were still high. I downloaded her meter and sure enough all readings were over 600mg/dl, except one reading which registered low, and this was over a 2 week period. She was on a fairly large dose of basal insulin and was also on mealtime insulin + correction scale with each meal. I checked her BG in the office and my meter read HI. She was fine, only complaint was that she was thirsty. After talking with the doctor we decided not to send her to the ER but to give insulin in the office and check blood sugar every ½ hour. She brought her insulin pens and other medications with her that day. I asked the patient to demonstrate administering her insulin, since she was on the insulin pens. Upon demonstrating, I found that she was not priming the pen needle, was dialing up correct dosage and sticking self but not pushing the injection button to administer the insulin. She thought that the pen administered the medication on its own. Needless to say, after 2 and ½ hours of giving her rapid acting insulin and checking finger stick blood glucose, her blood glucose was down to 345 mg/dl before going home. During this time, I allowed her to administer each dose of insulin using the insulin pen. Before going home she was able to demonstrate well how to prime pen, dial up dose and administer her insulin. Everyone was happy and I’m sure her readings will be much better at next visit.
Lesson Learned:
When my patients complain about giving their insulin and blood glucoses are still high I have them demonstrate their injection technique. If using an insulin pen I let them demonstrate priming, dialing up dosage and administrating medication. If they are using the vials, I have them demonstrate their drawing up technique. I have found this helps when troubleshooting blood sugar problems!
What have you experienced?
Annie Littlejohn, BSN, RN, CDE