Give patients a list of things to ask and expect at every doctor's visit.
Talking to Patients About Starting Insulin Therapy
Some tips to get started
- Ask patients about meal timing and composition
- If consistent, an unchanging dose may be effective
- If variable, flexible dosing will be needed to match needs
- If prescribing mixture insulin, counsel patients on the need to maintain consistent daily food intake and schedule to avoid the risk of hyperglycemia and hypoglycemia
- Consider a referral to a diabetes educator or recognized diabetes education program for instruction in injection techniques, carbohydrate management, and insulin self-adjustment
- Provide patients with a checklist of self-care suggestions to keep them on track
- Educate patients on the warning signs of hypoglycemia and consider providing a prescription for Lilly Glucagon [glucagon by injection (rDNA origin)], so patients are prepared in case of an emergency
No matter how compelling the need to start insulin may be, every healthcare provider has dealt with patients who resist or refuse. This behavior has been called "psychological insulin resistance." Below are some tips to help open a dialogue with patients who resist starting insulin.
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Start with a question to understand their concerns:
"What worries you most about starting insulin?"
"What do you think will happen if you start insulin?"
"Why do you think insulin is bad?"
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Reflect and probe:
"So, you're afraid it will hurt. Have you ever taken a shot with an insulin pen/syringe?" -
Create a sense of urgency:
"Your A1C is X, but your target is 7.0% or less. What do you think will happen if your control doesn't improve?" -
Acknowledge and commit together:
"Given what we've talked about, are you willing to give insulin a try with my support?"
Important Safety Information
Humalog insulins are contraindicated during episodes of hypoglycemia and in patients sensitive to Humalog or one of its excipients. The safety and effectiveness of Humalog in patients less than 3 years of age have not been established. Safety and effectiveness of Humalog Mix75/25 and Humalog Mix50/50 in patients less than 18 years of age have not been established. There are no adequate and well-controlled clinical studies of the use of Humalog in pregnant or nursing mothers.
Potential side effects associated with the use of all insulins include hypoglycemia, weight gain, hypokalemia, lipodystrophy, and hypersensitivity. Because of the difference in action of Humalog, care should be taken in patients in whom these conditions may be clinically relevant (e.g., those who are fasting, have autonomic neuropathy or renal impairment, are using potassium-lowering drugs, or taking drugs sensitive to serum potassium level). Patients should be advised not to mix Humalog Mix75/25 or Humalog Mix50/50 with another insulin. Starting or changing insulin therapy should be done cautiously and only under medical supervision.
When used in an external insulin pump, Humalog should not be diluted or mixed with any other insulin. Humalog Mix75/25 and Humalog Mix50/50 are not indicated for use in external insulin pumps.
Humalog differs from regular human insulin by its rapid onset of action, as well as a shorter duration of activity. Therefore, Humalog and Humalog Mixtures should be given within 15 minutes before a meal. Humalog can also be given immediately after a meal. The short duration of action of Humalog means that patients such as those with type 1 diabetes, whose basal insulin levels are inadequate, will also require a longer-acting insulin to give optimal glucose control (except when using an insulin pump).
Clinical studies comparing Humalog Mix75/25 with human insulin mixtures did not show a difference in the overall rate of hypoglycemia between the two treatments. The overall rate of hypoglycemia did not differ between type 1 and type 2 patients treated with Humalog, as compared with regular human insulin. The lower rate of hypoglycemia with Humalog may be related to higher nocturnal blood glucose levels, as reflected by a small increase in the mean fasting blood glucose levels.
The clinical significance of improvement in postmeal hyperglycemia has not been established. In 12-month clinical studies, A1C did not differ between patients treated with regular human insulin and those treated with Humalog.
Humalog, Humalog Mix75/25, and Humalog Mix50/50 are available by prescription only.
For other important safety information and prescribing considerations, please see Humalog, Humalog Mix75/25, and Humalog Mix50/50 Prescribing Information.
Humalog is a registered trademark of Eli Lilly and Company. Humalog Mix75/25 and Humalog Mix50/50 are trademarks of Eli Lilly and Company.
Humalog insulins are contraindicated during episodes of hypoglycemia and in patients sensitive to Humalog or one of its excipients. The safety and effectiveness of Humalog in patients less than 3 years of age have not been established. Safety and effectiveness of Humalog Mix75/25 and Humalog Mix50/50 in patients less than 18 years of age have not been established. There are no adequate and well-controlled clinical studies of the use of Humalog in pregnant or nursing mothers.
Potential side effects associated with the use of all insulins include hypoglycemia, weight gain, hypokalemia, lipodystrophy, and hypersensitivity. Because of the difference in action of Humalog, care should be taken in patients in whom these conditions may be clinically relevant (e.g., those who are fasting, have autonomic neuropathy or renal impairment, are using potassium-lowering drugs, or taking drugs sensitive to serum potassium level). Patients should be advised not to mix Humalog Mix75/25 or Humalog Mix50/50 with another insulin. Starting or changing insulin therapy should be done cautiously and only under medical supervision.
When used in an external insulin pump, Humalog should not be diluted or mixed with any other insulin. Humalog Mix75/25 and Humalog Mix50/50 are not indicated for use in external insulin pumps.
Humalog differs from regular human insulin by its rapid onset of action, as well as a shorter duration of activity. Therefore, Humalog and Humalog Mixtures should be given within 15 minutes before a meal. Humalog can also be given immediately after a meal. The short duration of action of Humalog means that patients such as those with type 1 diabetes, whose basal insulin levels are inadequate, will also require a longer-acting insulin to give optimal glucose control (except when using an insulin pump).
Clinical studies comparing Humalog Mix75/25 with human insulin mixtures did not show a difference in the overall rate of hypoglycemia between the two treatments. The overall rate of hypoglycemia did not differ between type 1 and type 2 patients treated with Humalog, as compared with regular human insulin. The lower rate of hypoglycemia with Humalog may be related to higher nocturnal blood glucose levels, as reflected by a small increase in the mean fasting blood glucose levels.
The clinical significance of improvement in postmeal hyperglycemia has not been established. In 12-month clinical studies, A1C did not differ between patients treated with regular human insulin and those treated with Humalog.
Humalog, Humalog Mix75/25, and Humalog Mix50/50 are available by prescription only.
For other important safety information and prescribing considerations, please see Humalog, Humalog Mix75/25, and Humalog Mix50/50 Prescribing Information.
Humalog is a registered trademark of Eli Lilly and Company. Humalog Mix75/25 and Humalog Mix50/50 are trademarks of Eli Lilly and Company.
