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Insulin Initiation in Primary Care

Insulin Treatment in Type 2 Diabetes. 50% of individuals will require insulinPhysician and patient reluctanceAverage HbA1c in UK 9%Referrals to Community Diabetes Team for insulin - mean HbA1c 10%Control poor for months or even years. Obesity IGT Diabetes Uncontrolled hyperglycaemia.

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Insulin Initiation in Primary Care

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    1. Insulin Initiation in Primary Care Elaine MacAninch Community Diabetes Dietitian

    2. Insulin Treatment in Type 2 Diabetes 50% of individuals will require insulin Physician and patient reluctance Average HbA1c in UK 9% Referrals to Community Diabetes Team for insulin - mean HbA1c 10% Control poor for months or even years

    3. There is a gradual deterioration in the ability of the body to respond adequately to endogenous insulin that is normally compensated for by increased insulin secretion in these patients. As insulin resistance worsens, impaired glucose tolerance may occur and patients often then progress to overt type 2 diabetes. This occurs when the ?-cells become exhausted and are unable to compensate for the increased insulin resistance.1,2 There is a gradual deterioration in the ability of the body to respond adequately to endogenous insulin that is normally compensated for by increased insulin secretion in these patients. As insulin resistance worsens, impaired glucose tolerance may occur and patients often then progress to overt type 2 diabetes. This occurs when the ?-cells become exhausted and are unable to compensate for the increased insulin resistance.1,2

    4. Insulin Initiation in Type 2

    5. NICE Guidelines – requisites for initiating insulin Provide structured education and continuing telephone support Frequent and understanding of self-monitoring Understanding of dose titration concepts to reach target Dietary understanding in relation to insulin

    6. NICE Guidelines – requisites for insulin initiation Management of hypoglycaemia Management of insulin during acute changes in glucose control ie; illness, alcohol, physical activity Ongoing support from an appropriately trained and experienced healthcare professional Legal and employments issues

    7. Insulin initiation in Type 2 Titration and optimisation can be complex Requires knowledge of suitable combinations of oral agents, time/action profiles of different insulins and impact of lifestyle behaviours on glycaemic control

    8. Insulin initiation in Type 2 Demands on time for health care professional (mean total appointment time required): DSN 4 hours 45 minutes Dietitian 1 hour 30 minutes Numerous telephone contacts in between appointments to assist self titration

    9. Insulin initiation Traditionally undertaken in secondary care but experienced practices wishing to develop skills (LES 73b) to provide payment Ensure education and support of primary care is appropriate so clinical governance structure is robust as possible LES 73b practices complete educational programme accredited by Warwick University

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