Incorporating more insulin into a patient’s treatment plan can be difficult. In “Overcoming Barriers to Insulin Intensification: Case Discussions – Part 1,” diabetes experts address issues surrounding initial insulin treatment by examining case studies with the goal of helping clinicians learn how to approach common clinical scenarios.
Presenters for this program include Richard Beaser, MD, Associate Clinical Professor of Medicine at Harvard Medical School; Om Ganda, MD, Associate Clinical Professor of Medicine at Harvard Medical School; and Stephen Brunton, MD, Adjunct Clinical Professor of Pharmacy Practice at Roseman University.
In this video, presenters review the case studies of two diabetic patients, “Roger” and “Celia,” who require insulin to manage their diabetes. Each patient has his or her own concerns related to insulin therapy, co-morbidities, and lifestyle factors. These concerns affect the type and administration of insulin each patient uses on a daily basis. By watching as the physicians in this video troubleshoot the patients’ concerns in the case studies, medical professionals can apply these principles to the management of their own patients.
Roger: Insulin Initiation and Responding to Patient Objections
In the first case study, the patient “Roger” has several objections about starting insulin therapy. Namely, he is concerned about hypoglycemic episodes and associates using insulin with his father, who died from complications of his diabetes. Dr. Brunton says that it is important to emphasize that insulin therapy is a natural treatment, and not a sign that a patient’s diabetes is worsening.
“This is not your father’s insulin anymore, we’ve really progressed a lot in terms of particularly analog insulins and the propensity for not only preventing hypoglycemia, but also getting much more easier to use,” Dr. Brunton says. “So when people say they don’t want insulin, I like to say ‘what is it that you don’t want’?”
During the presentation, the physicians work through evaluative steps that can help guide Roger’s ultimate insulin therapies. They review the suggested sequence for the assessment of glycemic patterns as well as Roger’s unique self-monitoring of blood glucose reports. The doctors also review a scenario after Roger is started on insulin to illustrate how physicians can further individualize therapy while monitoring for adverse effects, such as hypoglycemia.
Celia: The Benefits of Adding Bolus Insulin
The second case study is “Celia,” a 71-year-old female with coronary artery disease who is experiencing significant difficulty losing weight and who is frustrated over her diabetes control.
Celia’s case study serves as an example for physicians to use research-based recommendations on incorporating a “basal plus” program where bolus insulin is added to regular basal insulin values.
“To use some short-acting insulin at the largest meal gives you the opportunity to both decrease post-prandial glucose and actually getting the patient to use something that’s very friendly to use,” Dr. Brunton says.
While both case studies bring forth various challenges in managing a patient’s diabetes, each illustrates how diabetes management can require making regular adjustments to help a patient with diabetes meet his or her treatment goals.
“The point is that we need to keep following the patient closely, and we need to keep encouraging her to keep monitoring her blood sugars levels,” Dr. Ganda says.
To view each case more in-depth and to earn CME credits, please watch “Overcoming Barriers to Insulin Intensification: Case Discussions – Part 1” on DiabetesSeries Live.
By: Rachel Nall, RN, BSN, CCRN
Disclaimer: “All PlatformQ Health articles, reports, summaries, and recaps of events are for informational purposes only. The quotes and opinions of the speakers covered are not to be taken as direct advice for individual patients. Patients should always seek care from qualified, properly accredited healthcare professionals.”