CP04 Insulin and Blood Glucose - Devon Partnership NHS Trust

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Most people will have received their passport / insulin safety card and the patient information leaflet from either their diabetes specialist nurse or GP. However, Trust prescribers must check that the person has received this information and provide a replacement if necessary. The Medicines Management Team will provide the wards with passports Information leaflets can be printed from here (or contact Medicines Management for a copy) Ensure that you record the check and provision of a leaflet or passport on Rio. 2.4 All Insulins must be prescribed on form F11 Diabetes Chart (see Appendix 1). Care must be taken to ensure that the insulin type is fully documented including: Full brand name (e.g. Humulin M3 not just Humulin; Humalog Mix 50 not just Humalog Mix) Insulin species where applicable (e.g. human / bovine / porcine) Device (e.g. vial / cartridge / disposable pen) Dose (do NOT use the abbreviations IU or U for Units as this is a well documented source of dosage errors with the I being mistaken for the number one and U for a zero). A Guide to Insulin Preparations is available from MIMS: http://www.mims.co.uk/Tables/1096962/Insulin-Preparations/DCMP=ILC-SEARCH 2.5 The Diabetes Chart should be referenced on the front of the Prescription and Administration Chart in the additional chart section. The Insulin should also be listed in the regular medicines section of the Prescription and Administration Chart but no dosage instructions should be provided and the instruction “See Diabetes Chart” should be written in the additional information (i.e. all dosage and administration records should only be made on the Diabetes chart). 2.6 Non-insulin injectable products for the management of diabetes must be written on the inpatient prescription and administration record and not on the insulin chart. 2.7 If someone is admitted with a prescription for an insulin that isn’t included in the local formulary (click here to access the Devon formularies) every effort should be made to continue with this product during the inpatient stay. This can be achieved by using the person’s own supply (providing it has been stored as specified), by requesting a supply via FP10, or by the acute trust pharmacy making a special order. Contact your acute trust pharmacy and diabetes specialist centre for advice on an individual basis. 2.8 Some people may be prescribed an insulin dose range rather than a specific dose and they may be used to adjusting their insulin dose in response to their blood glucose results. Confirm the person’s’ treatment regime with the GP or specialist diabetes service and document in Rio notes and on the Diabetes Chart. 2.9 Once the Diabetes chart is complete or the person is discharged then it must be scanned into the clinical documentation section on Rio. 2.10 Contact your local diabetes specialist centre if you are unfamiliar with any aspect of a person’s diabetes care. CP04 Prescribing and Administering Insulin and Monitoring Blood Glucose Approved by Drug and Therapeutics Committee: April 2014 Review Date: April 2016 4 of 9
3. Glucose Monitoring 3.1. Blood glucose levels are assessed by measuring either glucose or glycosylated haemoglobin A1c (HbA1c). Blood glucose results provide a snap shot specific to the moment of the test whereas HBA1c results reflect blood glucose control over the previous 2 to 3 months. 3.2. Urine testing is occasionally used but it does not give information regarding hypoglycaemia and is unsuitable for use by people who use insulin to control their diabetes. 3.3 Glycosylated Haemoglobin Targets (HbA1c) When a person with diabetes is admitted to an inpatient unit, the prescriber should check the following with their GP and record the details in Rio. Date of the last HbA1c test Result of the last HbA1c test HbA1c target for this individual. 3.4 There are three target levels for HbA1c in GPs Quality and Outcomes Framework (QOF); 59, 64 and 75 mmol/mol. The three targets are provided as an incentive to improve glycaemic control across the distribution of HbA1c values. The lower level may not be achievable or appropriate for all patients. 3.5 HbA1c should be monitored at 2 to 6 monthly intervals until the level is stable and then at 6 monthly intervals. Blood samples need to be sent to pathology lab for analysis. Results should be recorded in Rio notes. 3.6 Blood Glucose Targets Blood glucose monitoring is appropriate for people with: type 1 or 2 diabetics who use insulin type 2 diabetics who are taking a sulphonylurea and who are at a greater risk of hypoglycaemia type 1 or 2 diabetics when the person has an intercurrent illness including infection, stress, or trauma that could affect insulin or oral hypoglycaemic drug requirements type 1 or 2 diabetics when introducing medication that may affect diabetes control (e.g. addition of an antipsychotic) 3.7 Blood-glucose concentrations vary substantially throughout the day. The usual target is to maintain a concentration of 4 to 7 mmol/l before meals and less than 9mmol/l after meals. 3.7 Blood glucose targets should be documented by the prescriber on the Diabetes Chart with actions to be taken if results are outside of the acceptable range. 3.8 For the Management of Hypoglycaemia in Adults with Diabetes Mellitus, see Clinical Protocol CP21 (available on the Trust website – For Professionals and Prescriber section) 3.9 There are no national guidelines for the frequency of glucose testing. The optimum testing regime will depend on the diabetes treatment, the degree of glycaemic control desired and the preferences of each individual. CP04 Prescribing and Administering Insulin and Monitoring Blood Glucose Approved by Drug and Therapeutics Committee: April 2014 Review Date: April 2016 5 of 9
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CP04 Insulin and Blood Glucose - Devon Partnership NHS Trust

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