Q&A: Community Pharmacists Educate Patients on Safe Insulin Use

In this interview, Jennifer Griffin, PharmD, clinical pharmacist at Harps Food Stores Inc, explains how pharmacists play a critical but often overlooked role in insulin management and diabetes care. As more patients are started on insulin without adequate education on injection technique, blood glucose monitoring, or even the basics of diabetes, pharmacists are stepping in to fill those gaps. Griffin describes how community pharmacists use their frequent contact with patients to provide hands-on instruction, identify early warning signs such as hypoglycemia or injection-site problems, and collaborate with the care team to adjust therapy. She also emphasizes the importance of tailoring insulin regimens to each patient’s age, hypoglycemia risk, cognitive and physical abilities, insurance coverage, and personal preferences. By simplifying regimens, selecting affordable options, and offering clear guidance on safe insulin use and self-titration, pharmacists can improve glycemic control and empower patients to better manage their condition.

Drug Topics®: What is the most critical contribution a pharmacist makes to the interdisciplinary care team when managing patients on insulin?

Jennifer Griffin, PharmD: In my opinion, one of our biggest roles as a pharmacist on that care team is going to be education. So whether that is educating the patient or even educating other members of the care team. We hear it all the time. Pharmacists are the medication experts. We have so much education when it comes to these medications and insulin management, so it's important that pharmacists are empowered to speak up and share that expertise, and this can look like educating patients on proper injection technique or how to manage their hypoglycemia, or even speaking up when we have a dosing concern and having those conversations with the care team.

Drug Topics: What knowledge gaps or procedural errors concerning insulin use are most frequent in the general patient population, and why is the pharmacist uniquely positioned to address them?

Griffin: This is going to sound really sad, but we have many patients that have been started on insulin therapy or recently diagnosed with diabetes or were told to start checking their blood glucose daily, but we're not educated at all on how to use insulin or how to use a blood glucose meter, or even what diabetes is. These are common situations where a pharmacist in the community setting can pull these patients aside and, for example, open up a blood glucose meter box and walk the patient through how to use it, step by step, and then what the results mean and what those ranges are and what we're looking for. Educating patients when it comes to these chronic disease states is going to be imperative because it's going to lead to them having better control of their conditions [and] because the patients are going to be empowered by having that knowledge. It's all worth it when patients are excited to tell you their last A1c reading or tell you how well their blood glucose has been managed lately, and they're proud of the progress that they've made because of your help and your education that you provided to them. Pharmacists may also be the first to know about any problems with a medication regimen. So in the community setting, the patient may just make a comment that they've been having some bouts of hypoglycemia, or they've maybe developed a lump where they always inject their insulin. These are simple statements that can prompt an educational conversation, where if we were not in that scenario, it may lead to further complications, and so pharmacists are uniquely positioned because of the frequent contact with the patient and our ability to provide that ongoing support to the patient.

Drug Topics: What primary clinical factors and patient characteristics must a pharmacist consider when recommending an optimal insulin product or regimen change?

Griffin: There are numerous clinical factors and patient characteristics that we need to consider. So thinking about patient characteristics, we want to look at their age. What is their risk of hypoglycemia? If they're older, are they more at risk of having episodes of hypoglycemia potentially leading to a fall? We need to consider things like that. What are their cognitive or physical capabilities? I think a lot about what their insurance coverage is, and then, of course, what is the patient's their preference in all of this. If the patient's not on board with the treatment plan, then it's not going to be successful when they're home and they're in control, and they're the one that's deciding whether or not they're going to take their medication or inject their insulin. Going back to kind of what I was saying about the insurance coverage, so in the community setting, cost and which insulin is on the patient's formulary is going to be a big factor. Working with the patient and the provider to make sure that we're getting something that the patient can afford each and every month, because if they can't afford it, and they can't get it, and they're not going to be using it, and then, regarding a patient's cognitive and physical capabilities, we need to make sure that the regimen is as simple as possible, I mean, for everyone, and that the patient can adhere to it on a daily basis. For example, patients may have an easier time using the insulin pens as compared to using a multidose vial and using the small syringes to draw up that amount, and then, this point is so important and it's very obvious, but we need to take a look at their glycemic control. This is going to help us make an informed decision of moving forward with their deciding on a medication regimen for them.

Drug Topics: What are the general rules or safe practices a pharmacist adheres to when instructing a patient on how to self-titrate their insulin doses?

Griffin: Safety is, of course, number one, and patients often do what they want to do. So they may say that because 1 tablet works great, 2 will work even better, or because they're feeling good, they aren't going to take their cholesterol medication. The same goes for insulin therapy. Patients may see that their blood sugar is high, so they will self-titrate. It happens all the time, and this is why, again, education is so, so important, and that patients understand the disease state and how their medications work from the beginning. Whenever a patient is first started on insulin therapy, I want them to know how dangerous insulin can be if used incorrectly, but I don't want them to be afraid of it, only cautious with it. So generally, I want patients to know the situations that can cause significant changes in their blood sugar, like being sick, steroids, new medications, and so they can know how to handle these situations. Also, we don't want to adjust too much at one time. So with self titrating, we want to make sure that, what are their blood glucose readings? We want to make sure that they're checking these regularly, and so they they need to have clear guidelines for self titration. For example, if their blood sugar is within a certain range, we're going to simply increase basal insulin by a couple units every few days. So those small changes and just having clear set guidelines for the patient, and so they're not confused and making too many changes at once.