Q&A: Helping Patients Navigate the First Steps of Insulin Therapy

Starting insulin can be an overwhelming experience for many patients, filled with uncertainty and fear. Community pharmacists are uniquely positioned to guide patients through this transition, offering education, encouragement, and hands-on support. By addressing both emotional and practical concerns, pharmacists help set the stage for insulin success.

Q&A: Helping Patients Navigate the First Steps of Insulin Therapy / 6okean - stock.adobe.com

Drug Topics® recently sat down with Susan Cornell, PharmD, CDCES, FAPhA, FADCES, experiential education specialist and professor emeritus at Midwestern University, to discuss the most important counseling points pharmacists should cover when a patient is picking up insulin for the first time and how pharmacists can handle conversations with patients who express fear or resistance toward starting insulin therapy.

READ MORE: Pharmacists Can Enhance Patient Confidence During Insulin Initiation

Drug Topics: What are the most important counseling points pharmacists should cover when a patient is picking up insulin for the first time?

Susan Cornell, PharmD, CDCES, FAPhA, FADCES: It depends on what type of insulin the patient is picking up. There's basal insulin, which is the long acting, and then there's mealtime insulin, which is short acting and just covering a meal. I think first of all, explaining that to the patient, the pharmacist needs to counsel on the type of insulin the patient is getting. If it's long acting, the majority of our long acting insulins today don't have that risk of hypoglycemia as much as the mealtime insulins or an intermediate insulin, something like NPH [neutral protamine Hagedorn]. It's very important for the patient to understand what type of insulin they're getting. What should they expect out of it?

In the terms of hypoglycemia, because everybody thinks,” Oh, insulin, it's bad. It means my diabetes is terrible.” First of all, reassuring the patient that insulin is a good drug. Our body makes insulin, and just because you're on it doesn't mean that you've done anything wrong. The other thing, too, is depending on the type of patients, if it's type 1 or type 2 [diabetes]. If it’s a person with type 1, they absolutely have to have insulin, so they need that because their body isn't making insulin. But if it's type 2, just because they started doesn't mean they're on it forever. I think that to alleviate some of the fears that a person with diabetes has when they're being prescribed insulin, that is one of the biggest things that a pharmacist needs to do.

Most importantly is showing the patient how to use the injection. Is it a vial and syringe, or is it an insulin pen? If it's a syringe, the patient needs to know how to put the air in, drop the appropriate dose of insulin, how to do proper injection technique. If it's an insulin pen, they have to be able to put on the pen, needle, take off the safety caps, and then dial up the priming dose, as well as the correct dose, to administer, and then administer it correctly.

I think for pharmacists, when they're counseling a patient for the first time, making sure the patient understands the type of insulin they're getting, what they should expect from it, in terms of is it going to be a long acting or short acting insulin? Is this something that they're going to be on forever, or is it just maybe we'll see how things go and as diabetes improves, we can de prescribe. And finally, how to use the medicine, how to administer it. I can't tell you how important it is for us to educate patients on how to properly dose the insulin and administer it. I could be here for days telling you stories of how things go bad. People forget to take the cap off the needle. They don't inject the right amount, they don't do the priming dose. There's so many things that could go wrong.

Making sure the patient understands how to do it, and if at all possible, if it is a long acting insulin, maybe the patient takes the first dose right there in front of the pharmacist, so the pharmacist knows their technique is correct. Those are some opportunities for pharmacists, especially in a community setting.

Drug Topics: How can pharmacists handle conversations with patients who express fear or resistance towards starting insulin therapy?

Cornell: We could be here for days talking about this, because this is really a hot topic. Insulin gets a bad rap. Insulin doesn't get the respect that it deserves. First of all, insulin has been around for over 100 years, and if it wasn't for the discovery of insulin, people with type 1 diabetes wouldn't have the lifespan that they do today. Insulin is a great drug, but it has to be used carefully. It comes with some rules and policies that have to be followed.

Insulin is a respectable drug, and we shouldn't give it the bad rap that it continues to get. Many people look at insulin as, “Oh my gosh, if I'm on insulin, that means I'm going to die.” Much of that has to do with insulins of 20, 30, 40, years ago, and granted, before the plethora of drugs that we have today, by the time people had to go on insulin, [their diabetes] had progressed so bad that maybe they didn't live much longer after that. But it wasn't the insulin that did the damage. Unfortunately, people waited too long to start insulin. The disease is progressive.

However, with everything we have today in terms of our lifestyle management, drugs, and devices, it is really an opportunity to manage diabetes better than we ever have before. One of the things we're seeing today, more than ever before, is people that are on insulin with type 2 diabetes. That's sometimes the first drug we prescribe as their diabetes becomes more managed. As their lifestyle gets better, their a1c goals improve, their blood sugars are in range, they're doing well, we can actually take insulin away.

I think one of the biggest things to share to patients is number 1, insulin is a respectable drug. It gets a bad rap. It will not kill you, it will help. Just because you started doesn't mean you're on it forever. It can be stopped, but only in type 2 diabetes at this point. I think when people realize that it helps. The other thing is to also talk to patients about if they would be willing to give insulin a try for a short time. Almost a trial period, a dating phase, so to speak. When you say that to a person, “Why don't we just give insulin a try for a month or so, or even a week. Let's just give it a try for a week, and let's see what it does to your blood sugar. Then we'll discuss after that.” When people hear that, they'll start on it, and then maybe they don't need to continue it, they're more likely to embrace it. Just reminding people it's a good drug. It does well, and just because you started, doesn't mean you're on it forever.

READ MORE: Insulin Management Resource Center

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