Authors: Jenny Wright, MD, Diane Britt, ARNP
Last updated:
Testing Supplies: who needs testing?
- Patients with type 2 diabetes who are well controlled on metformin or diet alone may not need to test their blood sugars daily. However, checking periodically is still useful to identify changes in glycemic control prior to the next A1c test.
- Testing is useful when:
-the patient is taking a hypoglycemic medication (eg sulfonylureas, insulin)
Testing Supplies: how to order
Check the ones you want:
- Blood Glucose Lancets
- Blood Glucose Monitoring Kit (Do not specify brand)
- Blood Glucose test strips (On Insulin) (Never specify brand unless asked to)
- Blood Glucose test strips (No insulin) (Never specify brand unless asked to)
Insurance issues:
- Medicare: Can’t be e-prescribed. Give prescription to patient or have faxed
- Medicare/Medicaid allowed quantity of test strips: Once a day if not on insulin, 3 a day if on insulin
- You will ALWAYS get a fax to fill out later, even if you put all required information on your script.
Insulin: how to order
Glargine:
Insulin glargine 100 units / mL solution (aka Lantus)
Option #1: Epic smart set:
Insulin syringe, ½ cc, 31g, 8mm (5/16). Insulin, typical starting prescription: Insulin glargine 10 units subcutaneous q HS, prescribe vials.
- If a patient uses 20 units qhs (0.2 mL), then per month would use 20×30=600 units, or 6 mL. (rough ballpark: 30 units a day is about 1 vial a month)
- Give 3 months supply (usually 2-3 vials, depending on their dose)
- Need to prescribe syringes. Needles are included with the insulin syringes.
Example
Dose: 20 units glargine qhs 3 months supply Number of needles / syringes Insulin glargine (1 vial has 10 mL, or 1000 units) 600 units a month 1800 units for 3 months = about 2 vials Needles: 90 days = __ box
Option #2: order individually. In this case you will be offered a dizzying array for options of syringes: recommend using Facility List and selecting INSULIN SYRINGE-NEEDLE U-100 31 G x 5/16” 0.5 ML or 15/64” length
Note: shorter, thinner needles are generally preferred by patients and do a fine job delivering insulin; 1 mL is needed for patients on >50 units of insulin per injection, ½ cc/mL if on <50 units. Can use a 0.3 mL if on <30 units, though often patients are quickly titrated up to or beyond this dose, therefore may just want to start with ½ mL.
Education:
How to teach a patient to use their glucose meter:
Order the glucose meter and have the patient bring it to the visit/class.
Options:
Referral to the DCC diabetes education class: In Meds&Orders enter Ref Diab Ed, then selects UWMC Endo/Diabetes Care Center, Group Education Class or Ask RN to review with patient or Refer to Diane Britt: not a referral, but indicate this on Epic in the follow-up details for the front desk staff.
How to teach a patient to use basal insulin:
Order insulin at time of referral, they should take all the supplies with them to the visit/class.
Options:
Refer to the Diabetes Care Center’s insulin start class to learn about insulin and be taught how to inject. In Meds&Orders enter Ref Diab Ed, then selects UWMC Endo/Diabetes Care Center, Insulin Start Class. Have the patient be seen by Diane Britt: not a referral, but indicate this on Epic in the follow-up details for the front desk staff. Clinic RNs can also teach patients how to do injections.
Notes on insulin pens:
- When taking once a day long acting insulin: using the old school bottle and syringe system is really not a big deal (very little convenience advantage with pens, and much higher cost)
- Give 3 months supply, noting that pens come in boxes of 5 (1500 units) and most pharmacies will not want to break a box
Example
Dose: 20 units glargine qhs 3 months supply Number of needles / syringes Insulin glargine pen-injector (1 pen has 3 mL, or 300 units) 600 units a month 1800 units for 3 months = 6 pens, round up to 2 boxes Needles: _____ Syringes: n/a
