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Brief Summary

GUIDELINE TITLE

Best practice guideline for the subcutaneous administration of insulin in adults with type 2 diabetes.

BIBLIOGRAPHIC SOURCE(S)

  • Registered Nurses Association of Ontario (RNAO). Best practice guideline for the subcutaneous administration of insulin in adults with type 2 diabetes. Toronto (ON): Registered Nurses Association of Ontario (RNAO); 2004 Jun. 91 p. [121 references]

GUIDELINE STATUS

This is the current release of the guideline.

BRIEF SUMMARY CONTENT

 RECOMMENDATIONS
 EVIDENCE SUPPORTING THE RECOMMENDATIONS
 IDENTIFYING INFORMATION AND AVAILABILITY
 DISCLAIMER

 Go to the Complete Summary

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

The levels of evidence supporting the recommendations (Ia, Ib, IIa, IIb, III, IV) are defined at the end of the "Major Recommendations" field

  Recommendation Level of Evidence

Practice Recommendations

1. Nurses should assess psychosocial factors that may affect the individual’s ability to successfully initiate insulin therapy. Assessment strategies that include the use of open-ended questions to assess barriers, stressors, self-efficacy, and beliefs about insulin initiation should be used.

 III

2. Education for administering insulin should be tailored in collaboration with the individual to address current knowledge, abilities, and needs.

 Ia

3. Nurses should provide and/or reinforce appropriate teaching regarding insulin preparation and administration. Topics to include are:

  • Insulin: type, action, stability, storage, and compatibility
  • Preparation and administration of insulin
  • Sharps disposal
  • Follow-up for medical and self-care support
 IV

4. Nurses should encourage blood glucose self-monitoring as an integral part of daily diabetes management for individuals taking insulin. The recommended frequency of testing will vary according to diabetes treatment and the individual’s need and ability.

 III

5. Individuals who self-monitor blood glucose should receive initial instruction and periodic reeducation regarding self-testing technique, meter maintenance, and verification of accuracy of self-testing results.

 III

6. Nurses should ensure clients taking insulin receive appropriate basic nutrition information.

 IV

7. Clients treated with insulin and their caregivers should be taught how to prevent, recognize, and treat hypoglycemia.

 IV

8. Nurses must be aware of the effects of acute illness, surgery, and diagnostic procedures on blood glucose levels.

 IV

9. Nurses should provide basic education on blood glucose monitoring, dietary, and medication adjustments for periods of illness. This information should be given initially and reviewed periodically with the client.

 IV

Education Recommendation

10. Nursing curriculum should include education about the care and management of diabetes.

 IV

Organization & Policy Recommendations

11. Health care organizations should facilitate ongoing diabetes education of nursing staff about diabetes care and management.

 IV

12. Organizations must ensure that individuals receiving insulin have ready access to an appropriate form of glucose at all times.

 IV

13. Organizations should develop and communicate appropriate policies and procedures to reduce the potential for medication errors related to insulin therapy.

 IV

14. Organizations should have a process for documentation to support nursing practice related to insulin therapy.

 IV

15. Nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational, and administrative support. Organizations may wish to develop a plan for implementation that includes:

  • An assessment of organizational readiness and barriers to education
  • Involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process
  • Dedication of a qualified individual to provide the support needed for the education and implementation process
  • Ongoing opportunities for discussion and education to reinforce the importance of best practices
  • Opportunities for reflection on personal and organizational experience in implementing guidelines

In this regard, the Registered Nurses Association of Ontario (RNAO) (through a panel of nurses, researchers, and administrators) has developed the Toolkit: Implementation of Clinical Practice Guidelines, based on available evidence, theoretical perspectives and consensus. The RNAO strongly recommends the use of this Toolkit for guiding the implementation of the best practice guideline on Best Practice Guideline for the Subcutaneous Administration of Insulin in Adults with Type 2 Diabetes.

 IV

Definitions:

Level of Evidence

Ia - Evidence obtained from meta-analysis or systematic review of randomized controlled trials

Ib - Evidence obtained from at least one randomized controlled trial

IIa - Evidence obtained from at least one well-designed controlled study without randomization

IIb - Evidence obtained from at least one other type of well-designed quasi-experimental study, without randomization

III - Evidence obtained from well-designed nonexperimental descriptive studies, such as comparative studies, correlation studies, and case studies

IV - Evidence obtained from expert committee reports or opinions and/or clinical experiences of respected authorities

CLINICAL ALGORITHM(S)

None provided

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EVIDENCE SUPPORTING THE RECOMMENDATIONS

TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence is provided for each recommendation (see "Major recommendations").

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IDENTIFYING INFORMATION AND AVAILABILITY

BIBLIOGRAPHIC SOURCE(S)

  • Registered Nurses Association of Ontario (RNAO). Best practice guideline for the subcutaneous administration of insulin in adults with type 2 diabetes. Toronto (ON): Registered Nurses Association of Ontario (RNAO); 2004 Jun. 91 p. [121 references]

ADAPTATION

The panel, following the appraisal process, identified the following guidelines, and related updates, to adapt and modify recommendations:

* The 1998 Clinical Practice Guidelines for the Management of Diabetes in Canada were updated in 2003. Information obtained from the 1998 guidelines was updated to reflect the new information from the 2003 Clinical Practice Guidelines for the Management of Diabetes in Canada.

DATE RELEASED

2004 Jun

GUIDELINE DEVELOPER(S)

Registered Nurses Association of Ontario - Professional Association

SOURCE(S) OF FUNDING

Funding was provided by the Ontario Ministry of Health and Long Term Care.

GUIDELINE COMMITTEE

Not stated

COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Guideline Development Panel Members

Anna Brundage, RN, BHSc(N), CDE
Team Leader
Manager
TRIDEC
Sunnybrook and Women’s College
Health Sciences Centre
Toronto, Ontario

Ceilia Ayotte, RN, CDE
Diabetes Educator
Peterborough Regional Health Centre
Peterborough, Ontario

Marianne Beckstead, RN, MN, CDE
Clinical Nurse Specialist – Diabetes
University Health Network
Toronto, Ontario

Sharon Brez, RN, BScN, MA(Ed), CDE
Advanced Practice Nurse
Endocrinology and Metabolism
The Ottawa Hospital
Ottawa, Ontario

Linda Fraser, RN, BScN, CDE
Diabetes Educator
Victorian Order of Nurses – Peel
Mississauga, Ontario

Karen Gorecki, RN, MN
Clinical Nurse Specialist – Diabetes
Leadership Sinai Centre for Diabetes
Mount Sinai Hospital
Toronto, Ontario

Robin Hokstad, RN, CDE
Diabetes Nurse Educator
Diabetes Centre – Nipissing District
North Bay, Ontario

Nancy Muller, RN, CDE
Diabetes Nurse Educator
Red Lake District Diabetes Program
Red Lake, Ontario

Mary Beth Neibert, RN, MS, CDE, ACNP
Clinical Nurse Specialist – Diabetes
St. Joseph’s Hospital
Hamilton, Ontario

Josephine Santos, RN, MN
Facilitator, Project Coordinator
Nursing Best Practice Guidelines Project
Registered Nurses Association of Ontario
Toronto, Ontario

Susan Stinson, RN, CDE
Diabetes Education Centre
Grand River Hospital
Type 2 Health Management Clinic
St. Mary’s Hospital
Kitchener, Ontario

FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Declarations of interest and confidentiality were made by all members of the guideline development panel. Further details are available from the Registered Nurses Association of Ontario (RNAO).

GUIDELINE STATUS

This is the current release of the guideline.

GUIDELINE AVAILABILITY

Electronic copies: Available in Portable Document Format (PDF) from the Registered Nurses Association of Ontario (RNAO) Web site.

Print copies: Available from the Registered Nurses Association of Ontario (RNAO), Nursing Best Practice Guidelines Project, 158 Pearl Street, Toronto, Ontario M5H 1L3.

AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

Print copies: Available from the Registered Nurses Association of Ontario (RNAO), Nursing Best Practice Guidelines Project, 158 Pearl Street, Toronto, Ontario M5H 1L3.

PATIENT RESOURCES

None available

NGC STATUS

This NGC summary was completed by ECRI on November 3, 2004. The information was verified by the guideline developer on November 23, 2004.

COPYRIGHT STATEMENT

This document is in the public domain and may be used and reprinted without special permission, except for those copyrighted materials noted for which further reproduction is prohibited without the specific permission of copyright holders. The Registered Nurses Association of Ontario (RNAO) will appreciate citation as to source. The suggested format for citation is indicated below:

Registered Nurses Association of Ontario (2004). Best practice guideline for the subcutaneous administration of insulin in adults with type 2 diabetes. Toronto, Canada: Registered Nurses Association of Ontario.

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DISCLAIMER

NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.

All guidelines summarized by NGC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public or private organizations, other government agencies, health care organizations or plans, and similar entities.

Guidelines represented on the NGC Web site are submitted by guideline developers, and are screened solely to determine that they meet the NGC Inclusion Criteria which may be found at http://www.guideline.gov/about/inclusion.aspx .

NGC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or clinical efficacy or effectiveness of the clinical practice guidelines and related materials represented on this site. Moreover, the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes.

Readers with questions regarding guideline content are directed to contact the guideline developer.
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