Discuss the possibility of insulin therapy well in advance of when it needs to be implemented, so patients have time to explore their fears and obtain information. Do not use insulin therapy as a threat when discussing compliance with diet, exercise, and medications—even compliant patients eventually require insulin.

Stock several insulin-start packets with instruction sheets, informational handouts, syringes, needles, and insulin samples to facilitate insulin initiation.

Consider use of insulin pens and other devices that do not require syringes.

Team up with a certified diabetes educator to teach patients nutritional therapy and how to adjust their insulin. Communicate the goals that you and the patient have discussed. Train one of the nursing staff to teach insulin administration to patients who need to start immediately and cannot wait for a scheduled meeting with the educator.

Tailor the insulin type and regimen to fit the patient’s lifestyle and budget. Patients who have irregular hours and meals may find that insulin glargine and rapid-acting analogues provide more flexibility, while those with a set routine can do well with the traditional insulins.

Schedule patients for follow-up within one week to adjust insulin doses and provide more education. Maintain contact with the patient through office visits, telephone calls, fax, or secure e-mail every three to seven days until blood sugar level is at the goal.

Always ask for the self-monitoring blood glucose log. Train staff to remind the patient, when making an appointment, to bring the log. Have the patient describe how he or she would make dose change decisions. Reinforce good decisions and gently correct poor decisions. Use the accompanying patient information handout to clarify future doses and adjustments.

Always find something to praise.

Useful resources from the American Diabetes Association include Practical Insulin: A Handbook for Prescribers, 2002 (http://store.diabetes.org) and the Diabetes Forecast Resource Guide published every January (http://www.diabetes.org/diabetes-forecast/resource-guide.jsp).