Insulin initiation, titration and escalation: a practical guide (Pharmacists)

Research Review E-Learning Module

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Insulin initiation, titration and escalation: a practical guide (Pharmacists)

This Research Review E-Learning Module is intended for New Zealand pharmacists, and provides practical advice for the initiation, titration and escalation of insulin therapy in primary care.  It is based on the Research Review Speaker Series publication ‘Insulin initiation, titration and escalation: a practical guide for busy clinicians in primary care’, which reports a webinar given by Dr Carl Peters.


Before starting the module please read the Research Review Speaker Series publication, accessed through the link below:

Insulin initiation, titration and escalation: a practical guide for busy clinicians in primary care

The PDF can be viewed on screen, saved and printed through the link above. 

This E-Learning Module covers:

  • Appropriate HbA1c targets for different patient populations
  • Tips for successful initiation of insulin
  • Advice for titrating basal insulin to target
  • When to intensify insulin therapy
  • Advice for titrating meal-time insulins
  • Patients who require insulin management in secondary care

Learning outcomes

After completing this module you should have an improved understanding of:

  • Appropriate HbA1c targets for different patient populations
  • How to initiate insulin therapy
  • Safe titration of basal insulin to target
  • When to intensify insulin therapy
  • Methods of titrating meal-time insulins
  • Which patients require insulin management in secondary care

Contributing experts

Expert commentary is provided by Dr Carl Peters, a specialist endocrinologist and diabetologist with expertise in the management of diabetes. Dr Peters is a consultant at Waitemata DHB and Honorary Senior Lecturer for the University of Auckland.

Module questions have been developed by Dr Chris Tofield who works part time in General Practice in Tauranga, New Zealand, is involved in clinical research and is a clinical advisor to the Bay of Plenty District Health Board.

Accreditation

Accreditation number: 2020/04; Expiry 23/04/2022. This online learning activity has been accredited by PSNZ ENHANCE for 1 hour of group 2 learning and pharmacists may allocate 2 group 2 points on successful completion of this learning activity evidenced by receipt of Research Review Certificate of Completion

References

  1. American Diabetes Association. 6. Glycemic Targets: Standards of Medical Care in Diabetes—2019. Diabetes Care. 2019;42(Supplement 1):S61-S70.
  2. Garber AJ, Abrahamson MJ, Barzilay JI, et al. CONSENSUS STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY ON THE COMPREHENSIVE TYPE 2 DIABETES MANAGEMENT ALGORITHM – 2019 EXECUTIVE SUMMARY. Endocrine Practice. 2019;25(1):69-100.
  3. Qaseem A, Wilt TJ, Kansagara D, et al. Hemoglobin A1c Targets for Glycemic Control With Pharmacologic Therapy for Nonpregnant Adults With Type 2 Diabetes Mellitus: A Guidance Statement Update From the American College of Physicians. Annals of Internal Medicine. 2018;168(8):569-76.
  4. American Geriatrics Society Expert Panel on Care of Older Adults with Diabetes M, Moreno G, Mangione CM, et al. Guidelines abstracted from the American Geriatrics Society Guidelines for Improving the Care of Older Adults with Diabetes Mellitus: 2013 update. J Am Geriatr Soc. 2013;61(11):2020-6.
  5. Lepore M, Pampanelli S, Fanelli C, et al. Pharmacokinetics and pharmacodynamics of subcutaneous injection of long-acting human insulin analog glargine, NPH insulin, and ultralente human insulin and continuous subcutaneous infusion of insulin lispro. Diabetes. 2000;49(12):2142-8.
  6. Guerci B, Sauvanet JP. Subcutaneous insulin: pharmacokinetic variability and glycemic variability. Diabetes Metab. 2005;31(4 Pt 2):4S7-4S24.
  7. Scholtz HE, Pretorius SG, Wessels DH, et al. Pharmacokinetic and glucodynamic variability: assessment of insulin glargine, NPH insulin and insulin ultralente in healthy volunteers using a euglycaemic clamp technique. Diabetologia. 2005;48(10):1988-95.
  8. American Diabetes Association. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2019. Diabetes Care. 2019;42(Supplement 1):S90-S102.
  9. RACGP, Diabetes Australia. General practice management of type 2 diabetes. 2016/2018.