1. Can your patient administer their own insulin?
--> Yes - go to point 2
--> No - go to point 3
2. Discharging patients who self administer their own insulin
--> check patient has sufficient supplies of insulin, insulin administration devices, needles, ability to monitor blood sugars at home.
--> ensure you are prescribing the correct form of insulin that the patient uses at home (cartridge, pen or vial)
--> if TYPE 1 diabetes check patient has a ketone meter
--> any concerns - please contact inpatient diabetes team
3. Discharging patients who cannot self administer their own insulin
--> Your patient has Type 1 diabetes, has a 'diabetes care plan' or uses a basal bolus regime - go to point 4
--> Your patient has Type 2 diabetes using once or twice daily insulin regime - go to point 5
4. Patients with Type 1 diabetes, or using a diabetes care plan or basal bolus regime
--> contact the inpatient diabetes team to ensure discharge plans are completed appropriately
--> These patients should not be provided with titration sheets - they will need district nurse green book completed with an insulin care plan or fixed doses of insulin.
ADDITIONAL TO CONSIDER FOR PATIENTS WITH TYPE 1 DIABETES
- They will need to go home with a ketone meter and ketone information - please contact the diabetes nurses to arrange this.
- Please ADD novorapid vial to IDL: 'prn', indication: 'for correction of hyperglycaemia after discussion with medical professional'.
5. Patients with Type 2 diabetes using once or twice daily insulin regime
--> a Green district nurse book will need completed
--> if the patient is using stable insulin doses which are not expected to change on discharge - complete green book with fixed dose prescription on the front page
--> if the patient is newly prescribed insulin or likely to need dose titration complete a titration sheet (below). Staple this to the front page of the green book and this acts as the prescription instead of the front page.
Please note that in the exception of emergency discharges, the diabetes team need 12-24h notice of discharge to organise this. Please ring in advance.
Please complete the correct form depending on your patient's insulin regime (option A, B, or C)
1
Please add a patient sticker or write the name, CHI and address
2
Write the most recent HbA1c result (HbA1c should be repeated every 3-6 months). Sign to authorise insulin administration
3
Write the dose of insulin prescribed on discharge
4
Most patients haven a target range of 6-12, this may be higher in frail patients, if you are unsure then contact the diabetes team
5
For most patients if BG is above target on 3 days then increasing insulin by 10% is sensible
6
For most patients if BG is low reducing insulin by 10% is sensible
C. Type 1 diabetes or Other Insulin Administration Plan
(e.g. basal and bolus, insulin plan in place)
Please contact the diabetes team as a bespoke plan will need to be organised and communicated to the community diabetes team.
Diabetes & endocrinology
