Starting Insulin In Type 2 Diabetes
Listen
Watch
Show notes:
The good news: there are a lot of options for treating patients with type 2 diabetes. The challenging news: there is a lot to know about medication options for your patient with type 2 diabetes. Getting comfortable with all this information can be overwhelming as a new grad Nurse Practitioner – and even as a seasoned Nurse Practitioner, especially if you don’t have a lot of diabetic patients in your practice. Some patients will be able to improve their diabetes and get their A1C down with lifestyle changes alone; others will need to add oral medication; others will need to add insulin to get optimal control of their diabetes.
When the time comes to have a conversation with your patient about starting insulin, they are likely to have lots of questions. If you want some talking points for this conversation, and you also want to be sure that you have answers, you have come to the right place.
What You Need To Know To Start Insulin In Your Type 2 Diabetes Patient
This week, we will walk through what you need to know when you have a patient who will be starting insulin for diabetes management. We’ll talk about:
The other options for treating their type 2 diabetes before you start insulin
How much improvement you can expect with various approaches to diabetes treatment
A framework for when to start insulin, and how to adjust the dose
Managing hypoglycemia after starting insulin
Why in-person visits are so beneficial for managing diabetes
Diabetes is a complex diagnosis for providers and patients. When you feel confused and overloaded with information, imagine how your patient feels. Being prepared for these conversations and clinical scenarios will help you to feel more confident, which will help you to be an even better resource for your patients.
Resources mentioned in this episode:
If you'd like support learning about how to manage these three chronic conditions, including medication management, most recent guidelines, when to refer and examples of real-life patient cases, join us for the Managing Diabetes, Hypertension & CKD Review Course. Comes with AANP accreditated continuing education hours, including pharmacology hours, downloadable cheat sheets and lifetime access! Click here to learn more.
If you liked this post, also check out:
-
WEBVTT
1
00:00:08.580 --> 00:00:12.780
Hey there, welcome to the Real World NP podcast.
2
00:00:13.120 --> 00:00:20.400
I'm Liz Rohr, family nurse practitioner, educator, and founder of Real World NP, an educational
3
00:00:20.400 --> 00:00:23.180
company for nurse practitioners in primary care.
4
00:00:24.280 --> 00:00:29.400
I'm on a mission to equip and guide new nurse practitioners so that they can feel
5
00:00:29.400 --> 00:00:33.020
confident, capable, and take the best care of their patients.
6
00:00:33.500 --> 00:00:38.280
If you're looking for clinical pearls and practice tips without the fluff, you're in
7
00:00:38.280 --> 00:00:39.080
the right place.
8
00:00:39.260 --> 00:00:42.980
Make sure you subscribe and leave a review so you won't miss an episode.
9
00:00:43.340 --> 00:00:49.260
Plus, you'll find links to all the episodes with extra goodies over at realworldnp.com
10
00:00:49.260 --> 00:00:50.420
slash podcast.
11
00:00:55.570 --> 00:00:59.430
Well, hey there, it's Liz Rohr from Real World NP and you're watching NP Practice
12
00:01:00.050 --> 00:01:04.610
weekly videos to help save you time, frustration, and help you learn faster so you can take
13
00:01:04.610 --> 00:01:06.190
the best care of your patients.
14
00:01:06.630 --> 00:01:12.010
So today I'm talking about a super highly requested topic, which is insulin initiation
15
00:01:12.010 --> 00:01:13.290
in type 2 diabetes.
16
00:01:13.650 --> 00:01:15.810
And I have a couple of notes before I jump in.
17
00:01:15.890 --> 00:01:18.730
So number one, I have a cheat sheet down below this video.
18
00:01:18.790 --> 00:01:22.470
I would love to be able to share my screen and make a beautiful presentation like
19
00:01:22.470 --> 00:01:27.150
I usually do, but quarantine life is a little different right now and limited time
20
00:01:27.150 --> 00:01:28.970
to make these with my daughter at home.
21
00:01:29.430 --> 00:01:32.770
The second note is that the lab interpretation crash course for new nurse practitioners
22
00:01:32.770 --> 00:01:35.630
opens this Friday, which I'm so excited.
23
00:01:35.710 --> 00:01:38.970
I would love to have you if you're struggling with labs, you're a new grad in primary
24
00:01:38.970 --> 00:01:41.270
care or an experienced grad and you still don't like labs.
25
00:01:41.450 --> 00:01:46.930
It's CBCs, CMPs, TSH, lipids, and all the main endocrine labs that I see in
26
00:01:46.930 --> 00:01:49.370
primary care as well as your analysis.
27
00:01:49.810 --> 00:01:53.650
And then my third note is that Kim Ellis, I want to give a shout out to her, is
28
00:01:53.650 --> 00:01:57.550
practitioner on YouTube as well and makes YouTube videos specifically about
29
00:01:57.550 --> 00:01:58.410
diabetes management.
30
00:01:58.550 --> 00:02:02.030
So definitely go check out her stuff if you haven't already and you have more
31
00:02:02.030 --> 00:02:04.850
diabetes related questions and then definitely let me know if you have other
32
00:02:04.850 --> 00:02:07.830
questions and things you want me to talk about when it comes to diabetes.
33
00:02:08.449 --> 00:02:13.510
So jumping right in though, number one, who needs insulin in diabetes and
34
00:02:13.510 --> 00:02:14.170
type 2 diabetes?
35
00:02:14.250 --> 00:02:15.830
So kind of three main scenarios.
36
00:02:15.990 --> 00:02:20.070
One is that somebody comes in with severe hyperglycemia that is symptomatic.
37
00:02:20.070 --> 00:02:25.570
So they have things like weight loss, ketonuria, malaise, things like that.
38
00:02:25.950 --> 00:02:30.310
And their A1C is greater than 9% or their blood sugars are greater than 300 or
39
00:02:30.310 --> 00:02:31.290
so persistently.
40
00:02:31.710 --> 00:02:34.950
And a quick note is that I have a video, a case study about hyperglycemia
41
00:02:34.950 --> 00:02:38.170
where I talk a little bit more about the symptoms of hyperglycemia and
42
00:02:38.170 --> 00:02:40.010
differentiating between type 1 and type 2.
43
00:02:40.250 --> 00:02:42.530
So I'll link down below this video to that if you want to check that
44
00:02:42.530 --> 00:02:44.150
out if you haven't seen that one already.
45
00:02:44.570 --> 00:02:48.810
Another scenario is that somebody has a persistent severe hyperglycemia,
46
00:02:48.810 --> 00:02:52.490
meaning their blood sugars on average are typically greater than 300 and
47
00:02:52.490 --> 00:02:54.770
their A1C is greater than 9%.
48
00:02:54.770 --> 00:02:56.310
And they may or may not have symptoms.
49
00:02:56.350 --> 00:02:59.150
They may not have the weight loss or ketonuria and they might feel fine.
50
00:02:59.430 --> 00:03:02.390
Those patients you can consider insulin therapy for them as well.
51
00:03:02.530 --> 00:03:05.290
And then the other situation is if they are in either of those
52
00:03:05.290 --> 00:03:07.870
categories and you're not quite sure if they have type 1 or type 2
53
00:03:07.870 --> 00:03:10.070
diabetes, those patients should be on insulin as well.
54
00:03:10.090 --> 00:03:12.450
And again, I talk about that a little bit more in that video.
55
00:03:12.750 --> 00:03:16.130
So I should back up and say that all of this is based on the AACE
56
00:03:16.130 --> 00:03:18.790
guidelines and I don't have rights to share their stuff.
57
00:03:18.790 --> 00:03:23.110
And so on my presentation itself, I am not able to reproduce it.
58
00:03:23.590 --> 00:03:25.830
So without permission, so I have it linked down below this video.
59
00:03:26.030 --> 00:03:28.610
I definitely encourage you to review that PowerPoint presentation that they
60
00:03:28.610 --> 00:03:32.290
have on their website and print out the slides that I'm going to be
61
00:03:32.290 --> 00:03:35.270
referencing to keep it at your desk to kind of make things a little bit
62
00:03:35.270 --> 00:03:37.930
easier. And I keep looking down because I have my notes and I want to
63
00:03:37.930 --> 00:03:39.110
make sure I don't forget anything.
64
00:03:39.350 --> 00:03:41.990
So kind of just to back up a little bit when it comes to the AACE
65
00:03:41.990 --> 00:03:46.610
guidelines, typically going from initial management all the way up to
66
00:03:47.210 --> 00:03:51.190
somebody is diagnosed with diabetes when their A1C is 6.5 and above.
67
00:03:51.390 --> 00:03:54.250
And so from there, patients are typically started first line on
68
00:03:54.250 --> 00:03:56.250
metformin if they don't have contraindications.
69
00:03:56.430 --> 00:03:58.590
And I'm not really going to get into all the nitty gritty here.
70
00:03:58.630 --> 00:04:02.370
I'm doing really high level overview because I could talk for hours
71
00:04:02.370 --> 00:04:04.790
and this is really just to kind of like the quick and dirty of it.
72
00:04:05.110 --> 00:04:07.870
So making sure that they don't have contraindications to metformin.
73
00:04:08.110 --> 00:04:11.530
And then the next steps from there, depending on their A1C level is
74
00:04:11.530 --> 00:04:15.130
if they want to do oral agents versus insulin.
75
00:04:15.130 --> 00:04:17.390
So do they do a second agent, a third agent.
76
00:04:17.670 --> 00:04:20.290
And once they get to three, then they have to progress to insulin if
77
00:04:20.290 --> 00:04:22.010
their A1C is still uncontrolled.
78
00:04:22.270 --> 00:04:25.630
However, you can always jump over that oral medication, the dual and
79
00:04:25.630 --> 00:04:28.390
triple therapy to go right to insulin if the patient prefers.
80
00:04:28.710 --> 00:04:31.870
So before I go any further into the nitty gritty of it all, I want to
81
00:04:31.870 --> 00:04:35.970
make a really important point here is that the most important thing is
82
00:04:35.970 --> 00:04:39.490
that you understand this well enough to explain it plainly to your
83
00:04:39.490 --> 00:04:42.550
patients, because it might feel as a brand new grad, I remember
84
00:04:42.550 --> 00:04:47.090
feeling totally like stressed out that someone's A1C was 13% and I needed
85
00:04:47.090 --> 00:04:48.890
to do all of the things for them right now.
86
00:04:48.890 --> 00:04:50.450
They didn't have their monofilament checked.
87
00:04:50.530 --> 00:04:52.530
They didn't have their microalbumin checked.
88
00:04:52.610 --> 00:04:56.250
They didn't have any education about the risks and benefits and
89
00:04:56.250 --> 00:04:57.150
side effects and all that stuff.
90
00:04:57.470 --> 00:04:58.790
And, and they needed all these medications.
91
00:04:58.790 --> 00:04:59.610
We had to get it down.
92
00:04:59.610 --> 00:05:00.510
They had to check their blood sugars.
93
00:05:00.570 --> 00:05:02.070
Like it was a lot of information.
94
00:05:02.570 --> 00:05:05.170
And can you imagine how overwhelming that is for a patient?
95
00:05:05.230 --> 00:05:07.450
Maybe it doesn't mean that much to you as somebody in healthcare,
96
00:05:07.490 --> 00:05:11.530
but the, my main takeaway, if you can, from this video is to
97
00:05:11.530 --> 00:05:15.130
include your patients and it's okay to break it into smaller chunks
98
00:05:15.130 --> 00:05:19.090
because this is, this is, you don't have to fix them right now.
99
00:05:19.350 --> 00:05:22.470
This is a lifelong diagnosis and a lifelong challenge that they
100
00:05:22.470 --> 00:05:24.130
need to manage themselves.
101
00:05:24.270 --> 00:05:27.950
And the more you can explain and get buy-in from patients to
102
00:05:27.950 --> 00:05:30.890
manage their own care, the more successful they're going to be.
103
00:05:30.930 --> 00:05:33.190
And then you are going to be in helping them to achieve
104
00:05:33.190 --> 00:05:34.030
the goals that they want.
105
00:05:34.090 --> 00:05:38.610
So when I, another thing to say about the management of, of type
106
00:05:38.610 --> 00:05:41.550
two diabetes, according to the ACE guidelines, is that a diet
107
00:05:41.550 --> 00:05:44.810
and my lifestyle always come first, which you know, but I
108
00:05:44.810 --> 00:05:50.370
have to say that each of the medications only lower A1C by
109
00:05:50.370 --> 00:05:52.870
about 1.5% maximum.
110
00:05:53.210 --> 00:05:56.770
So if you have one medication that lowers the A1C by 1.5%
111
00:05:56.770 --> 00:06:00.090
and their A1C is nine, it's not going to meet goal.
112
00:06:00.790 --> 00:06:03.770
And so knowing that, and some of the medications are only
113
00:06:03.770 --> 00:06:05.170
0.5%, right?
114
00:06:05.170 --> 00:06:10.090
So knowing that even if you max out a triple oral therapy, you
115
00:06:10.090 --> 00:06:14.550
may need to add insulin and dietary modification alone can
116
00:06:14.550 --> 00:06:18.250
drop somebody's A1C from 13 to six, like that.
117
00:06:18.430 --> 00:06:20.210
Like it's, it's not a hundred percent of the time.
118
00:06:20.230 --> 00:06:22.830
It's not a magic fix, but patients who are really
119
00:06:22.830 --> 00:06:25.530
motivated and able to consistently maintain those
120
00:06:25.530 --> 00:06:29.210
modifications, that is way more impactful than any
121
00:06:29.210 --> 00:06:30.310
medication you can give somebody.
122
00:06:30.570 --> 00:06:32.490
So really, again, having those conversations and
123
00:06:32.490 --> 00:06:34.490
explaining that to patients of like, listen, you have control
124
00:06:34.490 --> 00:06:37.770
over this, you can, you can do this and I can help you.
125
00:06:37.830 --> 00:06:41.170
And here are the ways that we can help you is very
126
00:06:41.170 --> 00:06:43.850
impactful versus, Hey, your A1C is 13%.
127
00:06:43.850 --> 00:06:45.650
Here's my checklist of all the things I need to do for
128
00:06:45.650 --> 00:06:45.810
you.
129
00:06:45.850 --> 00:06:47.430
And here's this medication and we need to tight
130
00:06:47.430 --> 00:06:48.070
treat it this way.
131
00:06:48.530 --> 00:06:50.870
So with that all said, I just want to jump into the
132
00:06:50.870 --> 00:06:53.190
actual nuts and bolts of probably why you're watching
133
00:06:53.190 --> 00:06:53.530
today.
134
00:06:53.590 --> 00:06:57.250
So when it comes to initiating insulin, you need to
135
00:06:57.250 --> 00:06:59.150
make that decision, share decision making with your
136
00:06:59.150 --> 00:06:59.470
patient.
137
00:06:59.650 --> 00:07:01.090
It's a pretty simple algorithm.
138
00:07:01.430 --> 00:07:03.930
So what you start with is basal insulin, meaning it's
139
00:07:03.930 --> 00:07:07.310
just that the longer acting insulin once or twice per
140
00:07:07.310 --> 00:07:09.790
day, depending on the, on the specific type that
141
00:07:09.790 --> 00:07:10.410
you're choosing.
142
00:07:10.510 --> 00:07:13.130
And then it's a weight based dosing on average.
143
00:07:13.330 --> 00:07:14.710
It depends on the resource that you're looking at,
144
00:07:14.830 --> 00:07:17.870
but to keep it really simple, it's typically
145
00:07:17.870 --> 00:07:21.670
0.1 to 0.2 units per kilogram per day is the
146
00:07:21.670 --> 00:07:24.610
total amount of their daily basal insulin.
147
00:07:24.810 --> 00:07:26.830
So those are things like insulin, Glargine, or
148
00:07:26.830 --> 00:07:28.090
there's a couple of other ones.
149
00:07:28.090 --> 00:07:30.730
And really the choice there depends on the
150
00:07:30.730 --> 00:07:32.590
insurance in my experience.
151
00:07:33.230 --> 00:07:35.350
The efficacies, I don't see a lot of differences
152
00:07:35.350 --> 00:07:36.310
between them.
153
00:07:36.870 --> 00:07:38.390
The most important thing is that they actually take
154
00:07:38.390 --> 00:07:38.770
them.
155
00:07:39.930 --> 00:07:42.010
So some of them are 12 hours and some of them
156
00:07:42.010 --> 00:07:44.010
are cue 20, every 24 hour dosing.
157
00:07:44.030 --> 00:07:44.930
And so you just have to look at the
158
00:07:44.930 --> 00:07:46.790
particular medication that is covered for your
159
00:07:46.790 --> 00:07:48.230
patient and what they're willing to do.
160
00:07:48.630 --> 00:07:50.450
So that's the total amount.
161
00:07:50.830 --> 00:07:52.710
The next step is that the patient needs to check
162
00:07:52.710 --> 00:07:54.850
their fasting blood sugar in the morning, every
163
00:07:54.850 --> 00:07:56.370
single morning, write them down.
164
00:07:56.550 --> 00:07:59.450
And then you titrate that dose of the total
165
00:07:59.450 --> 00:08:02.490
basal daily insulin dose based on that.
166
00:08:02.590 --> 00:08:05.250
And so if their blood sugar is greater than
167
00:08:05.250 --> 00:08:07.150
180, it depends.
168
00:08:07.350 --> 00:08:09.210
So the goal, it depends on the age of the
169
00:08:09.210 --> 00:08:10.290
patient, what their goal is.
170
00:08:10.310 --> 00:08:12.430
But typically I tend to go on the higher
171
00:08:12.430 --> 00:08:13.510
side for my older patients.
172
00:08:13.610 --> 00:08:15.370
So greater than 180 ish.
173
00:08:15.850 --> 00:08:18.030
But the true like normal fasting is like
174
00:08:18.030 --> 00:08:19.910
less than 130 or less than 110, depending
175
00:08:19.910 --> 00:08:20.910
on how strict you're being.
176
00:08:21.030 --> 00:08:23.070
I typically go to 130 just because I tend to
177
00:08:23.070 --> 00:08:25.410
be a little bit cautious, but that's your
178
00:08:25.410 --> 00:08:26.990
goal of your fasting blood sugars in the
179
00:08:26.990 --> 00:08:27.250
morning.
180
00:08:27.330 --> 00:08:30.670
And so every, every three days, the
181
00:08:30.670 --> 00:08:32.470
recommendations are to titrate up on the
182
00:08:32.470 --> 00:08:32.750
basal insulin.
183
00:08:32.750 --> 00:08:35.230
And so, for example, if somebody's basal
184
00:08:35.230 --> 00:08:36.929
insulin comes out to be 10 units, you can
185
00:08:36.929 --> 00:08:38.510
either do weight-based dosing or you can
186
00:08:38.510 --> 00:08:39.650
start with just 10 units.
187
00:08:40.710 --> 00:08:42.549
So starting with 10 units, you can do
188
00:08:43.049 --> 00:08:44.310
checking their fasting sugar.
189
00:08:44.530 --> 00:08:45.790
It's still not at goal.
190
00:08:46.210 --> 00:08:48.530
You increase it by two to four units,
191
00:08:48.650 --> 00:08:50.030
depending on how much higher it is.
192
00:08:50.250 --> 00:08:51.970
So if you're feeling a little overwhelmed,
193
00:08:52.030 --> 00:08:53.490
can you imagine how your patients feel?
194
00:08:54.750 --> 00:08:57.450
So the, the way, again, print out the
195
00:08:57.450 --> 00:08:58.630
cheat sheet down below this video if you
196
00:08:58.630 --> 00:08:59.390
haven't already.
197
00:08:59.810 --> 00:09:02.610
But the main thing here is that it is
198
00:09:02.610 --> 00:09:05.750
complicated and depending on the patient's
199
00:09:05.750 --> 00:09:07.370
health literacy, they might need a little
200
00:09:07.370 --> 00:09:08.310
bit more hand-holding.
201
00:09:08.490 --> 00:09:09.630
If someone has super high health
202
00:09:09.630 --> 00:09:10.870
literacy, they're very savvy with
203
00:09:10.870 --> 00:09:13.270
health-related things, they can do that.
204
00:09:13.330 --> 00:09:14.690
They can follow the directions, write
205
00:09:14.690 --> 00:09:15.890
it all down, go up and up and up
206
00:09:15.890 --> 00:09:16.610
and all that stuff.
207
00:09:16.930 --> 00:09:17.750
Then that's perfect.
208
00:09:18.090 --> 00:09:19.510
And once they get to the goal fasting
209
00:09:19.510 --> 00:09:21.910
blood sugar of less than 130 and they
210
00:09:21.910 --> 00:09:24.390
don't have hypoglycemia, they can
211
00:09:24.390 --> 00:09:25.290
chill at that dose.
212
00:09:25.430 --> 00:09:27.270
However, what typically happens is that
213
00:09:27.270 --> 00:09:29.050
this is confusing for nurse practitioners
214
00:09:29.050 --> 00:09:30.550
and people who are not nurse practitioners.
215
00:09:31.110 --> 00:09:33.630
So what I do for patients is I talk
216
00:09:33.630 --> 00:09:35.570
about, talk about it with them, right?
217
00:09:35.910 --> 00:09:37.310
It would be great to get it down
218
00:09:37.310 --> 00:09:39.030
immediately, but again, this is the
219
00:09:39.030 --> 00:09:40.150
rest of their life.
220
00:09:40.510 --> 00:09:42.170
So they need to make that decision.
221
00:09:42.190 --> 00:09:43.450
And so there's a couple of options.
222
00:09:43.470 --> 00:09:46.030
So I can either, as long as they feel
223
00:09:46.030 --> 00:09:47.110
comfortable checking their blood
224
00:09:47.110 --> 00:09:49.450
sugars and they have that skill down,
225
00:09:49.630 --> 00:09:50.910
they can go home and they can check
226
00:09:50.910 --> 00:09:52.130
it. They can come back in a week
227
00:09:52.130 --> 00:09:54.130
with me, two weeks, a month.
228
00:09:54.390 --> 00:09:56.690
They can come back with the nurse in
229
00:09:56.690 --> 00:09:57.970
a week or two weeks or a month.
230
00:09:57.970 --> 00:10:00.170
They can come in with the diabetes
231
00:10:00.170 --> 00:10:02.050
educator if you have that luxury.
232
00:10:02.130 --> 00:10:03.210
And then you can kind of just take
233
00:10:03.210 --> 00:10:04.270
it slow and go from there.
234
00:10:04.310 --> 00:10:05.430
I mean, most of the time when I'm
235
00:10:05.430 --> 00:10:06.610
titrating up on insulin for
236
00:10:06.610 --> 00:10:08.110
patients in this manner, they need
237
00:10:08.110 --> 00:10:08.790
some hand holding.
238
00:10:09.050 --> 00:10:10.490
So it's usually done in person
239
00:10:10.490 --> 00:10:11.950
and typically not even over the
240
00:10:11.950 --> 00:10:13.390
phone because it's just such a
241
00:10:13.390 --> 00:10:14.930
new skill. It's so overwhelming.
242
00:10:15.130 --> 00:10:16.250
Like there's, there's a lot to
243
00:10:16.250 --> 00:10:16.710
think about.
244
00:10:16.970 --> 00:10:18.610
So a note about hypoglycemia.
245
00:10:18.690 --> 00:10:20.390
If patients have any hypoglycemic
246
00:10:20.390 --> 00:10:23.250
episodes, less than 70 is typically
247
00:10:23.250 --> 00:10:24.530
the cutoff for the, for the blood
248
00:10:24.530 --> 00:10:25.190
sugar level.
249
00:10:25.430 --> 00:10:27.410
You can either decrease the daily
250
00:10:27.410 --> 00:10:30.930
basal dose by 10% or four units,
251
00:10:30.990 --> 00:10:32.410
whichever is greater, I believe.
252
00:10:32.490 --> 00:10:33.530
And it's again, in those ACE
253
00:10:33.530 --> 00:10:34.030
guidelines.
254
00:10:34.290 --> 00:10:35.610
But typically I'm, I'm scaling
255
00:10:35.610 --> 00:10:37.250
back by about four units at a
256
00:10:37.250 --> 00:10:38.330
time when patients are having
257
00:10:38.330 --> 00:10:39.630
those hypoglycemic episodes.
258
00:10:39.830 --> 00:10:40.970
And even if their fasting
259
00:10:40.970 --> 00:10:42.650
levels are high, I'd rather
260
00:10:42.650 --> 00:10:43.990
them not have hypoglycemia.
261
00:10:44.230 --> 00:10:45.310
There are further steps to
262
00:10:45.310 --> 00:10:47.330
take. You can add prandial
263
00:10:47.330 --> 00:10:49.410
insulin, meaning meal time
264
00:10:49.410 --> 00:10:50.650
shorter acting insulin.
265
00:10:50.810 --> 00:10:52.670
You can add on more oral agents.
266
00:10:52.990 --> 00:10:53.670
It's getting a little bit
267
00:10:53.670 --> 00:10:54.610
outside of the scope of this
268
00:10:54.610 --> 00:10:55.890
video for today, but I'm
269
00:10:55.890 --> 00:10:57.010
happy to talk about that more.
270
00:10:57.010 --> 00:10:58.010
If that's something that you're
271
00:10:58.010 --> 00:10:58.890
interested in.
272
00:10:59.230 --> 00:11:00.290
But yeah, the moral of the story
273
00:11:00.290 --> 00:11:02.090
is print out the cheat sheet,
274
00:11:02.190 --> 00:11:03.290
walk your patients through it
275
00:11:03.290 --> 00:11:05.530
really slowly and easily for
276
00:11:05.530 --> 00:11:06.930
them very clearly and definitely
277
00:11:06.930 --> 00:11:08.150
getting their buy-in, watching
278
00:11:08.150 --> 00:11:09.570
out for hypoglycemia, making
279
00:11:09.570 --> 00:11:11.110
sure that they understand what
280
00:11:11.110 --> 00:11:12.550
signs of hypoglycemia are,
281
00:11:12.870 --> 00:11:13.650
checking their blood sugars,
282
00:11:13.710 --> 00:11:15.450
how to use it, and just like
283
00:11:15.450 --> 00:11:16.730
giving them as much support as
284
00:11:16.730 --> 00:11:17.870
you can, because especially if
285
00:11:17.870 --> 00:11:18.970
this is a brand new diagnosis,
286
00:11:19.050 --> 00:11:20.410
that is incredibly overwhelming
287
00:11:20.410 --> 00:11:20.930
to them.
288
00:11:21.290 --> 00:11:22.510
So I hope you like this video.
289
00:11:22.670 --> 00:11:23.290
Definitely let me know if you
290
00:11:23.290 --> 00:11:24.410
have any questions or further
291
00:11:24.410 --> 00:11:25.690
topic requests when it comes to
292
00:11:25.690 --> 00:11:26.810
diabetes or otherwise.
293
00:11:27.010 --> 00:11:27.950
And definitely join us for the
294
00:11:27.950 --> 00:11:29.030
Lab Interpretation Crash Course
295
00:11:29.030 --> 00:11:30.330
for new nurse practitioners on
296
00:11:30.330 --> 00:11:30.730
Friday.
297
00:11:30.810 --> 00:11:32.730
If you feel so called, I'm super
298
00:11:32.730 --> 00:11:33.110
excited.
299
00:11:33.150 --> 00:11:34.770
It's at realworldnp.com slash
300
00:11:34.770 --> 00:11:35.230
labs.
301
00:11:35.590 --> 00:11:36.930
Thank you so much for watching.
302
00:11:37.050 --> 00:11:38.030
Hang in there and I'll see you
303
00:11:38.030 --> 00:11:38.310
soon.
304
00:11:42.600 --> 00:11:44.160
That's our episode for today.
305
00:11:44.320 --> 00:11:45.660
Thank you so much for
306
00:11:45.660 --> 00:11:46.100
listening.
307
00:11:46.340 --> 00:11:48.340
Make sure you subscribe, leave
308
00:11:48.340 --> 00:11:49.940
a review, and tell all your
309
00:11:49.940 --> 00:11:51.940
NP friends so together we can
310
00:11:51.940 --> 00:11:53.660
help as many nurse practitioners
311
00:11:53.660 --> 00:11:55.620
as possible give the best care
312
00:11:55.620 --> 00:11:56.420
to their patients.
313
00:11:56.740 --> 00:11:58.000
If you haven't gotten your
314
00:11:58.000 --> 00:11:59.520
copy of the Ultimate Resource
315
00:11:59.520 --> 00:12:01.740
Guide for the new NP, head over
316
00:12:01.740 --> 00:12:04.440
to realworldnp.com slash guide.
317
00:12:04.860 --> 00:12:06.440
You'll get these episodes sent
318
00:12:06.440 --> 00:12:07.760
straight to your inbox every
319
00:12:07.760 --> 00:12:09.460
week with notes from me,
320
00:12:09.860 --> 00:12:11.100
patient stories, and extra
321
00:12:11.100 --> 00:12:12.660
bonuses I really just don't
322
00:12:12.660 --> 00:12:13.700
share anywhere else.
323
00:12:14.080 --> 00:12:15.320
Thank you so much again for
324
00:12:15.320 --> 00:12:15.640
listening.
325
00:12:15.880 --> 00:12:17.040
Take care and talk soon.
© 2025 Real World NP. For educational and informational purposes only, see realworldnp.com/disclaimer for full details.
