Quality Standards for Diabetes Care Toolkit

Guidelines

The New Zealand Best Practice Advocacy Centre (BPAC) guidelines for initiating insulin can be found here: www.bpac.org.nz/BPJ/2012/february/insulin.aspx

The New Zealand Primary Care Handbook 2012 provides an algorithm for starting insulin on page 61.

* Currently funded isophane insulin is Protaphane or Humulin NPH.

Waitemata District Health Board (DHB) produced a set of algorithms to optimise medication for people with type 2 diabetes. They include advice on treatment and insulin initiation (www.waitematadhb.govt.nz/LinkClick.aspx?fileticket=ENo58lPEzSY%3D&tabid=93&mid=685).
The Institute for Clinical Systems Improvement (ICSI) provides a series of decision algorithms including one on the initiation of insulin (https://www.icsi.org/_asset/3rrm36/Diabetes-Interactive0412.pdf).
In relation to the administration of insulin, there is no New Zealand or UK competency assessment or accreditation in place. However, the New Zealand National Diabetes Nursing Knowledge and Skills Framework provides the following list of competencies for specialist diabetes nurses, the only ones listed as being able to initiate insulin:

demonstrate proficient knowledge of insulin and insulin regimens and act as a resource for the person with diabetes and their family/whānau, and health care professionals

describe potential insulin regimens and when each could be prescribed

explain how to manage missed or incorrect insulin dose

assess the person with diabetes’ educational needs and deliver appropriately

provide care and education to assist with the safe transition from oral therapy to insulin therapy

maintain contemporary knowledge of current practice and new developments (http://nzssd.org.nz/documents/dnss/National%20Diabetes%20Nursing%20Knowledge%20and%20Skills%20Framework%202009.pdf).
Similarly, an Integrated Career and Competency Framework for Diabetes Nursing was developed in the UK (TREND-UK 2011), which outlines the competencies for diabetes nurses at various levels. Insulin initiation is included at the ‘expert/proficient’ level requiring the following competencies, over and above those required of a ‘competent’ diabetes nurse:

demonstrate a broad knowledge of different insulin types (ie, action, use in regimens)

demonstrate a broad knowledge of GLP-1 receptor agonists (eg, drug type, action, side-effects)

assess individual patients’ self-management and educational needs and meet these needs or make appropriate referral

support and encourage self-management wherever appropriate

initiate insulin or GLP-1 receptor agonist therapy where clinically appropriate

recognise when injection therapy needs to be adjusted

recognise the potential psychological impact of insulin or GLP-1 receptor agonist therapies and offer support to the person with diabetes or their carer

recognise signs of needle fear/needle phobia and offer strategies to help manage this (www.diabetes.org.uk/Documents/Professionals/Competencies/An%20Integrated%20Career%20and%20Competency%20Framework%20for%20Diabetes%20Nursing_TREND_2011.pdf).