Initiating insulin is an increasing requirement of both secondary and primary care services but requires considerable knowledge, expertise and experience to manage safely. Research has demonstrated that many practitioners are wary of starting people on insulin and continue to apply other approaches and delay initiation. Diabetes nurse specialists are the key personnel in managing insulin starts and also providing education and supervision of other staff until they develop skills and proficiency to do insulin starts alone. An evaluation of the Wandsworth Insulin Start Programme (WISP), a course designed to educate and support GPs and practice nurses to initiate insulin in people with type 2 diabetes, was performed by Chadder (2013). The course provided 2.5 days of intensive training followed by supervision of between 3 and 10 starts over the following year. A GP and practice nurse from the same practice were encouraged to attend in order to develop a team approach to insulin starts in primary care. While feedback on the course was positive, its effectiveness over time could not be asserted due to variable numbers of starts being done and attendees not performing enough starts to develop the necessary skills and expertise. Chadder states that ‘Practice nurses and GPs need to be carrying out insulin initiation on a regular basis in order to maintain skills and confidence and have the time available to cover every aspect of education involved in an insulin start’ (2013, p 147).
