Practical Insulin Transition Guide for Nurses: Titration and Patient Support

Table of Contents

• Foundation of Successful Insulin Transitions
• Titration, Monitoring, and Education
• Step-By-Step Transition Recommendations
  • Step 1: Pre-transition planning and patient education
  • Step 2: Dosing and administration during the transition period
  • Step 3: Collaborative transition monitoring
  • Step 4: Continuity of care
• Conclusion
• Explore More

Foundation of Successful Insulin Transitions

When diabetes patients need to switch insulin products due to product discontinuations, nurses play an important role in supporting the transition process. This guide provides practical instructions for managing insulin transitions, including titration protocols and patient monitoring strategies.

Titration, Monitoring, and Education

Educating patients to ensure hypoglycaemia prevention, especially during the transition phase, is vital for ensuring adherence to any insulin regime.

This includes¹:

Step-By-Step Transition Recommendations

By following a systematic approach to titration, monitoring, and patient education, nurses may support patients transitioning between insulin products while helping maintain appropriate glycaemic control throughout the process.

Step 1: Pre-transition planning and patient education

Before initiating the switch in patients prescribed a different insulin product, nurses should ensure that the patient understands the process and safety considerations. Healthcare systems can reduce medication errors associated with similar-looking insulin products through proper patient counseling. Patients should be encouraged to verify both the insulin product name and dosage during appointments, especially when changes are communicated by phone.²

Nurses can foster patient partnership in treatment decisions by providing support during insulin product transitions. Key areas for patient support include³:

Step 2: Dosing and administration during the transition period

Initial start basal insulin dosing can be calculated using body weight 
(0.1– 0.2 units/kg per day) while considering the patient's current glucose levels, followed by personalised dose adjustments.¹ The approach involves beginning with basal insulin and adjusting doses systematically to reach personalised fasting glucose targets for each patient.¹ Patients should always adhere to the specific recommendations and dosing instructions provided by their healthcare provider at the time of prescription.

Toujeo (insulin glargine U300) is a basal insulin for once-daily administration at any time of the day, preferably at the same time every day. When needed, patients can administer Toujeo up to 3 hours before or after their usual time of administration.¹ This scheduling flexibility may help during transition periods when patients are adjusting to new treatment routines.

Step 3: Collaborative transition monitoring

Switching between basal insulin products requires careful monitoring of blood glucose during the transition period.⁴ Throughout this monitoring phase, nurses can help recognise indicators of glucose control changes and adjust care approaches accordingly.

Patient, family, and HCP education about hypoglycaemia represents another strategy. Additionally, expanding knowledge about glucagon administration for severe hypoglycaemia episodes benefits patients, families, and the broader community.⁵

Step 4: Continuity of care

Ensuring safe insulin transitions may require a comprehensive approach that integrates improved surveillance with informed, patient-centered decision-making based on individualised benefit-risk assessments.¹

Conclusion

Successful insulin product transitions require a systematic approach that combines clinical expertise with patient-centric care. You can help facilitate these transitions through titration protocols, consistent patient monitoring, and thorough education throughout the process.

Patient education is an important component of transitions, encompassing not only technical aspects of insulin administration but also enabling patients and their families to recognise and respond appropriately to potential complications, like risk of hypoglycaemia.^1,5 The approach involving nurses, patients, and the healthcare team may help manage insulin product switches, with a focus on patient needs.

Through the application of these strategies, nurses may help support insulin product transitions while helping to maintain adequate glycaemic control and address potential risks for people with diabetes who require changes in their insulin therapy.

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