Starting on insulin
The Community Insulin Start Group is an educational programme for suitable candidates with type 2 diabetes who are on maximum oral diabetes agents. The programme aims to help patients become more independent by teaching skills like insulin titration, as well as providing education about insulin administration, sick day rules, driving, travel, diet, alcohol and exercise.
In Lambeth and Southwark, community-based Insulin Start Groups are facilitated by Diabetes Specialist Nurses. The programme is delivered over four sessions in Southwark and three session in Lambeth.
Who Is the Service For?
Patients referred to the Community Insulin Start Group should meet the following criteria:
- Type 2 diabetes
- Taking maximum oral diabetes medications – please check prescription record for medication concordance. (Glitazones are to be stopped just before starting insulin)
- Seen dietitian within last 6 months
- If metformin not tolerated, consider trial of metformin SR (Glucophage SR) for those with BMI > 25
- HbA1c > 7.5%
- BMI > 22
- Has been instructed in the use of home blood glucose testing and had their competence assessed
- All baseline bloods and measurements obtained (HbA1c, fasting lipids, cholesterol, waist circumference, BMI)
- A prescription for intermediate-acting insulin and the appropriate insulin pen device and needles must be arranged during the individual assessment appointment.
Contacting the Service
Patients residing in Southwark can be referred to this service by a letter from the person’s GP, sent directly to:
Insulin Start Group
King’s Diabetes Centre
Suite 3, Ground Floor, Golden Jubilee Wing
King’s College Hospital
London SE5 9RS
Patients residing in Lambeth can be referred using the details on the Lambeth Insulin Start Group referral pathway and the Lambeth Insulin Start Group Fax Referral Form
Assessing Patients Prior to Joining the Programme
An individual assessment by a Diabetes Specialist Nurse is required prior to attending a Community Insulin Start Group. This will be conducted jointly with the patient’s GP or Practice Nurse in the GP clinic. Referrers should contact their locality Diabetes Specialist Nurse to arrange this assessment.
For clinical purposes the referrer must collect baseline assessment data, and data after insulin is commenced at 3 months, 6 months and 12 months. This should include the following:
- Waist circumference
Please note that rapid improvement of glycaemic control can worsen retinopathy. Patients who have significant retinopathy and high HbA1c may require an early DECS appointment between 3 and 6 months after commencing insulin.
The patient should avoid driving in the first week after commencing insulin. For legal reasons, the DVLA and the patient’s motor insurer will have to be informed of the patient’s conversion to insulin treatment.
The patient’s GP or Practice Nurse will receive feedback on whether the patient completes the course, and advice about support available from the Intermediate Care Team and secondary care.
Download more information from the Community Insulin Start Group below:
Community ISG Programme Overview (in pdf format)
Note these files are in Adobe Acrobat pdf format. If you have not installed and configured Adobe Acrobat Reader on your system, a free download is available from Adobe.