Discharging patients who need district nurse administration of insulin

Diabetes & endocrinology
NHS Lothian

Sending a patient home with insulin administered by District Nurses?
How to Complete the Green Book

 

1. Complete the appropriate titration sheet (separate to the green book) then ATTACH FIRMLY to the first page of the Green book entitled ‘Prescription Chart’. This acts INSTEAD of the prescription chart – do NOT fill both in.

 

2. Does your patient have Type 1 or Pancreatic Diabetes?
  • They will need to go home with a ketone meter and ketone information - please contact the diabetes nurses to arrange this.
  • Please ADD novorapid vial to IDL: 'prn', indication: 'for correction of hyperglycaemia after discussion with medical professional'.

 

Please note that in the exception of emergency discharges, the diabetes team need 12-24h notice of discharge to organise this. Please ring in advance.

How to fill in an DN insulin titration sheet

Please complete the correct form depending on your patient's insulin regime (option A, B, or C)

 

1
Please add a patient sticker or write the name, CHI and address
2
Write the most recent HbA1c result (HbA1c should be repeated every 3-6 months). Sign to authorise insulin administration
3
Write the dose of insulin prescribed on discharge
4
Most patients haven a target range of 6-12, this may be higher in frail patients, if you are unsure then contact the diabetes team
5
For most patients if BG is above target on 3 days then increasing insulin by 10% is sensible
6
For most patients if BG is low reducing insulin by 10% is sensible
Insulin titration sheet - Once daily
Insulin titration sheet - Twice daily

C. Other regimes

(e.g. basal and bolus, insulin plan in place)

Please contact the diabetes team as a bespoke plan will need to be organised and communicated to the community diabetes team.