The pharmacist’s role in supporting insulin therapy

In this article:

• Challenges
• Support
• Bottom line

In this article

• Challenges
• Support
• Bottom line

Millions of people depend on insulin to control their blood sugar every single day. However, many might worry about side effects, get tripped up by injection techniques, or feel lost about timing and dosing. Plenty of patients just starting insulin might be overwhelmed or even a bit scared. 

As a pharmacist, you’re probably the most accessible healthcare provider these folks see regularly. Pharmacists can be a real source of support, tackling concerns and giving ongoing advice that can tip the scales between treatment working out or not. Whether someone’s picking up their first insulin pen or has been at it for years, your counsel can help them feel more confident and improve their health.

Potential challenges patients on insulin may experience

Hurdles often come up when patients start insulin. Around a third of people admit to skipping doses or not sticking to their insulin treatment. Research shows that 18% to 26% of people with Type 2 diabetes who start insulin stop taking it within the first year.

But what’s causing the challenges with insulin? Potential challenges patients might have to overcome include:

• Fear of needles and injections
• Worry about low blood sugar episodes
• Weight gain concerns
• Difficulty scheduling injections around meals and activities
• Storage and handling headaches
• Cost and insurance hassles

Negative emotions surrounding insulin aren’t uncommon. Some people might feel down or angry, and plenty worry that insulin will just add more stress to their lives. It’s no surprise that the idea of daily injections can be intimidating. Many people might also worry that once they start, they’re stuck on insulin for life.

Misconceptions about insulin don’t help. Some might think their healthcare provider is using insulin as a threat to get them to eat better or exercise. Others might see needing insulin as proof of failing to take care of their own health, which just isn’t true.

6 ways to support patients on insulin

Pharmacists play a key role in helping patients stay on top of their insulin therapy. They can give real-life advice, from showing how to inject to helping with cost concerns. These ideas to support patients may help them stay on track:

1. Make injections less overwhelming

Pharmacists can break down injections into simple steps to ease anxiety. Show patients that insulin needles are way thinner than they probably think. Most people expect pain, but today’s needles are usually tiny and barely hurt.

If you’re showing how to inject insulin for the first time, walk through each step slowly. Let patients fiddle with the pen or syringe. Some people find it helps to practice with saline before doing the real thing.

Hand over a simple checklist for home:

• Check the expiration date
• Prep the injection spot
• Take off the needle cap
• Go in at a 90-degree angle
• Push the plunger slowly
• Count to 10 before pulling out
• Dispose of the needle safely

Don’t ignore the emotional side. Patients sometimes see insulin as proof that their condition has worsened or feel embarrassed. Remind them that insulin is there to protect their health and prevent complications.

2. Remind patients to watch their highs and lows

Blood sugar checks become much more important with insulin. Pharmacists should discuss which numbers matter and when to check. They should also teach patients how to spot hypoglycemia early: shaking, sweating, confusion, weakness, or dizziness. Fear of lows is one of the top reasons people avoid or quit insulin.

Give patients clear steps for treating low blood sugar (below 709 mg/dL):

• Eat 15 grams of fast carbs like glucose tablets
• Wait 15 minutes and recheck
• Repeat if still low
• Grab a snack after things are back to normal

Explain when to call the doctor for high blood sugar. Anything over 300 mg/dL or readings stuck above 250 mg/dL need attention. Suggest keeping a blood sugar log. It helps patients and their providers make the right changes to insulin, and apps make this easier than ever.

3. Show them proper injection technique

Bad injection techniques can mess up blood sugar control and cause skin problems. Mention rotating between the arms, thighs, and belly when picking an injection site. The abdomen absorbs insulin fastest, then arms, then thighs. Skip spots that are lumpy, bruised, or scarred.

Needle angle depends on length. Use 90 degrees for needles 5mm or longer. Shorter ones can go straight in. Pinch the skin if the patient’s really thin.

Timing also matters. For example, count to 10 after injecting before pulling the needle out. That way, the whole dose goes in. You can also recommend watching for problems from not rotating sites. Some people get lumpy spots (lipodystrophy) from using the same area. Those spots don’t absorb insulin well.

4. Help them find affordable alternatives

Insulin costs are a nightmare for a lot of people. Pharmacists can point patients toward savings programs and more accessible options. Manufacturer programs can help knock the price down. Lilly, Novo Nordisk, and Sanofi all run assistance programs that can reduce costs for those who qualify.

Biosimilars can be less expensive than popular brand-name insulins. Semglee (insulin glargine) and Rezvoglar (insulin glargine) work about the same as Lantus but cost less. Walmart’s ReliOn brand is a bargain. ReliOn NovoLog is around $70 per vial, compared to $300+ for name brands.

In addition, SingleCare gives instant discounts, with people saving up to 80% on insulin without much effort. You can guide them on how to sign up for discount coupons online or with a simple download of the app. 

5. Guide them on storage and handling

Storing insulin incorrectly can make it less effective and can waste money in the long run. Pharmacists should provide clear tips for storage and troubleshooting.

Temperature is everything. Remind patients to keep unopened insulin in the fridge and to never freeze insulin or leave it in the sun or a hot car. Although room temperature is fine for a bit, once opened, most insulins are good for 28 days at room temperature. Circle or highlight the discard date on the label to help patients remember.

Travel takes a little planning. Patients need insulated cases for car rides and a healthcare provider’s note for flights. They should always keep insulin in carry-on bags, not checked luggage.

Teach patients to check their insulin each time. Clear insulins shouldn’t have particles or clumps, and cloudy insulins should mix evenly without any visible chunks. Remind them that pen care also matters. Take off the needle after each shot to prevent clogging. Keep the cap on when not using it, and if a pen jams up, try a new needle before tossing the whole thing.

6. Explain potential drug interactions

Lots of medications can mess with blood sugar or change how insulin does its job. As a pharmacist, you may want to go over everything they’re taking, even those random vitamins and supplements.

Many patients may be on corticosteroids like prednisone or methylprednisolone, unaware that they’re raising their blood sugar. They might find their insulin needs go through the roof, sometimes doubling or tripling what they usually take. 

Some drugs can push sugars the other way, leading to hypoglycemia, especially for people on other diabetes medications like sulfonylureas. Beta blockers can be difficult because they mask warning signs of hypoglycemia, which may cause patients to miss early symptoms. 

You’ll also run into patients taking herbal products and supplements that seem harmless but still affect glucose control. For example, ginseng, chromium, or cinnamon may lower blood sugar, sometimes unpredictably. On the other side, niacin and certain over-the-counter decongestants can push sugars higher. The takeaway is that nothing should be dismissed as “just a supplement.”

Bottom line

Pharmacists can do a lot for people trying to manage insulin therapy. They’re the ones who can help fill in the gaps between quick doctor appointments and the daily routine of managing diabetes. 

Helping patients on insulin means more than just teaching proper injection techniques. It’s also about clearing up misunderstandings and showing practical ways to make insulin a smooth and automatic part of their life, almost like brushing their teeth. With the help of a pharmacist, patients can feel more empowered to take care of their health and see actual improvements as a result.