Insulin injection technique can be taught without hospitalization

Although hospitalization of the diabetic may be seen as a failure of management, and places the patient in an artificial situation, admission for initiation of insulin therapy is the custom in most Ethiopian hospitals. From January 1987 to January 1988, 144 diabetics were taught insulin injection technique in the Diabetic Clinic of Yekatit 12 Hospital in Addis Ababa, Ethiopia, by two nurses in early morning, six days weekly, sessions. Of these, 85 were inpatients aged 6 to 73 years from all wards, admitted because of ketoacidosis, intercurrent illnesses or rural home. The 59 outpatients, aged 7 to 70 years, attended each morning, and started therapy with 8 to 12 units of Lente insulin daily, the dose being increased every 2 or 3 days by small increments until control was attained. These outpatients needed an average of 4.7 mornings (range 1-13) to learn the technique, and an additional 3 to 4 weeks of frequent checkup to achieve control: several continued their jobs while learning. The method failed with 2 very symptomatic patients; there were no severe hypoglycaemic reactions or other complications. In addition to the financial saving for patients, and reduction of hospital bed use by diabetics, the patients helped and encouraged each other, learning faster than when taught individually as "ill" inpatients.