Registered Nurses' Association of Ontario

Background about Diabetes

  • Diabetes is a serious, life-long condition affecting many Canadians. Approximately 1.9 million Canadians have diabetes. In 2005/2006, the National Diabetes Survey System identified that one in 17 Canadians (5.5% of all women and 6.2% of all men) were diagnosed and living with diabetes.
  •  With the current understanding of the importance of glucose management for complication prevention in type 2 diabetes, insulin therapy is being considered as an early treatment option.
  • Insulin therapy is no longer the treatment of last resort, but may be a proactive choice for many people (Canadian Diabetes Association (CDA), 2003a; Meltzer et al., 1998).
  • According to the Institute for Safe Medication Practice (ISMP) Canada, insulin is one of the top five “high-alert” medications (ISMP Canada, 2003). Errors in dosing and administration can cause severe adverse effects. Too much insulin can rapidly lead to hypoglycemia that may further progress to seizures and coma, while under dosing can lead to worsening of hyperglycemia (ISMP Canada, 2003).
  • There are three main forms of diabetes:

1. Type 1 diabetes affects approximately 10% of all people with diabetes and is primarily a result of an inability to produce insulin due to autoimmune destruction of the pancreatic beta cells. It is often diagnosed at a young age and requires insulin treatment. People with type 1 diabetes are susceptible to diabetic ketoacidosis if they do not take the required insulin.

2. Type 2 diabetes affects approximately 90% of those diagnosed with diabetes and results from a combination of insufficient insulin production and/or insulin resistance at the cell level.

3. Gestational diabetes (GDM) is diagnosed during pregnancy and affects 3.5 to 3.8% in the non-Aboriginal population (CDA, 2003a). Up to 40% of women who have had GDM will develop type 2 diabetes as they age (Health Canada, 2002).

  • Type 2 diabetes is considered to be a progressive condition. Many individuals develop secondary failure on oral antihyperglycemic agents, which means that eventually insulin is
  • Approximately 50% of all clients with type 2 diabetes eventually require insulin therapy to maintain optimal glycemic control (DeWitt & Hirsch, 2003; Grissinger & Lease, 2003; Turner, Cull, Frighi, Holman, & UKPDS Group, 1999).
  • Client education is essential for effective insulin treatment. Education should emphasize the effective use of medical nutrition, oral agent therapy and physical activity to increase insulin sensitivity.
  • Some elements are essential to any client starting insulin therapy. These include the ability to self-inject insulin safely using a syringe or insulin pen. They also include recognition of signs and symptoms of hypoglycemia and a basic knowledge of how to prevent and treat hypoglycemia.
Chronic Disease
Subcutaneous Administration of Insulin in Adults with Type 2 Diabetes
Background Information