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## Complete Summary

#### GUIDELINE TITLE

Best practice guideline for the subcutaneous administration of insulin
in adults with type 2 diabetes.

#### BIBLIOGRAPHIC SOURCE(S)

Registered Nurses Association of Ontario (RNAO). Best practice guideline
for the subcutaneous administration of insulin in adults with type 2
diabetes. Toronto (ON): Registered Nurses Association of Ontario (RNAO);
2004 Jun. 91 p. \[121 references\]

#### GUIDELINE STATUS

This is the current release of the guideline.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Type 2 diabetes

#### GUIDELINE CATEGORY

Counseling\
Evaluation\
Management

#### CLINICAL SPECIALTY

Nursing

#### INTENDED USERS

Advanced Practice Nurses\
Nurses

#### GUIDELINE OBJECTIVE(S)

-   To present nursing best practice guidelines for the subcutaneous
    administration of insulin in adults with type 2 diabetes

-   To assist nurses who do not specialize in diabetes education and
    care to administer insulin safely and to teach basic self-management
    skills to clients who require insulin therapy

#### TARGET POPULATION

Individuals 18 years and older with type 2 diabetes requiring
subcutaneous insulin therapy

#### INTERVENTIONS AND PRACTICES CONSIDERED

**Evaluation**

Assessment of patient psychosocial factors

**Management/Treatment/Counseling**

1.  Provide appropriate teaching for patients and their caregivers to
    include:

    -   Insulin preparation and administration

    -   Self-testing technique, meter maintenance and accuracy
        verification

    -   Prevention, recognition, and treatment of hypoglycemia

    -   Management adjustments during periods of illness

2.  Evaluate understanding of previous teaching and reeducate or
    reinforce as needed

3.  Nursing education recommendations and strategies directed at the
    competencies required for practice

4.  Organization and policy recommendations and strategies directed at
    practice settings and the environment in order to facilitate nurses´
    practice.

#### MAJOR OUTCOMES CONSIDERED

-   Morbidity

-   Glycemic control

-   Safety of subcutaneous administration of insulin

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)\
Searches of Electronic Databases\
Searches of Unpublished Data

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

A database search for existing guidelines was conducted by a university
health sciences library. An initial search of the MEDLINE, Embase, and
CINAHL databases for guidelines and articles published from January 1,
1995, to December 2002, was conducted using the following search terms:
\"type 2 diabetes\", \"diabetes self-care education\", \"insulin
initiation\", \"self-care\", \"self management\", \"systematic
reviews\", \"practice guideline(s)\", \"clinical practice
guideline(s)\", \"standards\", \"consensus statement(s)\",
\"consensus\", \"evidence-based guidelines\" and \"best practice
guidelines\".

One individual searched an established list of Web sites for content
related to the topic area. This list of sites, reviewed and updated in
October 2002, was compiled based on existing knowledge of evidence-based
practice Web sites, known guideline developers, and recommendations from
the literature. Presence or absence of guidelines was noted for each
site searched as well as date searched. The Web sites at times did not
house a guideline but directed to another Web site or source for
guideline retrieval. Guidelines were either downloaded if full versions
were available or were ordered by phone/e-mail.

A Web site search for existing diabetes guidelines was conducted via the
search engine \"Google\", using the search terms identified above. One
individual conducted this search, noting the search term results, the
Web sites reviewed, date and a summary of the findings. The search
results were further critiqued by a second individual who identified
guidelines and literature not previously retrieved.

Additionally, panel members were already in possession of a few of the
identified guidelines. Is some instances, a guideline was identified by
panel members and not found through the previous search strategies.
These were guidelines that were developed by local groups or specific
professional associations.

The final step in determining whether the clinical practice guideline
would be critically appraised was to have two individuals screen the
guidelines based on the following criteria. These criteria were
determined by panel consensus:

-   Guideline was in English, international in scope.

-   Guideline dated no earlier than 1998.

-   Guideline was strictly about the topic area.

-   Guideline was evidence-based (e.g. contained references, description
    of evidence, sources of evidence).

-   Guideline was available and accessible for retrieval.

Four guidelines were deemed suitable for critical review using the
Appraisal of Guidelines for Research and Evaluation instrument.

#### NUMBER OF SOURCE DOCUMENTS

Following the appraisal process, the guideline development panel
identified four guidelines to develop the recommendations cited in the
guideline.

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Weighting According to a Rating Scheme (Scheme Given)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

**Level of Evidence**

**Ia** - Evidence obtained from meta-analysis or systematic review of
randomized controlled trials

**Ib** - Evidence obtained from at least one randomized controlled trial

**IIa** - Evidence obtained from at least one well-designed controlled
study without randomization

**IIb** - Evidence obtained from at least one other type of
well-designed quasi-experimental study, without randomization

**III** - Evidence obtained from well-designed nonexperimental
descriptive studies, such as comparative studies, correlation studies,
and case studies

**IV** - Evidence obtained from expert committee reports or opinions
and/or clinical experiences of respected authorities

#### METHODS USED TO ANALYZE THE EVIDENCE

Review of Published Meta-Analyses\
Systematic Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

In January of 2003, a panel of nurses with expertise in practice and
education related to diabetes, from institutional and community
settings, was established by the Registered Nurses Association of
Ontario (RNAO). At the onset, the panel discussed and came to consensus
on the scope of the best practice guideline.

The panel members divided into subgroups to undergo specific activities
using the short-listed guidelines, other literature, and additional
resources for the purpose of drafting recommendations for nursing
interventions. This process yielded a draft set of recommendations. The
panel members as a whole reviewed the recommendations, discussed gaps
and available evidence, and came to consensus on a draft guideline.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

External Peer Review\
Internal Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

The development process yielded an initial set of recommendations. The
panel members as a whole reviewed the recommendations, discussed gaps
and available evidence, and came to a consensus on a draft guideline.

This draft was submitted to a set of external stakeholders for review
and feedback. Stakeholders represented various health care disciplines,
as well as professional associations. External stakeholders were
provided with specific questions for comment, as well as the opportunity
to give overall feedback and general impressions. The results were
compiled and reviewed by the development panel. Discussion and consensus
resulted in revisions to the draft document prior to publication and
evaluation.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

The levels of evidence supporting the recommendations (Ia, Ib, IIa, IIb,
III, IV) are defined at the end of the \"Major Recommendations\" field

+------------------+----------------------------------------+---------+
| ** **            | **Recommendation**                     | **Level |
|                  |                                        | of      |
|                  |                                        | Evi     |
|                  |                                        | dence** |
+==================+========================================+=========+
| Practice         | 1\. Nurses should assess psychosocial  | III     |
| Recommendations  | factors that may affect the            |         |
|                  | individual´s ability to successfully   |         |
|                  | initiate insulin therapy. Assessment   |         |
|                  | strategies that include the use of     |         |
|                  | open-ended questions to assess         |         |
|                  | barriers, stressors, self-efficacy,    |         |
|                  | and beliefs about insulin initiation   |         |
|                  | should be used.                        |         |
+------------------+----------------------------------------+---------+
|                  | 2\. Education for administering        | Ia      |
|                  | insulin should be tailored in          |         |
|                  | collaboration with the individual to   |         |
|                  | address current knowledge, abilities,  |         |
|                  | and needs.                             |         |
+------------------+----------------------------------------+---------+
|                  | 3\. Nurses should provide and/or       | IV      |
|                  | reinforce appropriate teaching         |         |
|                  | regarding insulin preparation and      |         |
|                  | administration. Topics to include are: |         |
|                  |                                        |         |
|                  | -   Insulin: type, action, stability,  |         |
|                  |     storage, and compatibility         |         |
|                  |                                        |         |
|                  | -   Preparation and administration of  |         |
|                  |     insulin                            |         |
|                  |                                        |         |
|                  | -   Sharps disposal                    |         |
|                  |                                        |         |
|                  | -   Follow-up for medical and          |         |
|                  |     self-care support                  |         |
+------------------+----------------------------------------+---------+
|                  | 4\. Nurses should encourage blood      | III     |
|                  | glucose self-monitoring as an integral |         |
|                  | part of daily diabetes management for  |         |
|                  | individuals taking insulin. The        |         |
|                  | recommended frequency of testing will  |         |
|                  | vary according to diabetes treatment   |         |
|                  | and the individual´s need and ability. |         |
+------------------+----------------------------------------+---------+
|                  | 5\. Individuals who self-monitor blood | III     |
|                  | glucose should receive initial         |         |
|                  | instruction and periodic reeducation   |         |
|                  | regarding self-testing technique,      |         |
|                  | meter maintenance, and verification of |         |
|                  | accuracy of self-testing results.      |         |
+------------------+----------------------------------------+---------+
|                  | 6\. Nurses should ensure clients       | IV      |
|                  | taking insulin receive appropriate     |         |
|                  | basic nutrition information.           |         |
+------------------+----------------------------------------+---------+
|                  | 7\. Clients treated with insulin and   | IV      |
|                  | their caregivers should be taught how  |         |
|                  | to prevent, recognize, and treat       |         |
|                  | hypoglycemia.                          |         |
+------------------+----------------------------------------+---------+
|                  | 8\. Nurses must be aware of the        | IV      |
|                  | effects of acute illness, surgery, and |         |
|                  | diagnostic procedures on blood glucose |         |
|                  | levels.                                |         |
+------------------+----------------------------------------+---------+
|                  | 9\. Nurses should provide basic        | IV      |
|                  | education on blood glucose monitoring, |         |
|                  | dietary, and medication adjustments    |         |
|                  | for periods of illness. This           |         |
|                  | information should be given initially  |         |
|                  | and reviewed periodically with the     |         |
|                  | client.                                |         |
+------------------+----------------------------------------+---------+
| Education        | 10\. Nursing curriculum should include | IV      |
| Recommendation   | education about the care and           |         |
|                  | management of diabetes.                |         |
+------------------+----------------------------------------+---------+
| Organization &   | 11\. Health care organizations should  | IV      |
| Policy           | facilitate ongoing diabetes education  |         |
| Recommendations  | of nursing staff about diabetes care   |         |
|                  | and management.                        |         |
+------------------+----------------------------------------+---------+
|                  | 12\. Organizations must ensure that    | IV      |
|                  | individuals receiving insulin have     |         |
|                  | ready access to an appropriate form of |         |
|                  | glucose at all times.                  |         |
+------------------+----------------------------------------+---------+
|                  | 13\. Organizations should develop and  | IV      |
|                  | communicate appropriate policies and   |         |
|                  | procedures to reduce the potential for |         |
|                  | medication errors related to insulin   |         |
|                  | therapy.                               |         |
+------------------+----------------------------------------+---------+
|                  | 14\. Organizations should have a       | IV      |
|                  | process for documentation to support   |         |
|                  | nursing practice related to insulin    |         |
|                  | therapy.                               |         |
+------------------+----------------------------------------+---------+
|                  | 15\. Nursing best practice guidelines  | IV      |
|                  | can be successfully implemented only   |         |
|                  | where there are adequate planning,     |         |
|                  | resources, organizational, and         |         |
|                  | administrative support. Organizations  |         |
|                  | may wish to develop a plan for         |         |
|                  | implementation that includes:          |         |
|                  |                                        |         |
|                  | -   An assessment of organizational    |         |
|                  |     readiness and barriers to          |         |
|                  |     education                          |         |
|                  |                                        |         |
|                  | -   Involvement of all members         |         |
|                  |     (whether in a direct or indirect   |         |
|                  |     supportive function) who will      |         |
|                  |     contribute to the implementation   |         |
|                  |     process                            |         |
|                  |                                        |         |
|                  | -   Dedication of a qualified          |         |
|                  |     individual to provide the support  |         |
|                  |     needed for the education and       |         |
|                  |     implementation process             |         |
|                  |                                        |         |
|                  | -   Ongoing opportunities for          |         |
|                  |     discussion and education to        |         |
|                  |     reinforce the importance of best   |         |
|                  |     practices                          |         |
|                  |                                        |         |
|                  | -   Opportunities for reflection on    |         |
|                  |     personal and organizational        |         |
|                  |     experience in implementing         |         |
|                  |     guidelines                         |         |
|                  |                                        |         |
|                  | In this regard, the Registered Nurses  |         |
|                  | Association of Ontario (RNAO) (through |         |
|                  | a panel of nurses, researchers, and    |         |
|                  | administrators) has developed the      |         |
|                  | *Toolkit: Implementation of Clinical   |         |
|                  | Practice Guidelines*, based on         |         |
|                  | available evidence, theoretical        |         |
|                  | perspectives and consensus. The RNAO   |         |
|                  | strongly recommends the use of this    |         |
|                  | *Toolkit* for guiding the              |         |
|                  | implementation of the best practice    |         |
|                  | guideline on *Best Practice Guideline  |         |
|                  | for the Subcutaneous Administration of |         |
|                  | Insulin in Adults with Type 2          |         |
|                  | Diabetes*.                             |         |
+------------------+----------------------------------------+---------+

**Definitions**:

**Level of Evidence**

**Ia** - Evidence obtained from meta-analysis or systematic review of
randomized controlled trials

**Ib** - Evidence obtained from at least one randomized controlled trial

**IIa** - Evidence obtained from at least one well-designed controlled
study without randomization

**IIb** - Evidence obtained from at least one other type of
well-designed quasi-experimental study, without randomization

**III** - Evidence obtained from well-designed nonexperimental
descriptive studies, such as comparative studies, correlation studies,
and case studies

**IV** - Evidence obtained from expert committee reports or opinions
and/or clinical experiences of respected authorities

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence is provided for each recommendation (see \"Major
recommendations\").

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

-   This guideline will assist nurses who are not specialists in
    diabetes care to safely initiate and administer insulin, a
    \"high-alert\" medication.

-   This guideline will provide answers to the question: What are the
    essential client self-care components to be addressed by nurses when
    caring for an adult with type 2 diabetes who requires subcutaneous
    insulin.

-   Patients who receive support in achieving optimal glycemic control
    significantly reduce the risk of microvascular damage; the major
    cause of blindness and kidney disease and non-traumatic amputations.

#### POTENTIAL HARMS

Not stated

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

-   The document needs to be reviewed and applied, based on the specific
    needs of the organization or practice setting/environment, as well
    as the needs and wishes of the client. Guidelines should not be
    applied in a \"cookbook\" fashion but used as a tool to assist in
    decision making for individualized client care, as well as ensuring
    that appropriate structures and supports are in place to provide the
    best possible care.

-   These best practice guidelines are related only to nursing practice
    and not intended to take into account fiscal efficiencies. These
    guidelines are not binding for nurses and their use should be
    flexible to accommodate client/family wishes and local
    circumstances. They neither constitute a liability nor discharge
    from liability. While every effort has been made to ensure the
    accuracy of the contents at the time of publication, neither the
    authors nor the Registered Nurses Association of Ontario (RNAO) give
    any guarantee as to the accuracy of the information contained in
    them nor accept any liability, with respect to loss, damage, injury
    or expense arising from any such errors or omission in the contents
    of this work. Any reference throughout the document to specific
    pharmaceutical products as examples does not imply endorsement of
    any of these products.

-   It is acknowledged that the individual competencies of nurses varies
    between nurses and across categories of nursing professionals
    (registered practical nurses \[RPNs\] and registered nurses \[RNs\])
    and are based on knowledge, skills, attitudes, and judgement
    enhanced over time by experience and education. It is expected that
    individual nurses will perform only those aspects of care for which
    they have obtained appropriate education and experience. Both RNs
    and RPNs should seek consultation in instances where the client´s
    care needs surpass the individual nurse´s ability to act
    independently.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

Best practice guidelines can only be successfully implemented if there
are adequate planning, resources, organizational and administrative
support, as well as appropriate facilitation. Registered Nurses
Association of Ontario (RNAO), through a panel of nurses, researchers,
and administrators has developed the *Toolkit: Implementation of
Clinical Practice Guidelines* based on available evidence, theoretical
perspectives, and consensus. The *Toolkit* is recommended for guiding
the implementation of any clinical practice guideline in a health care
organization.

The *Toolkit* provides step-by-step directions to individuals and groups
involved in planning, coordinating, and facilitating guideline
implementation. Specifically, the *Toolkit* addresses the following key
steps:

1.  Identifying a well-developed, evidence-based clinical practice
    guideline

2.  Identification, assessment, and engagement of stakeholders

3.  Assessment of environmental readiness for guideline implementation

4.  Identifying and planning evidence-based implementation strategies

5.  Planning and implementing evaluation

6.  Identifying and securing required resources for implementation

Implementing practice guidelines that result in successful practice
changes and positive clinical impact is a complex undertaking. The
*Toolkit* is one key resource for managing this process.

**Evaluation and Monitoring**

Organizations implementing the recommendations in this nursing best
practice guideline are advised to consider how the implementation and
its impact will be monitored and evaluated. A table found in the
original guideline document, based on the framework outlined in the RNAO
*Toolkit: Implementation of clinical practice guidelines* (2002b),
illustrates some suggested indicators for monitoring and evaluation.

#### IMPLEMENTATION TOOLS

Tool Kits

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Living with Illness

#### IOM DOMAIN

Effectiveness\
Patient-centeredness\
Safety

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Registered Nurses Association of Ontario (RNAO). Best practice guideline
for the subcutaneous administration of insulin in adults with type 2
diabetes. Toronto (ON): Registered Nurses Association of Ontario (RNAO);
2004 Jun. 91 p. \[121 references\]

#### ADAPTATION

The panel, following the appraisal process, identified the following
guidelines, and related updates, to adapt and modify recommendations:

-   American Diabetes Association (2003). American Diabetes Association:
    Clinical practice recommendations 2003. Diabetes Care, 26, (Suppl),
    S1-S156.

-   \*Meltzer, S., Leiter, L., Daneman, D., Gerstein, H. C., Lau, D.,
    Ludwig, S. et al. (1998). 1998 clinical practice guidelines for the
    management of diabetes in Canada. Canadian Medical Association
    Journal. \[On-line\]. Available:
    [www.cmaj.ca/cgi/data/159/8/DC1/1](http://www.cmaj.ca/cgi/data/159/8/DC1/1)

-   Wolever, T., Barbeau, M. C., Charron, S., Harrigan, K., Leung, S.,
    Madrick, B. et al. (1998). Guidelines for the nutritional management
    of diabetes mellitus in the new millennium: A position statement by
    the Canadian Diabetes Association. Canadian Journal of Diabetes
    Care, 23(3), 56-69.

-   Yale, J. F., Begg, I., Gerstein, H., Houlden, R., Jones, H.,
    Maheux, P. et al. (2002). 2001 Canadian Diabetes Association
    clinical practice guidelines for the prevention and management of
    hypoglycemia in diabetes. Canadian Journal of Diabetes, 26, 22-35.
    \[On-line\]. Available:
    [www.diabetes.ca/Files/CDAHypoglycemiaGuidelines.pdf](http://www.diabetes.ca/Files/CDAHypoglycemiaGuidelines.pdf)

\* The *1998 Clinical Practice Guidelines for the Management of Diabetes
in Canada* were updated in 2003. Information obtained from the 1998
guidelines was updated to reflect the new information from the *2003
Clinical Practice Guidelines for the Management of Diabetes in Canada*.

#### DATE RELEASED

2004 Jun

#### GUIDELINE DEVELOPER(S)

Registered Nurses Association of Ontario - Professional Association

#### SOURCE(S) OF FUNDING

Funding was provided by the Ontario Ministry of Health and Long Term
Care.

#### GUIDELINE COMMITTEE

Not stated

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Guideline Development Panel Members*

Anna Brundage, RN, BHSc(N), CDE\
Team Leader\
Manager\
TRIDEC\
Sunnybrook and Women´s College\
Health Sciences Centre\
Toronto, Ontario

Ceilia Ayotte, RN, CDE\
Diabetes Educator\
Peterborough Regional Health Centre\
Peterborough, Ontario

Marianne Beckstead, RN, MN, CDE\
Clinical Nurse Specialist -- Diabetes\
University Health Network\
Toronto, Ontario

Sharon Brez, RN, BScN, MA(Ed), CDE\
Advanced Practice Nurse\
Endocrinology and Metabolism\
The Ottawa Hospital\
Ottawa, Ontario

Linda Fraser, RN, BScN, CDE\
Diabetes Educator\
Victorian Order of Nurses -- Peel\
Mississauga, Ontario

Karen Gorecki, RN, MN\
Clinical Nurse Specialist -- Diabetes\
Leadership Sinai Centre for Diabetes\
Mount Sinai Hospital\
Toronto, Ontario

Robin Hokstad, RN, CDE\
Diabetes Nurse Educator\
Diabetes Centre -- Nipissing District\
North Bay, Ontario

Nancy Muller, RN, CDE\
Diabetes Nurse Educator\
Red Lake District Diabetes Program\
Red Lake, Ontario

Mary Beth Neibert, RN, MS, CDE, ACNP\
Clinical Nurse Specialist -- Diabetes\
St. Joseph´s Hospital\
Hamilton, Ontario

Josephine Santos, RN, MN\
Facilitator, Project Coordinator\
Nursing Best Practice Guidelines Project\
Registered Nurses Association of Ontario\
Toronto, Ontario

Susan Stinson, RN, CDE\
Diabetes Education Centre\
Grand River Hospital\
Type 2 Health Management Clinic\
St. Mary´s Hospital\
Kitchener, Ontario

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Declarations of interest and confidentiality were made by all members of
the guideline development panel. Further details are available from the
Registered Nurses Association of Ontario (RNAO).

#### GUIDELINE STATUS

This is the current release of the guideline.

#### GUIDELINE AVAILABILITY

Electronic copies: Available in Portable Document Format (PDF) from the
[Registered Nurses Association of Ontario (RNAO) Web
site](http://www.rnao.org/bestpractices/PDF/BPG_Insulin_Type2_Diabetes.pdf).

Print copies: Available from the Registered Nurses Association of
Ontario (RNAO), Nursing Best Practice Guidelines Project, 158 Pearl
Street, Toronto, Ontario M5H 1L3.

#### AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

-   Summary of recommendations. Best practice guideline for the
    subcutaneous administration of insulin in adults with Type 2
    diabetes. Toronto (ON): Registered Nurses Association of Ontario
    (RNAO); 2004 Jun. 2 p.

> Electronic copies: Available in Portable Document Format (PDF) from
> the [Registered Nurses Association of Ontario (RNAO) Web
> site](http://www.rnao.org/bestpractices/PDF/BPG_Insulin_Type2_Diabetes_summary.pdf).

-   Toolkit: implementation of clinical practice guidelines. Toronto
    (ON): Registered Nurses Association of Ontario (RNAO); 2002 Mar. 88
    p.

> Electronic copies: Available in Portable Document Format (PDF) from
> the [Registered Nurses Association of Ontario (RNAO) Web
> site](http://www.rnao.org/bestpractices/PDF/BPG_Toolkit.pdf).

Print copies: Available from the Registered Nurses Association of
Ontario (RNAO), Nursing Best Practice Guidelines Project, 158 Pearl
Street, Toronto, Ontario M5H 1L3.

#### PATIENT RESOURCES

None available

#### NGC STATUS

This NGC summary was completed by ECRI on November 3, 2004. The
information was verified by the guideline developer on November 23,
2004.

#### COPYRIGHT STATEMENT

This document is in the public domain and may be used and reprinted
without special permission, except for those copyrighted materials noted
for which further reproduction is prohibited without the specific
permission of copyright holders. The Registered Nurses Association of
Ontario (RNAO) will appreciate citation as to source. The suggested
format for citation is indicated below:

Registered Nurses Association of Ontario (2004). Best practice guideline
for the subcutaneous administration of insulin in adults with type 2
diabetes. Toronto, Canada: Registered Nurses Association of Ontario.

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Date Modified: 11/3/2008