What Medication Therapy Management (MTM) questions would you ask a patient on Jardiance (Empagliflozin) and Lispro insulin?

Medication Therapy Management Questions for Patients on Jardiance and Lispro Insulin

When conducting MTM for a patient on Jardiance (empagliflozin) and Lispro insulin, focus on hypoglycemia risk, medication timing, and specific side effects monitoring to optimize patient outcomes and safety.

General Medication Assessment Questions

• When do you take your Jardiance in relation to meals?
• What time(s) of day do you inject your Lispro insulin?
• How many minutes before meals do you inject your Lispro insulin?
• Have you missed any doses of either medication in the past week?
• Do you check your blood glucose regularly? How often and when?
• What are your typical blood glucose readings (fasting, before meals, and 2 hours after meals)?

Hypoglycemia Assessment

• Have you experienced any symptoms of low blood sugar (shakiness, sweating, confusion, irritability, dizziness)?
• How do you treat hypoglycemia when it occurs?
• Do you carry a source of quick-acting carbohydrates with you?
• Has your healthcare provider adjusted your insulin dose since starting Jardiance? 1

Jardiance-Specific Questions

• Have you experienced any symptoms of dehydration such as dizziness, lightheadedness, or weakness, especially when standing up? 2
• Have you noticed increased urination since starting Jardiance?
• Have you had any urinary tract infections or genital yeast infections since starting this medication? 2
• Do you know when to temporarily stop taking Jardiance (during illness with vomiting, diarrhea, or reduced fluid intake)? 1
• Are you aware of the symptoms of ketoacidosis (nausea, vomiting, abdominal pain, tiredness, labored breathing) that require immediate medical attention? 2

Insulin Lispro-Specific Questions

• How do you store your insulin?
• Do you rotate your injection sites? Which sites do you use?
• Have you noticed any lumps, redness, or pain at injection sites?
• Do you use a consistent technique when drawing up and injecting your insulin?
• If you're using a premixed insulin, how do you prepare it? 1

Medication Interaction Questions

• Has your insulin requirement changed since starting Jardiance? 1
• Have you been instructed to adjust your insulin dose when starting Jardiance? (Consider 10-20% reduction) 1
• Are you taking any other medications that might affect your blood glucose levels (such as steroids, certain antibiotics, or over-the-counter medications)?
• Do you take any herbal supplements or vitamins?

Lifestyle and Self-Management Questions

• What do you do for physical activity, and has this changed recently?
• How do you adjust your insulin dose for exercise?
• How do you manage your diet? Do you count carbohydrates?
• How do you handle sick days when you may not be eating normally? 1
• Do you have a plan for managing your medications during travel?

Monitoring and Follow-up Questions

• When was your last HbA1c test and what was the result?
• When was your last kidney function test?
• Have you had any recent changes in your weight?
• Do you monitor for ketones when sick, even if your blood glucose is not very high? 2
• Have you had any recent hospitalizations or emergency room visits related to your diabetes?

Education Assessment

• What is your understanding of how Jardiance works differently from insulin?
• Do you know the signs of hypoglycemia and hyperglycemia?
• Are you aware that Jardiance can reduce the risk of cardiovascular events? 3
• Do you understand the importance of adequate fluid intake while on Jardiance? 2

Common Pitfalls to Address

• Failure to reduce insulin dose when starting Jardiance can increase hypoglycemia risk 1
• Not recognizing that ketoacidosis can occur with normal blood glucose levels in patients on SGLT2 inhibitors like Jardiance 2
• Inadequate fluid intake while on Jardiance can increase risk of dehydration and hypotension 2
• Continuing Jardiance during acute illness with vomiting or diarrhea can increase risk of acute kidney injury 1
• Injecting Lispro insulin too far in advance of meals can cause hypoglycemia due to its rapid onset of action 1, 4

Remember to document all responses and create an action plan addressing any identified issues with the patient's medication regimen.