Nursing — Advice Letter on Starting Insulin Injections
A diabetes nurse writes an advice letter to a 61-year-old woman who is starting insulin injections for the first time after her type 2 diabetes can no longer be controlled by tablets. The intermediate challenge is explaining a procedure and a significant lifestyle change in plain, supportive language — including the practical steps, the hypoglycaemia risk, and the monitoring plan.
Letter type
Advice
Write to
Patient
Target length
180–200 words
The case notes
Patient: Mrs Yetunde Ade, 61 years old
Background: T2DM for 9 years; HbA1c 88 mmol/mol despite optimised tablets (metformin, sitagliptin, empagliflozin)
Decision: Insulin initiated: insulin glargine 10 units once nightly at 22:00; tablets continued except empagliflozin (discontinued — not to be combined with insulin without specialist review)
Injection technique: Demonstrated in clinic; abdomen preferred; rotate sites; insulin pen explained; sharps disposal bin provided
Hypoglycaemia: Symptoms: shakiness, sweating, confusion; treat with 15–20 g fast-acting carbohydrate (e.g. 3–4 glucose tablets or 150 mL fruit juice)
Monitoring: Fasting blood glucose daily before injection; target 5–8 mmol/L fasting; contact clinic if consistently above 10 or below 4
Follow-up: Telephone review in 1 week to review glucose diary; clinic in 6 weeks for dose adjustment
Driving: Must check blood glucose before driving; cannot drive if below 5 mmol/L; DVLA notification explained
Task: Write an advice letter to Mrs Ade explaining how to take her new insulin safely and how to recognise and treat low blood sugar.
Writing task
Write an advice letter to Mrs Ade explaining how to take her new insulin safely and how to recognise and treat low blood sugar.
What to include, what to cut
The hardest mark to win is selection. The same case notes contain decision-relevant facts and distractors. Here is what an examiner expects to see in a Grade B letter for this scenario, and what should be left out.
Include
-
When to inject (22:00 nightly) and the basic technique reminder (rotate sites)
Consistent timing is critical for glargine. Rotating sites prevents lipohypertrophy — a practical instruction that directly affects insulin absorption.
-
Hypoglycaemia symptoms and exactly how to treat it
This is the most important safety content in the letter. A patient starting insulin who does not recognise or treat a hypo correctly is at risk. Name the symptoms, give the specific treatment (dose and examples), and say when to seek help.
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The blood glucose target range and when to call the clinic
A concrete action threshold (above 10 or below 4) gives the patient a decision rule, not a vague instruction to 'monitor'.
Leave out
-
The reason empagliflozin was discontinued
Relevant as a medication change but not as a letter explanation. State that her tablet regimen has been adjusted; the clinical reason is for the GP letter.
-
The full 9-year diabetic history and previous HbA1c values
The patient knows her own history. The letter's purpose is practical guidance, not a retrospective summary.
Criterion in focus · Conciseness & Clarity
Starting insulin is frightening for patients. An advice letter that is too long, too clinical or too jargon-heavy will not be read carefully. Every sentence must be actionable and in plain language. 'Shake, sweat, or feel confused — eat 3–4 glucose tablets and check your glucose after 15 minutes' is clear; 'administer a carbohydrate bolus upon symptom recognition' is not.
Now write the letter — and find out what is blocking your Grade B
Write a 180–200 words advice letter from these notes, paste it into the free checker for an instant read, then submit it for a human grade against all six criteria. Dr Mariam's team returns line-by-line feedback, from $12.