Q1: Are Dietitians able to practice Insulin Dose Adjustment (IDA)?
Yes, it is within dietitians’ scope of practice to provide and/or teach insulin dose adjustment (IDA). Dietitians must practice IDA within limits of their knowledge, skills, abilities and judgment, in compliance with CDBC Standards of Practice and Code of Ethics, and current evidence-informed clinical practice guidelines as well as any policies and guidelines that may be required by their employer. A Health Authority, hospital or health care facility may restrict the scope of practice for health care professionals. Dietitians must comply with employer policies related to IDA.
Q2: Are Dietitians allowed to initiate an insulin order?
No, dietitians cannot initiate an insulin order. Initiation of an insulin order is equivalent to “prescribing” insulin. In the current Dietitians Regulation, dietitians are not authorized to prescribe.
Q3: As an insulin pump trainer in a private practice setting, prior to training a patient, the referring physician orders insulin and insulin pump teaching for the patient. I then train patients to use insulin pumps, and I provide insulin dose adjustment. Am I working with scope of practice?
Yes. Insulin dose adjustment is within the dietitian scope of practice, regardless of the mechanism used to administer the insulin dose as long as the dose is self-administered by the patient.
Q4: Can I administer insulin to my patients?
No, dietitians cannot administer insulin in any setting. In the current Dietitians Regulation, Dietitians are not authorized to “administer” drugs.
Q5: Am I allowed to provide my patients with free, pre-dosed insulin samples to my patients?
No, dietitians cannot hand out or “dispense” free, pre-dosed insulin samples to patients in any setting as insulin is a Schedule II drug in the BC Drugs Schedule Regulation. In the current Dietitians Regulation, Dietitians are not authorized to “dispense” drugs. Note: Vitamin/mineral supplements that can be purchased from non-pharmacy outlets are classified as “Unscheduled” in the BC Drugs Schedules Regulation. These Unscheduled vitamin/mineral Supplements can be dispensed by dietitians. Who else may dispense insulin? Registered Nurses and Pharmacists may dispense Schedule II drugs such as insulin.
Q6: I’m a Certified Diabetes Educator who has completed competencies in Insulin Dose Adjustment and received training in Insulin Pumps, insertion of pump devices and on Continuous Glucose Monitoring. Am I able to insert a soft flexible cannula for insulin injection to a client with diabetes?
No, dietitians cannot perform any procedures “below the dermis”, such as insertion of cannulas and insulin injections. This type of procedure is classified as a Restricted Activity in British Columbia and is not currently part of the Dietitians Regulation. Note: finger pricks are not considered “below the dermis” and may be done by anyone, with consent.
Q7: In my new role as a community outpatient dietitian, I am working with a large population of individuals with diabetes. The RD who was previously in this role held a Certified Diabetes Educator (CDE) designation, however I do not. What is my scope regarding insulin adjustments?
Although an employer may require CDE designation to adjust insulin the CDBC does not. However, if you do not feel confident and safe discussing insulin adjustments with your inter-professional team and your patients, please inform them and refer them to a health professional who is able to help them. The answer to your situation is supported in Principle 3 of the CDBC Code of Ethics. It relates to your individual level of competence and practice readiness.
Q8: In a new work environment, such as becoming part of a mobile diabetes team, is testing a client’s blood glucose using finger prick test within my scope?
Performing blood glucose monitoring using a finger prick test is considered a public domain activity. Being in the public domain means that the activity is not restricted to any specific health professional. Anyone can prick another person’s finger and draw blood, assuming consent is provided. RDs may perform public domain activities. However, as health professionals, RDs must have a dietetic-based reason to carry out these activities. Additionally, RDs must understand the implications of results obtained from performing these public domain activities and refer clients to the suitable health professionals when the results obtained relate to another health professional’s scope of practice (for example, a dietitian may not “diagnose” diabetes following a high blood glucose reading and should refer the client to their physician).
Testing and/or knowing a diabetic patient’s blood glucose concentration may be an important component of a dietetic assessment and may directly impact an RD’s therapeutic nutrition plan and counselling to the diabetic patient.
Q9: In the context of my work with diabetic out-patients, can I perform a retinal exam (once properly trained)?
Retinal Examinations are not part of the dietetic scope of practice. In the Optometrists Regulation, optometry is defined as: “the health profession in which a person provides the services of
- assessment of the eye or vision system through the use of instruments, devices, diagnostic drugs or other means,
- treatment, management or prevention of
- disorders of refraction,
- sensory or ocular motor disorders, or
- diseases or disorders of the eye or anatomical structure directly related to the vision system, and
- dispensing vision appliances.”
Part of the diabetic nutrition plan and counselling may include the prevention of adverse complications of poor blood glucose control to patients’ capillaries. However, the eye health of a patient should ultimately be overseen by an Optometrist or Ophthalmologist.