Recently I saw a type 1 DM patient diagnosed in 1980 at 15 years of age. She had not seen an educator in quite some time but had changed from NPH/Regular to Lantus & Regular....
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She was interested in learning more about the insulin pens that were available. As we were discussing her routine she became less responsive in her answers and started digging into her purse but did not know what she was looking for. I decided to check her blood sugar and she was 25. We were able to avoid a catastrophic event and she nicely came up to 99 after 45 grams of carbs 45 minutes later.
In further discussion I learned she was mixing her Lantus/Regular and was told by her previous PCP that it was okay. She also was dosing her regular insulin based on a sliding scale and had not learned carb counting.
Lessons Learned:
Don't assume that a seasoned individual is injecting without a problem or has been updated with the most recent ways to manage their DM. Lantus insulin also cannot be mixed with any other insulin and must be injected separately. And it is always important to review a patient's technique to see if there is something they might benefit from and manage differently.
Lynnette Hartwig RN, BSN, CDE
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