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Basal Insulins Incorrectly Withheld

Mar 30, 2014

You may be surprised to learn that nurses sometimes inappropriately hold basal insulin doses (daily or every 12 hours) when a patient’s blood glucose is normal at the time a dose is due. This may be appropriate for mealtime or short-acting insulin products, but not basal insulins that can last for up to 24 hours, such as insulin glargine (LANTUS) or insulin detemir (LEVEMIR). These events occurred with medical patients, not patients undergoing surgical procedures for whom it may have been appropriate to withhold doses or partial doses if they were not eating post-operatively…. 

When a basal dose is withheld, the patient’s fasting blood glucose the following morning is likely to rise. In the hospital, staff found patients with blood glucose readings in the 200–300 mg/dL range.

This error is more likely to be noticed if a pharmacy prepares basal insulin doses and investigates when the doses have not been administered. One hospital told us that they were seeing a few cases per week until they looked into the situation and made changes. The hospital’s education department chose this as a topic for a program. The hospital also has changed their Lantus labels, adding a reminder, "Don’t hold without MD order."

Diabetes in Control would like to acknowledge the Institute for Safe Medication Practices’ outstanding work in medication safety, including the above excerpt. For more information on this issue as well as other important safety issues, please visit

Report Medication Errors to ISMP:

Diabetes in Control is partnered with the Institute for Safe Medication Practices (ISMP) to help ensure errors and near-miss events get reported and shared with millions of health care practitioners. The ISMP is a Patient Safety Organization obligated by law to maintain the anonymity of anyone involved, as well as omitting or changing contextual details for that purpose. Help save lives and protect patients and colleagues by confidentially reporting errors to the ISMP.



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