I work in a large teaching hospital in the Northeast and recently had an order written for mixed insulin for a new admission that seemed very odd. One of our newer residents wrote an order for Humalog 75/25: give 9 units at breakfast, 7 units at lunch and 13 units at dinner. I thought for sure that using this 3 times a day, especially at the high dosage at dinner would lead to severe hypoglycemia….
I questioned the resident and he informed me that this was a very common protocol when he was a student. He recommended that I ask the pharmacist about the action curves if I had any questions.
The pharmacist agreed with me and called the resident to get more information. A couple of hours later the pharmacist called me back to give me a new dosage regimen. After the conversation with the resident the dose was changed to Humalog 75/25 18 units at breakfast and 11 units at dinner.
When the pharmacist called the resident and discussed the dosing, it came out that the resident had gone to school in Germany and their mixed insulin is short acting first and long acting second, just the opposite of how it is written in the US. So when he ordered 75/25 he was expecting 75% short acting and 25% long acting which would have made sense.
Many of our physicians have been trained in other countries where other percent mixtures of insulin are available and so it is important that when we see an odd dose of mixed insulin we verify which one is the long acting component and which is the short acting.
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