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Diabetes Disaster Averted #58: Ask the Right Questions

We had a type 2 diabetes patient who was scheduled for surgery. The surgeon knew she was going to need assistance with this patient and contacted an appropriate medical doctor. The doctor suggested that the patient take only half of the usual dose of Lantus insulin the night before. The patient was obese and had a Lantus dose of over 300 units per night plus another 300 units of Lispro for associated meals.  We gave the patient 150 units of Lantus. Within 6 hours the patient was complaining of feeling "odd." Her blood sugar was below 50 — she needed more than 4 amps of D50 before the night was over….

After much puzzling and careful questioning over this situation, we discovered that the patient did not like needles. She had asked her pharmacy for the "teeniest" needle they had, an ultrafine needle which was also ultra-short. The patient was not injecting her insulin deep enough to reach the subcutaneous tissue due to her obesity. Once we began using longer needles (standard insulin syringes) the medication could reach the correct area.

Needless to say she was discharged on a total daily dose of 50 units of insulin. Her diabetes team was astounded when we shared our experience with them!

Lesson Learned:

Asking the correct questions can prevent a disaster. For obese patients, ask them to show you the needles they use.

Kate, RN

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