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Diabetes Disaster Averted #76: Insulin Confusion

I recently had an elderly, ill gentleman discharged from the hospital, who was not a new diabetic, but new to insulin. He had steroid induced hyperglycemia, and would need a correction aspart coverage until his Prednisone was tapered off. He was struggling in the hospital, and suggestions of a home health care nurse were made — however, he is the caretaker for his elderly wife with dementia, and insisted on going home alone….

I spent a great deal of time with him writing out, and practicing a correction scale. I personally placed the order for his 3/10th syringes in the med list, as he had poor vision and drawing up 2, 4, 6 units with a U-100 would have been difficult. This is the snapshot of what printed on his med list to go home:

  • BD INSULIN SYRINGE ULTRA-FINE 0.3 mL 30 x 1/2″ Syrg
  • Use as directed 3 times daily before meals. For: DIABETES MELLITUS
  • Associated Diagnoses: DM type 2 (diabetes mellitus, type 2)
On his first day home, he placed multiple calls to Internal Medicine, Endocrinology, confused about his insulin. I received reports that he was looking for his “second insulin to give with the Novolog.” I called him at home, asked him to share his day with me, and exactly what he did. He tested his BS at breakfast and it was 146. He looked on his correction scale and knew he did not need any Novolog, but what he was looking for was a “BD” insulin to take with his meals!Lesson learned:

Place the generic name of a syringe on a med list, and write, “as needed” for frequency, instead of “before meals.”

Christine Henson RN, BSN, CDE

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