It was 8:15 pm. A patient who lives alone called me. “Joy, I just mixed up my Humalog and my Lantus. I took 20 units of Humalog but I was supposed to take 20 units of Lantus, and I took 10 units of Lantus.” I knew that the onset of Humalog (lispro) is about 15 minutes, the peak is about 30-90 minutes, and the duration is about 3-6 hours. For Lantus, the onset is about 60-90 minutes, it’s relatively peakless, and the duration is 20-24 hours. With that in mind, I thought I could help her avert a serious hypoglycemic event and a visit to the emergency room….
This patient did not have a continuous glucose monitor. Her blood glucose was 128 at the time. My main concern was the increased dose of Humalog. I recommended she eat something with about 15 grams of fast-acting carbohydrate immediately, then check her blood sugar in 10 minutes. Then every 15 minutes or sooner if she started to feel symptoms of hypoglycemia, she should take another 15 grams and continue to do so for the next hour and a half.
She did as I recommended. Her blood glucose stayed in the 100’s. We talked several times during that next hour and a half. At the hour and a half time, I told her she could stop because I knew the peak of her insulin action should be over. I encouraged her to eat something with protein and/or fat like cheese, and to continue to check her blood glucose every half hour until six hours from when she had first taken her Humalog (at 2:15 a.m.). I also recommended she set her alarm and check her blood glucose hourly during the night, just in case her levels got too low or too high.
She did well. She did not become hypoglycemic nor hyperglycemic. A serious hypoglycemic event and a visit to the ED were averted.
Teach your patients the importance of storing their different types of insulin in different places. Show them the difference in how the vials and/or pens look. Also, be sure to teach the onset, peak, and duration of action of the insulin(s) they are taking.
You can also print out our Comprehensive List of Insulins (PDF) with all of this information and more. Please feel free to print as many copies as you need. Comprehensive List of Insulins (PDF)
Joy Pape, MSN RN FNP-C, CDE, CFCN, FAADE
Associate Medical Editor, Diabetes In Control
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