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Medical Residents and Real-World Experience

A few years ago, I was working in an ER when a patient was admitted who had accidently injected 60 units of Novolog instead of Levemir. The patient had called her daughter who had advised her to chew 10 glucose tabs, take 2 tablespoons of sugar, drink a large glass of regular cola and then call 911….

The patient was brought in 35 minutes after the injection, we checked her glucose and it was at 221 mg/dl. The on-duty physician had us check her glucose every 15 minutes — 45 minutes later her glucose had gone to 354 mg/dl and a resident who was on-duty in the ER advised giving her 10 units of Novolog to bring her glucose back in line. We were getting ready to deliver the dose when the physician returned and saw what we were doing and immediately stopped us. He explained that the Novolog had not had time to work and that her glucose climb did not reflect the effects of the Novolog. It was a good thing we withheld the insulin as the glucose started to fall about one and one-half hours after the accidental Novolog dose, and we ended up giving the patient dextrose to prevent severe hypoglycemia.

Lessons Learned:

When rapid-acting insulin is injected it takes about one hour to go to work while simple glucose starts to raise glucose within 5 minutes, so if a patient takes in a lot of glucose there is a good chance that levels will rise significantly before they fall.

New residents have often not had much real-world experience with the actions of different insulins and these mistakes can easily be life-threatening to our patients.

Benjamin Benoit, RN

Please note: 

The duration of action for Novolog is 3 to 5 hours according to the manufacturer. The insulin had not yet completed its action by the time the resident advised administering more insulin to bring the patients glucose back down. It is best to wait until the insulin has completed its action before determining how much more the patient actually requires and administering more. — AY

 

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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