A patient came into our emergency room recently with severe hypoglycemia (blood glucose of 34 mg/dl).
She had recently been discharged from the hospital with prescriptions for glyburide, Levemir and Novolog. In addition, upon discharge during a previous admission, the hospitalist had advised the patient to increase her glyburide from 5 mg to 10 mg daily. Our first thought was that the increase in glyburide was the reason for the hypoglycemia, and the hospitalist referred the patient’s husband who was also her caregiver to me for training on how to measure and inject insulin.
I visited with the patient’s husband who insisted that he already knew how to give his wife her insulin: in fact he had been doing her injections for her from the start of her insulin therapy. After a lengthly chat I finally convinced him to demonstrate how to draw and administer insulin. I told him to draw 1 unit, and he pulled 10 units out. Then I asked him to draw up her regular dose, and he filled the syringe with 80 units instead of 40. When I pointed out what he had done, he finally realized that he had been giving her considerably more insulin than what she was prescribed. I pointed that out to him and showed him the correct way of drawing insulin. He commented that, “Nobody told me that,” and was very thankful.
Most of the time when patients or caregivers say they haven’t been trained on how to do something, it’s more likely that they have forgotten what they learned or indicated to the trainer that they understood everything when they didn’t. Patients and caregivers should explain the procedure back to you rather just acknowledging that they understand. In addition this patient would be an excellent candidate for pen therapy.
Alicia G. Fletcher, MSN, RN, ACNS-BC, CCRN, CDE
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