Disasters Averted

Susan received a phone call from her clinician’s office recommending that she start using a pen for her insulin. She had also been prescribed a GLP-1 receptor agonist and was to go to the pharmacy to pick them up. She went and signed up for the long ‘discourse’ patients receive …

Ricardo, a 35-year-old man newly diagnosed with type 1 diabetes, was hospitalized for diabetic ketoacidosis (DKA). Once he was stabilized, he wanted to go home. He refused to learn how to self-administer insulin. However, he was told he would not be discharged until he self-administered insulin, at least one time. I …

Recently, a patient of mine called about her post-meal glucose levels which were increasing.

An 83-year-old woman who lived alone and was very active in her community was having wide swings in her glucose levels. She reported sometimes waking up hours after dinner with her head in her dinner plate. She did not understand why. She did not have family or caretakers nearby to …

A patient of mine was newly diagnosed with type 1 diabetes. He started on insulin and I taught him about glucose targets; insulin administration, including the signs and symptoms of hypoglycemia; and how to prevent, recognize, and treat hypoglycemia. I also taught him about the “honeymoon period,” which, I told …

A patient of mine who had diabetes and peripheral neuropathy came home from the hospital after a below-the-knee amputation of her right leg. She lived alone and was housebound. Having lost one leg, I knew she was at increased risk for losing her other leg. While in rehab, she had …

Last week in the pharmacy we received an electronic refill authorization for regular and nph insulin.   The patient had been using the two insulins together for about two years and seemed to be in relatively good control. The refills had the sig code “uad”. Usually we would ask for …

The patient is a 91-year-old female with a 10-year history of type 2 diabetes. Two years ago, despite use of multiple oral hypoglycemic agents, her glycated hemoglobin (HbA1c) remained at 9.2% (77 mmol/mol) and her home glucose levels were in the mid-200 mg/dL (approximately 11.1 mmol/L) range. Her caretaker was …

I was reviewing a client’s insulin administration. She was administering Levemir (insulin detemir), 60 units, with a FlexPen. She said that she just dialed the dose to the maximum it would allow her as she knew it only would dial to 60 units. She did not confirm the dose visually. Although …

From our partners at the Institute for Safe Medication Practices (ISMP.org): A nurse gave orange juice to a patient with a blood glucose level of less than 50 mg/dL, but it did not raise the glucose level much, so he administered a dose of IV GLUCAGON EMERGENCY (glucagon) per policy. …