Disasters Averted

From our partners at the Institute for Safe Medication Practices (ISMP): Office staff at an endocrinology practice was asked to see a patient who was having low blood glucose while receiving their insulin using a Medtronic MiniMed Revel portable infusion pump. The pump allows information to be downloaded and it showed …

You may be surprised to learn that nurses sometimes inappropriately hold basal insulin doses (daily or every 12 hours) when a patient’s blood glucose is normal at the time a dose is due. This may be appropriate for mealtime or short-acting insulin products, but not basal insulins that can last …

Last week I saw a patient who seemed to be losing control of her blood glucose levels. She had been doing well and her A1c had been around 6.0 – 6.3 for the past couple of years. She was doing this while only on metformin 1000 twice a day. She …

I had a new patient who has had diabetes for decades. She was referred to me after her blood sugars went from good to bad. I asked her to bring her supplies with her when she came in to the office for her appointment. She did so and during her …

A patient came to my office to learn to use long-acting insulin. The referring provider’s note stated that the new patient, who was establishing care without outside records, was taking only mealtime insulin: NovoLog. During my assessment, the patient stated "NovoLog 75/25" was used three times per day, before meals. Knowing …

A woman with type 2 diabetes was taking Lantus using a vial and syringe, and Novolog using a prefilled insulin pen device. Novolog was a new medication for her, and she had only been on it for 10 days. Her pre-meal glucose readings were still high though, in the mid …

I had a type 2 patient on metformin whose blood sugars were elevated every day at lunchtime. All of his other readings including fasting, pre- and post- dinner, and bedtime, were fine. When he demonstrated his testing method over a Skype internet video call, everything he did seemed correct. After …

Recently I saw a type 1 diabetes mellitus patient who was diagnosed in 1980 at 15 years of age. She had not seen an educator in quite some time but had changed from NPH/Regular to Lantus & Regular. She was interested in learning more about the insulin pens that were …

At our podiatry clinic, we had a Native American patient who came in once a week for diabetic ulcer debridement and dressing changes. He would do his home care and then return for further debridement and a new topical if the current one wasn’t healing the ulcer. Because it was …

I do a lot of inpatient diabetes education. One of my patients was new to insulin and needed to go home on twice daily injections of 70/30. We educated her with all she needed to know to be successful at home. Two weeks after discharge the patient experienced a severe …