Disasters Averted

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. …

When prescribing NovoLog® Mix 70/30 analog insulin, health care professionals may write an unclear prescription, or if using an EMR system, inadvertently select Novolin® 70/30 human insulin instead. Be on the lookout for these errors. Read on for a breakdown of the key differences between these 2 types of insulin. Before …

I recently had a home care patient who had been discharged from a skilled nursing facility with a prescription for regular insulin, and who was put on a sliding scale dosage. The patient was experiencing hypoglycemic reactions. I was called to see him to find out why he was having multiple …

Recently I assessed an 84 year old inpatient with diabetes for his insulin usage at home. In reporting his dosing he stated that after he checked his glucose before each meal he took the "first two numbers of the result," and made that his dosage for meal-time insulin. For example, if the …