Recently, a patient with an inexplicably high A1c was referred to me.
In reviewing the patient’s chart, I saw that she had received diabetes education and had been started on a sample 75/25 Humalog Kwik Pen a full 16 months before.
Her initial A1c after starting the insulin therapy was improved. After a few months, it started to rise and continued trending up all year until it was 10%. Prescriptions were viewable in the EMR, and I could see that about the time she would have run out of samples, a Kwik Pen was ordered, but with no mention of 75/25.
There are 3 different Kwik Pen formulations, and the practitioner must not have been aware of this and ordered just a Kwik Pen based on the educator’s recommendation. As a result, the pharmacy provided a Humalog Kwik Pen and the patient had been without background insulin for many months.
There are many variations in insulin brands. Patients should always bring their medications and meters for review, and then verbally repeat and demonstrate their understanding of our instructions.
Anonymous, RD, CDE
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