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The Power and Dangers of Advertising

Nov 17, 2013

Recently a 69-year-old man returned to see me after being started on a single bedtime dose of Levemir via the Flex pen along with a long-acting sulfonylurea. He had received education about basal insulin action from the start. On return his morning glucose was terrible but I noticed that the rest of the day his glucose was near goal. I began to wonder if his sulfonylurea was working better with the addition of basal insulin but was puzzled by the worsening overnight rise. I was considering lowering the oral dose and increasing the basal dosing to balance glucose control better when he volunteered a critical piece of information nonchalantly….

He proudly announced that he had been listening to NovoNordisk commercials on TV and realized that when you use the Flex pen you need to eat a meal right afterwards. Since he was getting his insulin at bedtime, he decided he should add a fourth meal to the day. This was occurring after his bedtime dose of insulin and AFTER his glucose check.

It was then obvious he did not need a basal rate increase but instruction in the action of Levemir and the difference to the Novolog Flex pen action. If adjustments had been made without changing the dietary cause, this individual may have needed a very high basal dose to control this prandial problem and could have experienced increased hypoglycemia during the day.

Lesson Learned:

Many other sources of information through the media are now available and can be very confusing to a patient. Take time to re-evaluate a patient’s understanding of their medications at subsequent visits.

Lynn White MS, FNP, CDE, BC-ADM


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