An unexpected issue with how the patient used his Lantus pen.
Sometimes, just a simple instruction on the use of an insulin pen can prevent serious problems….
After several weeks of successful insulin dose refinement, John W’s blood sugars were coming down nicely as we gradually increased his Lantus dose. Then one week his fasting sugars climbed without reasonable cause and he reported the plunger on the pen “is harder to push.” I asked him to come in with his pen. He was leaving the same needle on the pen and had been reusing his pen needles. The needle had become occluded and he was “pushing” 60 units of Lantus but not getting the insulin. When I removed the pen needle from the pen there was so much pressure on the rubber stopper of the pen (it was bulging) that the rubber stopper shot out and most of the insulin in the pen shot to the ceiling. Lesson learned — don’t store needles on your pen.
Dana L. Stainbrook RN, MSN, CDE
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