To ERR is Human (Unfortunately): Insulin Dosing and Monitoring Misadventures
The U. S. Pharmacopeia Medication Errors Reporting Program states that approximately 50 percent of all medication errors involve insulin. Also, half of all insulin dosing errors are in patients 60 and older.
The most common insulin errors include:
- Clinician errors including illegible orders and prescribing errors. In fact, insulin is the single most frequently misprescribed medication. A common prescribing error is to use the abbreviation U for units to indicate the insulin dose. A good example is a dose of 4U being interpreted as 40 units. Other clinician errors include poorly labeled vials and incorrect rates programmed into an insulin pump.
- Self-administration errors. A “grave” dosing error is defined as a dose administered that is more than 15 percent above or below the dose intended. These can result from confusing instructions, inadequate patient training and education, or improper equipment. Contributing factors include the use of incorrect needles, improper injection technique and poor drawing-up procedure. Finally, timing of insulin doses is critical. Delayed dosing can result in elevated blood glucose. In one study, about a third of participants delayed their morning injection by one or two hours, for unknown reasons.
- Self-monitoring errors. Monitoring of blood glucose and hemoglobin A1C is critical to improve clinical outcomes and improve quality of life. National surveys suggest that one-third of all diabetics do not self-monitor at all. Newer home blood glucose meters are much easier to use than older models, more convenient to carry in pocket or purse and require a very small drop of blood.
In summary, insulin is a powerful medication with serious consequences if misused. There are several ways people can make mistakes when administering insulin and monitoring blood glucose. Finally, clinicians also make frequent errors when prescribing and dispensing insulin.
What is a diabetic patient to do? First become educated about the disease and treatment and always question any order or labeling that does not seem right. Second, establish and stick to a regimen of insulin dosing and blood glucose monitoring at home and report any trends or questionable results to your doctor or other clinician. Finally, talk to your diabetes clinician about newer insulin administration devices and blood glucose monitors to see if you might benefit from this newer technology.