4/15/15
Practices for Avoiding Common Insulin Fails
Using insulin seems like a pretty
straightforward topic. It is never a
bad idea to be reminded that often the teaching of insulin starts involves a
great deal of information. For someone
who is new to diabetes the amount of information can be a lot to sort through
and remember. In the perfect world every
detail of teaching the “rules” of using insulin is preserved, however we are
all human first and when learning new information details can be missed. It is also important for the long term users
of insulin to consider a refresher of the “rules” that are intended to support
safety and proper use of insulin.
Technique Review
A recent patient interaction in our clinic involved a
gentleman who had been using insulin for some time when we met him. He was referred for help with his
uncontrolled diabetes and when several increases to his regimen were not
solving the problem of his increasing blood glucose, we had him explain his
technique. His use of his insulin pen
had him removing the outer cover but not the needle cover before he
injected. We learned he had not been
getting any of his injections from his insulin pen, prompting us to keep in
mind with all patients, even those who we expect to have been taught insulin
prior to our intervention, the importance of reviewing technique for
appropriate insulin administration.
Not removing a needle protector or cap is an extreme
example, however technique of use of pens and syringes should always be
considered as a review topic when thinking about how insulin is dosed. For those using insulin long term, a technique refresher never hurts.
Safe and Proper Storage
A patient was seen for a follow up a week after discharge
from her hospital stay and wondered why she was not getting control from her
new basal insulin plan as she had during her hospital stay. Her family had procured her insulin at the
pharmacy prior to her long wintery drive home, safely packing it away with her
luggage which was placed in the outside back of the truck she was travelling
in. Not realizing she was using insulin
that had frozen during the two hour drive, the patient was experiencing the
effect of denatured and ineffective insulin from exposure to temperatures less
than 36 degrees. Given the flurry of
activity at her discharge, the patient did not recall if she was taught the
importance of avoiding exposing her insulin to extreme temperatures. The up-coming warmer months should also serve
as a reminder that insulin exposed to hot temperatures above 86 degrees, such
as left in a car or out in the sun for several hours could also denature
insulin causing ineffective medication.
Expiration Date
For some patients, seeing the words “keep refrigerated” on
the package labeling of their insulin bottle seems to imply a protection that
will allow them to use their insulin even with the expiration date long
past. Another common misuse of insulin
is using insulin for more days that manufacturer recommends after opening the
bottle or pen, assumed by the patient that as long as the refrigeration rule is
followed again this would make the insulin safe to use. It is important to remember that the
manufacturer specifies and prints on the insulin packaging the recommend date
to discard insulin after opening, and a review of this information for all
patients using insulin is a good idea.
This is an especially good idea for those patients whose regimens
include small doses of insulin.