Top Ten Drugs Involved in Medication Errors: Insulin

#1: Insulin

Basic Characteristics

Insulin is a hormone made by cells inside the pancreas. Its purpose is to help the body use and store the blood glucose it obtains from food. In people with Type 1 diabetes the pancreas can no longer produce insulin. Therefore, these patients require insulin shots in order to make use of the glucose contained in food. People with Type 2 diabetes can make insulin but their bodies do not effectively react to it. Insulin shots allow them to make use of and derive energy from glucose. Insulin must be injected into the fat under the skin (subcutaneous injection) in order to enter the bloodstream. It cannot be taken in pill form because it would be broken down by digestion.

In the past, diabetes patients relied on insulin made by the pancreas of pigs and cows. Today, human insulin made in the United States is produced synthetically from genetically engineered bacteria.

Types of Insulin

When insulins are dispensed they are dissolved or suspended in liquids. They contain additives to prolong their use which may cause allergic reactions in some people. Insulin solutions come in different strengths, the most common of which is U-100, meaning 100 units of insulin per milliliter of fluid.

Rapid-Acting Insulin works within 5 minutes of injection, peaks in about 1 hour and continues working for 2 to 4 hours. Regular or Short-Acting Insulin works within 30 minutes after injection, peaks in 2 to 3 hours and remains effective for 3 to 6 hours. Intermediate-Acting Insulin reaches the bloodstream 2 to 4 hours after injection, peaks within 4 to 12 hours, and continues to work for 12 to 18 hours. Long-Acting Insulin reaches the bloodstream 6 to 10 hours after injection and is effective for 20 to 24 hours.

Common Medication Errors Involving Insulin

  • The prescription: Handwritten orders for insulin may be illegible. Verbal orders, such as those received over the telephone, may also be unclear. The use of standardized order forms might help to eliminate this type of error.
  • Dangerous abbreviations: The use of the letter U, for units, can cause significant error. It is often misread as a zero. An order for 4U may be misread as 40 units and result in a tenfold overdose of insulin. Using a preprinted order sheet that lists specific insulin products and has the word “units” already printed on the form can be a useful way to avoid mistakes.
  • Similar packaging: A rapid-acting insulin called Apidra comes in packaging that is very similar to Lantus, a 24 hour medication to be administered once a day. Patients have administered large doses of Apidra thinking they were administering an all-day dose of Lantus. The basic difference between the two packages is that Apidra’s label is blue while the Lantus label is purple. In order to avoid confusion, the products should be marked with different colored pens and stored in very different areas of the refrigerator.
  • Similar names: Products such as NovoLog Mix 70/30, and Novolin 70/30 have similar names and create great potential for confusion and error. When using continuous subcutaneous insulin infusion pumps, patients must be very careful to use the rapid-acting NovoLog. The pumps administer very small amounts of insulin over a 24 hour period and an error involving the type of insulin used can be fatal.
  • Administration: Diabetes patients must be carefully counseled by pharmacists and other health care providers as to syringe technique, diet, mixing of insulin, and avoiding reuse of needles.
  • Storage: Unopened vials of insulin stored in a refrigerator are good until the expiration date printed on the bottle. Once opened, insulin in a vial is generally effective for 1 month, whether stored at room temperature (59-86°F) or in a refrigerator. Once the seal has been broken, a bottle is considered open. Recording the date the vial was opened on the bottle itself reduces the chance of using insulin that has expired.

Especially to inexperienced users, the proper storage, mixing, labeling and administration of insulin can be complex and confusing. Pharmacists who pay attention to common errors in insulin prescriptions, names and packaging, and who carefully counsel insulin users, can make the drug immeasurably safer.

Contact The Orlow Firm Today

If you or a loved one has suffered harm due to negligence in the dispensing of insulin, contact New York prescription error attorneys at The Orlow Firm for a caring and knowledgeable legal consultation.

Call (646) 647-3398 or contact us online.