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Insulin use: numerous preventable errors

Insulin-related errors are frequent and often preventable. It is better for health professionals to listen to patients, who are often adept at managing their treatment.

Insulin is vital for patients with type 1 diabetes and useful for some type 2 diabetics. Its use is delicate since the dosage needs to be tailored to each patient, and the consequences of dosage errors can be severe: hypoglycaemia with convulsions, coma, even death in the case of overdose; hyperglycaemia, sometimes fatal ketoacidosis in the case of insufficient dosage. Training in the use of insulin is required for health professionals and above all for patients who administer and manage their treatment themselves, and so become particularly competent.

Errors can occur in the prescription, especially if it is handwritten and illegible: confusion between brand names; error of overdose by a factor of 10 when abbreviations are used such as U (Unit) or IU (International Unit) sometimes confused with a 0 or a 10. Errors in computer inputting can be due to confusion between brand names, or the use of computer-aided prescription or inappropriate dispensing software, errors can result from confusion between the percentages of insulin associated with the brand name and the dose to be administered.

Similarities between brand names, or between forms or bottles of the different insulins can also cause confusion. The coexistence of insulin solutions of different concentrations and the use of inappropriate syringes also carry a risk of severe overdose.

In the hospital setting, health professionals can sometimes muddle up patients or contaminate patients by using the same pen, etc.

In short, involve the patient in the treatment details, draw on their competence and apply preventive measures that will help prevent many errors.

©Prescrire 1 January 2014

"Insulin use: preventable errors" Prescrire Int 2014; 23 (145): 14-17. (Pdf, subscribers only).
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