Page 17 - Delaware Medical Journal - May 2017
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SCIENTIFIC ARTICLE
the same syringe. They should check the expiration date on the vial and discard
the open vial after 40 days, even if there
is insulin in the vial. The patient should not use it if it is cloudy, colored, or has
solid particles in it. They will need to use a new syringe for each injection to prevent infections and blocked needles.
Whether it is given by syringe or pen, rotating injection sites with each dose is important. Areas of lipodystrophy should be avoided. Blood sugar monitoring is vital to see trends of blood sugars and proper adjustment of medication by their health care provider. Doses of U-500 may need to change if patient has changed their level of physical activity/exercise, weight gain or loss, times of illness, and change in diet.
A sound understanding of possible
side effects of U-500 is important.
These include hypoglycemia (signs
and treatment), and the patient may be prescribed a glucagon emergency kit. If a patient is admitted to the hospital or ER, they must be able to communicate that they are receiving U-500 regular insulin and
not U-100 regular insulin, and they should be able to tell the hospital staff the units of Humulin R U-500 insulin prescribed.
inpatient on Humulin R U-500 insulin also. U-500 is not available in all hospitals. All hospitals that include this product should include extra steps to minimize medication errors. Administration errors from hospital providers can include incorrect insulin, dose, or timing of insulin, omission error, or extra doses administered. Potential errors could include not understanding how to use the protocol for administering U-500 insulin, miscalculations, failure to recognize a new order or dosing regimen, transcription errors, delay in delivering dose, or giving wrong type of insulin. Hospital staff should be familiar with
U-500 insulin has unique pharmacologic properties that make it useful in the treatment of hyperglycemia in the setting of extreme insulin resistance. There are also a number of safety concerns regarding this insulin, with risks and complexity inherent in the dosing.
U-500 insulin orders and protocols to ensure patient safety. Frequency of blood sugar testing should be ordered clearly and symptoms and treatment of hypoglycemia should be clear.
PHARMACIST CONCERNS WITH HUMULIN R U-500 INSULIN
dedicated syringe. The U-500 syringe will decrease dosing errors especially when the dose is being ordered in units which will help patients accurately draw up the dose in measurements they are familiar with. The patient will no longer need to convert the units to milliliters. The new Humulin U-500 intervals.12 The dose has to be rounded up or down to the next 5 unit interval.
The U-500 syringe will not be manufactured as a safety syringe to minimize needle sticks to health care staff, and therefore, its use in hospitals may be limited.
U-500 INSULIN DOSING AND SAFETY
The Institute for Safe Medication Practices (ISMP) has declared that insulin is the drug that has the most associated errors, and U-500 insulin is thought to be a major contributor to this.12 Until recently, there has not been a pen device nor a dedicated syringe for U-500 insulin. Attempts to have patients use a volumetric TB syringe for
dosing U-500 insulin generally failed. There were multiple reasons for this, including poor insurance coverage for TB syringes, decreased availability, a perception of increased discomfort of the injection, and confusion amongst health care providers. This has led most U-500 insulin users to dose the insulin in U-100 syringes, despite the lack of a U-500 insulin scale. The
result has been frequent confusion, with patients forced to communicate their dose by “syringe units” — for example, “100 units of U-500 insulin obtained by drawing up to 20 syringe units on a U-100 syringe.” The confusion is often experienced by inpatients. On occasion a provider will attempt to order U-500 insulin without learning about its unique properties, or even its existence. The substitution to U-100 regular insulin is a common occurrence. On other occasions, the patient can become confused and think that their new dose
of U-500 at the time of discharge is 100 units, measured on a U-100 syringe. Many US hospitals have adopted U-500 insulin policies to enhance safety. Common techniques employed have included
having all doses of U-500 insulin drawn
up in tuberculin syringes in the pharmacy department, storage of U-500 insulin vials in the pharmacy only, restricting prescribing to the endocrine service, patient education materials, computerized pop-up warnings to physicians ordering U-500 insulin, and 6
In 2015, a U-500 insulin pen was approved by the FDA and in 2016 a dedicated U-500 syringe was approved. The U-500 syringe
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