Letter of the Week: There’s One More Thing Insulin Manufacturers Can Do to Prevent Potentially Deadly Mix-Ups

Apr 10, 2008

Editor: I’m writing in regard to an article in Diabetes Health (Feb/March 2008) on page 27 about help in avoiding near-fatal mistakes taking insulin. To read the original article, go here.

I take about six shots daily, including two in the morning and two before going to bed at night – Lantus and NovoLog. I’ve been injecting 23 years. Luckily I’ve mixed up the two insulins only once, but it was scary.

Color-coding the bottles would only partially help a multiple user. Once the insulin is in the needle, it looks the same whether it is Lantus or NovoLog. What would really be helpful would be a color added to the insulin itself – all fast-acting insulin would be colored, all slow-acting would be left as it is.

Then, when I pick up my needle to inject, I would definitely know which insulin is in it.

Is this a possibility?

I would love to see an answer to this question.

I love this magazine. I read it thoroughly.

Thank you.

Mona O’Connor

Cincinnati, OH

Editor-in-Chief Scott King poses:  I have heard of folks putting injectable (bright orange) vitamin B-12 into their insulin.  Doctors used to give shots of B-12 to folks who were tired or B-12 deficient.

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Categories: Diabetes, Diabetes, Insulin, Lantus, Letters to the Editor, Type 1 Issues

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Posted by Anonymous on 10 April 2008

I don't think additives to something you inject yourself with thousands and thousands of times during your lifetime is the answer. Pens (which are color coded) really help ... at least you know what you have in your hand. Even then, you can make a mistake and afterwards have no idea whether you did the right thing or not (wrong dose, wrong insulin, extra dose, etc). I think the best bet is to make pens with memories. The two I know about, the HumaPen Memoir and the Innovo Duo, are a great step forward. They tell you what you took and when you took it. So if you've just taken your regular and can't remember if you did .. it's all right there in the pen's memory. I think these are a great advance for diabetics. Unfortunately they don't support all fast acting insulins and neither supports long acting insulins. I'd like to see all the pen manufacturers add memory features. For years, meters didn't have memory features so if you couldn't remember if you'd taken your blood sugar or what it was you had to do it all over again. That was annoying but not fatal like taking your fast acting insulin twice. For those who will complain that I'm beating up on the manufacturers, I'm not. We're all responsible for getting it right for ourselves, but when you do something thousands and thousands of times, it's inevitable to slip up eventually, with potentially disasterous consequences. Anything that can be done with technology to prevent those mistakes is great.

Posted by Anonymous on 10 April 2008

My husband is on the Omnipod insulin delivery system. The pod has a very tiny clear cannula that inserts subQ, after activation we have to inspect it to be sure that it is properly inserted, being that it is clear, it is very hard to see. In a conversation with Insulet, I suggested that it be tinted so that we could see it better. Their response was that the dye used could potentially cause an allergic reaction for some people.
My husband used both Novalog and Lantus before going on the pump, on two occasions he mixed up the two, indeed it is a VERY serious situation, we are truly lucky he is still with us. I agree something needs to be done, I think it will have to be in the packaging.

Posted by thecjake on 10 April 2008

I myself have had this happen to me. I had taken fast acting insulin for my Lantus (which I take 24 units every morning).
I was out running errands and was in a store trying to check out with my atm card, luckaly for me the cashier has a family member that also has diabetes, and she recognized the symtoms and called the ambulance. Luckaly I was given iv drugs and such so that I only lost about 15 min. of my memory. But if the bottles had something that would alert me.. I would have never had the problem. I am a veteran, and go to the VA hospital here... my nutritionist and diabetic councelor is finding too many of us vets are getting it mixed up.. and is trying to get enough patients to send something to the drug manufaturers. But I hope that all nurses and drs continue to follow up on this.. it is a definate problem.
Thank You,
Cathy Jacobson
Memphis, TN

Posted by Anonymous on 12 April 2008

another is to have LANTUS or LEVEMIR in a pen AT HOME and use a totally different version of a pen, as so if you are a lantus and a apidra user, since both use the opticlic.. well DO NOT USE that way you are not mixing the two up, or have one or the other in pen and the other vial/syringe (per article).
I have myself mixed my meds up, but since one was CLOUDY, I realized just before I was to inject that I was doing the wrong one. (NPH is cloudy, and I had mixed it up with R.. mind you this was back in the eary 90's, before the insulin analogs)

Also to Mr King's post at the bottom of this article about colouring the insulin with B12 - I have heard of folks putting injectable (bright orange) vitamin B-12 into their insulin. Doctors used to give shots of B-12 to folks who were tired or B-12 deficient.

Mr King.. ANSWER THIS ONE, if they USED to give B12 shots, then why in sadies do I get a MONTHLY 3000mcg shot of B12 (upped from 1500mcg montly)? Next one 28, April 08

Posted by Anonymous on 16 April 2008

Another small tip on keeping track of which insulin you're giving. Even though the two pens my husband uses are color-coded, every so often he picks up the wrong pen. Usually he notices in time but a couple of times we had serious episodes where he gave himself the wrong insulin. So no, in addition to other safeguards, he puts a rubber band around one of the pens. So if he picks up the wrong pen, he has another chance to notice it becaue it "doesn't feel right". The tactile difference really helps.

Posted by Anonymous on 23 April 2008

This very incidence happened to me just over a month after diagnosis. I was just sitting around, talking to my family, giving my nightly shot of 17 units NPH. Not 5 minutes later I realized I injected 17 Novolog instead, and broke down crying. I realized further that I had about 30 minutes to get to the hospital before I could potentially die - it was a very scary night. I spent the next 6 hours in the hospital being watched constantly and having my BG checked every half hour by the nurse. This type of mistake is inevitable by the way the bottles are made - exactly the same except the letters on it and the clear/cloudy effect. Even with that, I made the mistake and it could have cost me my life. I pray that someone takes the next step in improving this...to save our lives.

Posted by Anonymous on 27 April 2008

I use Lantus via a syringe, and NovoLog via a pen. To help avoid mixups, I keep a small calendar in the baggie with the Lantus and syringe. As I am preparing to inject the Lantus, I mark the calendar with a highlighter pen, at the top for AM and again at the bottom of the date for the PM dose. For the Novolog in the pen, every morning I load the pen case with 3 needles. After I inject, I set the used needle down on the table, along with the used Lantus syringe. All that helps me remember that I have injected what, and when. However, it does not absolutely protect me from injecting Lantus at the calculated Novolog dose and vice versa. For that, I sternly advise my spouse to not distract me while preparing to inject my insulins.

Posted by Anonymous on 30 April 2008

Have you heard of Pernicious Anemia and lack of the Intrinsic Factor? Both can cause patients to take B12 injections. I have both conditions and take B12 injections. It is a prescription item.
Reading labels insure taking correct medications and dosage.

Posted by Anonymous on 11 May 2008

I recall taking the fast acting in place of my lantus only one time. Yes, I had some one distracting me. Now I have Lantus in a vial and I use the Novolog pen. I take Lantus at bedtime, the Novolog before meals. Much easier not to mix up. Type 1 DM since 1973. S

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