Readers Challenge Insulin Manufacturers: Help Us Avoid Near-Fatal Mistakes!

This article was originally published in Diabetes Health in February, 2008.

Note: This article was updated on February 12, 2008 with responses from the three insulin manufacturers - see below.

Fast-acting insulin should come in red bottles

| Dec 25, 2008

Sandy was giving her son his evening dose of NPH insulin - something she had done many times. But as she finished pushing in the plunger, she said to herself, "That shot took too long." She immediately realized that she had given Joey the wrong dose. In other words, by mistake, she had given him a potentially lethal dose of insulin.

We wish we could tell you that this was an isolated incident, but it's not!

Over the years we have heard of this happening many times, and have published several articles where someone accidentally takes (or gives) the wrong insulin. Our latest account of this kind of mistake is the article by Ann Gann, "I Just Injected 46 Units of the Wrong Insulin!" By mistake she took 46 units of quick-acting Apidra instead of Lantus.

This is most dangerous mistake of all - reversing your insulins - thinking you are taking a big shot of your long-acting insulin, only to realize that you have just shot up 46 units of quick-acting insulin! Ann was fine in the end, but her story spurred many to reply with their own horror stories.

An insulin overdose for an insulin-resistant type 2 might be solved merely by having some soda pop and a few slices of cake. But for an insulin-sensitive type 1, an overdose could easily be a fatal mistake if emergency care is not immediately available.

I cannot think of another medication that could prove fatal with an accidental mix-up. If you get confused and mix up your antidepressants with your cholesterol meds, it's not likely to be a fatal dose.

What is a fatal dose of quick-acting insulin? That depends on you, and how fast you can get food into your system. If you are unable to get food, even a small dose of insulin could be fatal. And with a large dose, you might not be able to eat fast enough to turn the tide.

This problem is obviously way more prevalent than most people (or insulin companies) realize.

We share these stories with you, in the hopes that they may prevent you from having the same experience.

An Appeal

We also appeal to the three insulin companies: PLEASE HELP US! Read these suggestions and respond with a plan that will stop these mix-ups. It seems to me that an insulin company could show us diabetics that it really cares by marking the dangerous insulins with a bright red label or a red metal cap.

These are the truly dangerous insulins if you mistakenly take too much: Regular, Humalog, Novolog and Apidra. How hard would it be to have a bright red label or red cap for these?

We challenge the makers of these insulins to provide a solution that will help us all stay safe.

 

Insulin Manufacturers Respond

 

Eli Lilly

In an effort to enhance clarity on our product labels, Lilly has worked with the FDA on approval of color-coding of the label and packaging of all our U-100 insulin formulations, including Humalog and Humulin. This will launch this month [February] with the introduction of KwikPen™ for Humalog® and Humalog Mixtures.

KwikPen will be the first of Lilly's insulin products to incorporate color coding, and it is anticipated that other Lilly insulin products will be color-coded by the end of 2008. This color coding system is an important part of our ongoing commitment to patient safety. As always, all Lilly insulin products will continue to be clearly labeled with the product name.

  • Humalog = burgundy
  • Humalog Mix 75/25 = burgundy and yellow
  • Humalog Mix 50/50 = burgundy and red
  • Humulin 70/30 = dark blue and brown
  • Humulin R = dark blue and light yellow
  • Humulin N = dark blue and bright green
  • Humulin 50/50 = dark blue and gray

J. Scott MacGregor
Eli Lilly and Company
Global Product Communications, Diabetes

 

sanofi-aventis

The safety of all patients, including those with diabetes, is of paramount importance to sanofi-aventis. In calling attention to the potential serious safety issues associated with administering the wrong insulin, Diabetes Health is raising a very important topic.

Sanofi-aventis has worked and is working with regulatory agencies around the world to help minimize the likelihood of a person with diabetes administering the wrong insulin.

For example, our insulins - Lantus® (insulin glargine [rDNA origin] injection) and Apidra® (insulin glulisine [rDNA origin] injection) - can be differentiated from each other and other insulins by their names and associated unique colors, both of which appear clearly on the cartons, insulin vials, insulin cartridge holders, product leaflets and product labels. In developing insulin pens for both Lantus and Apidra, sanofi-aventis has conducted and continues to conduct engineering evaluations and ergonomic and clinical assessments to help minimize the risk for patient error. Sanofi-aventis optimizes the differentiation of its insulin pens, including distinguishing pens by color. To ensure safe delivery of medication through devices marketed by the company, sanofi-aventis provides physicians, healthcare providers and diabetes patients with detailed educational information and training.

Sanofi-aventis also supports the Certified Diabetes Educator (CDE) H.E.L.P. Program for patients taking Lantus and/or Apidra, designed to encourage a partnership between patients and CDEs to learn methods for proper insulin administration.

At sanofi-aventis, we are continuously reassessing the practices for insulin administration, including the review of the current patient instructions, patient teaching support materials, and the packaging of our insulins and insulin devices. We remain committed to ensuring that proper measures are taken to help minimize the chance of patient errors in administering insulin.

Sincerely,

Douglas Greene, MD
Senior Vice President and Chief Medical Officer
sanofi-aventis

P. Antonio Tataranni, MD
Vice President, Metabolism Business Unit
sanofi-aventis

 

Novo Nordisk

Patient safety is the highest priority for us at Novo Nordisk. Novo Nordisk has been innovating and changing diabetes since 1923; we understand and listen to our patients and the physicians who care for them and continually evolve and innovate our therapies so they can stay in good glycemic control.

The feedback you received from your readers has been communicated to departments responsible for product design and safety and will be included with other feedback we get from physicians, patients, and partner organizations for consideration.

In our currently marketed products, we have already taken a broad-based approach to enabling both caregiver and patient to avoid mis-dosing or mistaken administration of insulin, including design and patient education:

  • We have the broadest portfolio of color-branded insulin products on the market. Our company pioneered color branding to add color to the insulin labels as an aid to distinguish products. This initiative was approved by FDA in October 2004. We selected very distinguishable colors for our insulin analogs and all drug names are shown as black text on a white background for clarity, as it is critical for the patient to read the drug names prior to use. For example, NovoLog is bright orange, which is a more discernable color for people with diabetes, where it is estimated a large percentage of people with diabetes have visual impairment.
  • Novo Nordisk recently created and distributed a hospital education piece titled, "Selected U.S. Safety Guidelines and Standards for Preventing High-Alert-Medication Errors and Needlestick Injuries," which highlights some of the most common errors seen in hospital administration of medications, including insulin, and steps to avoid them.
  • Insulin vials for insulin analogs have color branding to distinguish between types of insulin.
  • According to the Institute for Safe Medication Practices, one of the causes for medication errors for injectable medications is multiple manipulations to prepare the drug, e.g., vial to syringe transfer. The ISMP recommends that injectable medications should be taken in "ready-to-use" doses or in pre-filled form. Pre-filled pen devices provide accurate dosing and fewer manipulations than vial and syringe administration.
  • As a precaution, patients should also have a Glucagen Hypokit readily available for use by friends or family on the patient. It is a life-saving product when patients are experiencing a severe hypoglycemic incident.

Sean Clements
Associate Director, Media Relations,
Communications, and Public Affairs
Novo Nordisk, Inc.

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Categories: Diabetes, Diabetes, Food, Insulin, Lantus, Novo Nordisk, Pens, Professional Issues, Syringes, Type 1 Issues, Type 2 Issues


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Comments

Posted by bdebruler on 18 January 2008

I agree that the vials should be much more distinctive between types of insulins. This article, however, begins with a mistake that is not related to that issue (too much of the right kind) and then turns into a plea for better vial marking. If you want to build a case to pressure the FDA or drug manufacturers, you need relevant arguments.

Posted by bdebruler on 18 January 2008

P.S.
In the mean time, if you have a hard time distinguishing between your insulin types, buy some colored tape or labels, and wrap your different types of insulin differently.

Posted by Anonymous on 18 January 2008

Colored electric tape is available at all of the major hardware store chains. Red tape for rapid acting, green for detemir and blue for glargine. Wrap each vial with the respective color when you buy it. This would go part way to correct the above described problem. Just make sure you reach for the correct tape and insulin vial when you label. Caio.

Posted by Anonymous on 18 January 2008

At some point you have to take some responsibility. I don't see very well and at night I'm colour blind. I mark my bottles with tactile code and colour using plastic label tape. Try it, or devise a system which works for you. Don't ask others to take responsibility for your inattention.

Posted by kimlarson on 18 January 2008

I absolutely agree!

Different bottling and/or labeling would be most helpful!!

Posted by Anonymous on 18 January 2008

My problem with this article is the implication that it is somehow the pharmaceutical companies' "fault" that patients make these careless mistakes. I have in fact made similar errors not only with insulin dosages, but with oral medications (pills) over the years. I have been a type I diabetic for 30 years, and due to other health issues, in addition to insulin, I take a handful of pills twice a day. In every one of these incidents, it was completely my own carelessness that was at fault, and I can say unequivically that changing the colors of the labels would have made no difference. While changing packaging might not be cumbersome or more costly to the drug companies in and of itself, the fact that you've put the idea of suing the drug companies into the heads of every personal injury attorney in the country for their clients' own gross negligence has just helped to shoot up the price of insulin even more than the ridiculous amounts they're charging already. Thanks a lot. Oh, and I'm a lawyer by the way.

Posted by Anonymous on 18 January 2008

I use 2 entirely different pens.

Posted by Anonymous on 18 January 2008

This has happened in our household. I have two type-1 diabetics children. They are both on Lantus and Humalog (fast acting). It was a horrible experience. A large amount of Humalog (22 units) was given instead of Lantus. This happended at bedtime. I thank our good Lord my daughter (age 14) realized her mistake; otherwise, they would have gone to bed. Of course, this was the ONE evening I didn't watch the injection as I usually did. Even though Lantus is a taller vial and Humalog is the regular size vial, mistakes happen. I immediately called the 24-hour hotline. I was so panicked. I was given great instructions on what to do (4 ozs. of apple juice with several tablespoons of sugar we had them drink as we rushed them to the emergency room. One of them was worse than the other. He started vomiting and going low. They were put on a drip asap. We were there for until the next morning. Needless to say, we constantly double check.

Posted by LKP-RPH on 19 January 2008

Perhaps-but on the other hand ALL prescription vials and many tablets also look pretty much alike. We deal with that by READING THE LABEL. We don't expect the pharmacy to put different colored lids on the bottle or drug manufacturers to make all the pills different colors do we? Being vision impaired can be a different story but as the resourceful gentleman above demonstrated even that can be dealt with. If you notice nurses in hospitals always check labels and even the id bracelet on the patient each time they give meds. Why? As a precaution to prevent an error-it is part of their routine. When injecting insulin checking the label should be just as much a part of the routine as drawing up the insulin.

Posted by Anonymous on 19 January 2008

Exellent article with an excellent point! My daughter, diagnosed at 10 months, is now on an insulin pump which uses fast acting insulin. The pump takes only some of the danger away but I remember the days of dosing long acting/short acting and yes the vials can look the same especially when you have to dose 5 times a day. This only increases this risk factor of getting them mixed up!

Posted by Anonymous on 19 January 2008

The frequency of the problem can be reduced by all the measures you cite above, but in the end, anyone who has taken literally thousands and thousands of insulin shots day in and day out for years and years is inevitably going to have that one momentary lapse in concentration that can result in a deadly situation - despite a routine of checking, double-checking, counting syringes, labeling bottles or pens, etc.. My husband has had diabetes for 25 years. He is incredibly careful. But on several occassions he has either made a serious error or (which is almost as bad) not been sure if he did. A few of these episodes resulted in blood sugars so low we almost wound up in the emergency room and one actually resulted in an ambulance ride.

One of the new insulin pens (not sure which one but regrettably not for the insulins my husband takes) has a memory for the last shots taken and the amount. That way if you have any doubt about what's happened, the information is right there and you can act on it immediately. I'm sure this adds a small amount to the cost of the pen, but savings in suffering, potential fatalities, and the cost of hospitalizations and emergency room visits would more than pay for adding this technology to all of the pens.

Posted by Russ Thurston on 19 January 2008

OH MY GOSH.......This has got to stop!!! The people of this world need to start taking responceability for there own actions. It is NOT the fault of the manufactures that these people cant read. I have and take both a slow acting and a fast acting insulin, and i would NEVER blame somebody else for me taking the wrong one or the wrong dose!! WAKE UP READ THE LABELS AND BE ACCOUNTABLE!!

Posted by Anonymous on 19 January 2008

Why are you using vial and syringe - join the 2008 world use color coded pen delivery systems - most accurate , less waste , smaller needles

Posted by Anonymous on 19 January 2008

I agree. We must take responsibility for our actions. I use different little holders to mark my insulin,as was recommended to me from day one. I was also told to alway check the label. Diffrent colored lids will not make a difference if checking the label doesn't.

Posted by cgentry@dirtware.net on 19 January 2008

I use a syringe for Lantus and inject. pen for Humalog. All have good ideas, we just have to be extra careful the worse our BG are, or the more tire we become. If your ill with a virus etc. remember those BGs can go Way up. Carole

Posted by Anonymous on 19 January 2008

Yes, people have to take responsibility. And all the ideas for how to take precautions and pay attention are great. It's just important to remember that we're still human and NO MATTER HOW MANY LEVELS OF PRECAUTIONS YOU TAKE someday most people will make a mistake. With the new faster acting insulins, those mistakes (like accidentally taking fast acting instead of a night time shot of long acting) can catch up with you so fast that you don't have time to act before you're too incoherant to do so.

I don't blame these errors on the manufacturers (although the Pen with a memory seems like a great idea) ... it's just that it's too easy to think we have it under control and then BAM..

Posted by Xerelda on 20 January 2008

I agree with the red bottle. I keep my quick acting insulin in its box, hoping that taking the extra time to take it out of the box each time will make me think about which one I'm taking, but still I have mixed them up before. It just becomes such a routine reaching for the quick acting every time I eat or drink. I do it without thinking. I'm afraid the red bottle might mean the same thing. Still if it works for some it's worth coloring them.

Posted by wayouttashape on 20 January 2008

I've had type 1 for 27 years and I've quite literally lost count of the number of times I've taken the wrong dose, wrong insulin or whether I'd taken it or not. It's even easier to screw up when your glucose levels aren't at the level they're supposed to be. But, at the end of the day, it's our responsibility to take the right stuff at the right time. I've been using a pump for just over a week and although it's not as easy to get it wrong, it can, and probably will, happen again.

Posted by chickadee410 on 20 January 2008

It would be wonderful if the manufactures would put different bright labels on insulin. I take Lantus and Humalog, and my dog is on NPH. So I have 3 different bottles to worry about. I put different colored rubber bands around the bottles.

Posted by Anonymous on 20 January 2008

Why do pills, tablets and capsuls come in such a variety of colors, sizes, and shapes? Why do some have code numbers and code letters? It's to cut down on packaging errors, selling errors, and user errors. I think brightly colored labels for insulin vials make sense and is consistent with already existing business practice. Another thing we patients can do is read Dr. Richard K. Bernstein (and others) who advocate taking low dosages of insulins. If you take low doses and you goof, your chance of survival is better than taking what Dr. Bernstein calls "industrial size doses." The doctors also claim we'll have fewer complications.

Posted by Anonymous on 21 January 2008

Humalog DOES come with a red cap... I guess it's maroon, but still, I don't think that it is the manufacturer's fault. I personally keep my Lantus in one place (by my bed) and my Humalog with me all the time. I have made mistakes in the past, but this helps.

Posted by rbragg on 21 January 2008

Twice I have filled my pump with Symlin instead of Novolog. The Symlin vial is smaller but otherwise looks the same. If the two vials are not side by side it's possible to use the wrong one. Now I put a colored sticker on the Symlin.

Posted by Anonymous on 21 January 2008

I am a type one diabetic, and have wondered if a harmless, natural, colored dye could be added to different types of insulin. That would be one way to TRY to avoid mistakes.
Also, in response to "Russ" yes, I agree that we must all take responsibility for our actions, and I am sure that it isn't because people do not know how to read that we goof sometimes. By the way, please check your dictionary, you made several grammar and spelling errors in your comment.

Posted by Anonymous on 22 January 2008

I am a type 1, and over the years (37, to be exact) I have been on different types of insulin, sometimes 2 or more daily.
I always wondered if drug companies could possibly tint the insulin with a safe, natural dye for each type. It might be another way to avoid mistakes. Apparently, it can't be done, or some manufacturer would have done it by now, right ?

Posted by Anonymous on 23 January 2008

I triple check everything, no matter what I do, and now that my son has been diagnosed with type 1 and I have to give him three different insulins, I find that I second-guess myself all the time. Fortunately, we've only had two mistakes (so far): 1. I read our sliding-scale wrong and gave more insulin (2 units extra, not that big a deal) than I should have; 2. I didn't double-check my son's meter after he said his value was "59," he had transposed the numbers and was really 95 (he does have dyslexia but not sure if that is why he transposed - we all do that now and then, lol). Anyway, my husband ended up treating him for a low, so when we had checked him 10 minutes later, he was really high.

I agree with several above that I don't think it's going to make a huge difference if drug companies change their bottles - humans make mistakes. Maybe, with insulins that look and sound alike, like Novolog and Novolin, perhaps a label can be placed on them or a different name, I don't know -- but the bottom-line is that the person giving the insulin needs to DOUBLE-CHECK the labels just like the nurses do. However, even hospitals, nurses make mistakes.

I just moved into a new home which has it's own kitchen in the basement - after reading this article, I'm thinking I will keep his rapid-acting insulin in the fridge upstairs and his Lantus and NPH in the basement fridge. Now I'm worried I may make the same mistake -- a little scary to me.

Posted by Anonymous on 24 January 2008

As a mom of three, one of which has diabetes, I have also wished for something to make mistakes less likely. My son is now on the pump which has made life much easier at hectic mealtimes and trying to get kids where they are supposed to be. I do remember that it took lots of concentration to make sure I was on track with his breakfast novolog and his morning lantus. I actually had to have a check-list that I marked after giving each insulin to help me along. I am especially sleepy on those mornings following middle of the night blood sugar checks and my littlest one waking up from night terrors! One thing I think that some people find helpful is taking meal-time insulin with a pen and basal insulin with vial/syringe. (we could't do that at first because my son's novolog doses were too small for the pens) Hope this helps someone!

Posted by Anonymous on 24 January 2008

Letters to the Editor

My comments are my personal experiences and thoughts on the subject.
I am a 52 year insulin dependant diabetic. I am also 79 years old. I have gone through every change in insulin regimens. At present I use novolog pens and was taking lantus by syringe.
I have changed over to solostar lantus pens. Here are my observations.

The literature for the pen states; "the pen features lower injection force then similar insulin pens, easing use for patients with limited joint mobility in their hands." This may be very true, but conversely should you happen to touch the button at any time before the injection you can discharge the dose in the pen. There is no tactile resistance in the plunger, leading to the possibilty of partial oe total discharge of the dose before injection. I happened upon this one day when I noticed that my readings were above my usual numbers. I inadvertantly happened to notice this the next time I took my shot (twice a day 10units). I notified the company and bought another box of the pens. After a few more near accidents I have switched to the Novo Levimr pen as it has tactile resistance on plunger so you cannot accidentally discharge any of the insulin.

Love your magazine, keep up the good work

Sol Tabachnick

Posted by Anonymous on 24 January 2008

Would someone who has been educated in the pharmaceutical industry explain why they can or cannot TINT insulins according to the different types???

Posted by Tazmanian08 on 24 January 2008

While I agree that the insulin companies could do a much better job at marking the different types of insulin with different colors, Lilly does mark their Humalog bottles with a red head/top. But lets face it whether we are the person taking the insulin or administering the insulin it is our ultimate responsibility not the insulin companies to pay attention to what we are doing. You can not blame someone else for your own mistake. All this sounds like is another way to point the finger at someone else who has no control over your own actions. By the way I have been a Type I diabetic since I was 11 yrs old any child who has Type I (not infant or toddler) should be administering their own insulin with the supervision of an adult or caregiver.

Posted by Anonymous on 24 January 2008

Hello,
WIll you be posting "template" letters, addresses for postal mail, and / or email addresses of the companies that make insulin, in order to make it easier for MANY readers to contact the insulin makers? It will be appreciated; thanks.

Posted by Anonymous on 25 January 2008

First point: The real problem here is that Ann injected 46 iu of ANY insulin in one shot. Nobody should be injecting FORTY SIX iu of Lantus or any other insulin in one shot. Even if her dose is 46 iu Lantus, (which I seriously doubt it should be so much), she should split it into 23 in the morning and 23 at night, or perhaps 33 in the morning and 10 at night...

But I suspect that 46 iu is way too much... I am guessing that she is not on a low carb (sugar=100% carb) diet so that she would require much less dose of Lantus or any other insulin.

Second: You imply that the pharmaceutical companies are the bad guys and are at fault for this mistake because they haven't marked the fast acting insulin with red labels. I am thankful that the pharmaceutical companies make insulin, and I think the vials are plainly distinctive. If you are not able to read, you should not prepare your own insulin.

Third: I agree that the pharmaceutical companies could and should tint fast-acting insulin, perhaps red, or orange, to help avoid mistakes.

Posted by Anonymous on 26 January 2008

Personally, I disagree with the idea of tinting. I don't want *anything* added to my insulin - keep it as natural as possible, please! Whatever is used will have an effect on someone, and it's not worth taking the risk. I wouldn't want anyone finding that they're allergic and thus can't take their life-saving insulin. Yikes.

I agree with all messages above re being responsible for ourselves.

My two insulin pens are very different. Different shapes, different colours, the buttons are in different places, and they have a different 'feel'. However a mistake is still possible due to injecting becoming an automatic thing. Anything does when you do it so many times every single day of your life.

Trying to avoid this mistake is a very very good idea! But it will still happen to a lot of us at some time.

Posted by Anonymous on 27 January 2008

I would like to see color coded insulin-say red for short acting & blue for lantus-as we could see at a glance which is which & how much is in the syringe--clear liquid in a cleaqr syring is often hard to read & you get the incorrect dose....

Posted by Anonymous on 29 January 2008

Take Dr Richard Bernstein's advice: never inject more than seven units of any insulin at any one time. If you need 14 units take two injections of seven units. If you need 21 units take three injections of seven units. Problem solved. I NEVER INJECT MORE THAN SEVEN UNITS OF LANTUS, LEVEMIR - OR APIDRA, NOVORAPID, ETC! Guess what? I never have to worry about a bad overdose again.

Posted by Anonymous on 31 January 2008

As a CDE (and type 1 patient for 40 years) I recommend that my patients who cannot afford pens keep their different insulins in separate locations in the home. For example, keep the lantus and a supply of syringes in the bedroom and the mealtime insulin with syringes in the kitchen or dining room.

Posted by raw girl on 4 February 2008

I agree if a diabetic is on a proper diet they will need very small amounts of insulin.
I have been a type 1 diabetic for 37 years. For many years I followed Dr. Bernstein's low carb diet. Which I did without eating red meat and ate only whole natural foods. I did this for 7 years and did quite well. 5 years ago I began a quest for healing the diabetic condition and went on a raw food diet. I am taking very little insulin now and am hoping to be able to discontinue it altogether. My pointis that if a diabetic eats very low carbs the danger no longer exists because they will need very little lantus. A mistake can be very easily taken care of with some fruit or fruit juice.
Aimee

Posted by Anonymous on 18 February 2008

Thism unfortunately is just another case of someone blaming everyone else for their mistakes!!!
Let's just face it people have been taking insulin for years how many people have you seen complain about the insulin being marked improperly and that's why someone had an issue.
I am type 1 and have been for 33 yrs, my Mom and dad gave my shots for yrs and I have done it for the rest of the time, I am 45 yrs old today and have never had an issue. Actually I'm lying, I did think that I had my Lantus one time and had my Humalog instead because I had a few drinks, I did realize my mistake after the fact but, hey it was MY fault not Lily or anyone elses. This world is just getting rediculous about noone excepting responsibility for anything that they do. It crazy. Take responsibility for yourselves for a change and quit blaming everyone else! Double check what you're doing and make sure you have the right insulin in your hand, in 33 yrs that was the only time I had something like that happen, and YES it WAS MY fault!!! As I am human and make mistakes but I am also honest and will admit when it was my mistake that I made.
I have gotten wrong meds from the very company I work for in the past and taken them back. It's all about double checking yourself, and everyone else around you!! Not blaming everyone else for your mistakes, you made a mistake, we're not perfect, I know I'm certainly not! Just admit your mistakes, learn from them and move on.

Posted by Anonymous on 18 February 2008

I would like to see the pharmacy stop putting their labels on the insulin boxes. Their labels all look alike and makes all the insulins look the same.

Posted by Anonymous on 18 February 2008

I take 2 diffrent insulins Novolog at lunch and dinner Levemir at bed time I have often thought oh my goodness did I take the righjt one? I keep them in the fridge, next to each other. I keep them in the box they came in with the color strip and name of the insulin out for identification.I think we all need to slow down when injecting any drug into our bodies we need to focus on the task at hand. Everyone seems to be in a hurry these days living life to the fullest does not mean we have to be careless you would not, I hope take medications without looking at the bottle or label would you? And parents need to supervise their children closer until they are very mature, as a lot of adults stated in other opinions even they make mistakes.

Posted by Anonymous on 19 February 2008

Lilly's product names are too similar and the colors on the cartons (which consumers discard) and bottles are too small. The names should be changed to indicate duration of insulin release and the whole label should be a clear color. The label should also state the duration of release. Finally, the bottles should FEEL different. A different shape would alert the user to which product is being used. Currently, I put a rubber band around my fast acting insulin to be one more indicator of which is which as I mix the insulins.

Posted by Anonymous on 20 February 2008

Resveratrol can help you to lead a long and healthy life so says Dr. Oz. Resveratrol is now being used by doctors to treat diabetes.
Resveratrol Supplements can help you control your weight naturally
by increasing energy, reducing cravings, and limiting your appetite.
According to Wikipedia, Consumer Lab, an independent dietary
supplement and over the counter products evaluation organization,
published a report on 13 November 2007 on the popular resveratrol
supplements. The organization reported that there exists a wide range
in quality, dose, and price among the 13 resveratrol products
evaluated. The actual amount of resveratrol contained in the
different brands range from 2.2mg for Revatrol, which claimed to have
400mg of "Red Wine Grape Complex", to 500mg for Biotivia.com Transmax,
which is consistent with the amount claimed on the product's label.
Prices per 100mg of resveratrol ranged from less than $.30 for
products made by Biotivia.com, jarrow, and country life, to a high of
$45.27 for the Revatrol brand. None of the products tested were found
to have significant levels of heavy metals or other contaminants.

Posted by Anonymous on 5 March 2008

I came across this Post after taking the WRONG insulin for the 4th time in about 3 Months... My mistake and a serious one as I took twice the dosage of my fast acting insulin before bed. I have NEVER done this in the 13 Years that I have had Diabetes. Why now, because I just changed from a bright yellow fast acting insulin pen to A blue fast acting pen. So now my Apidra (Fast) and my Levimir (Long) are BOTH BLUE!
I'm not blaming the company, Myself and those who understand are simply saying it would make sense to have a standard colour for short and long acting insulin that remains the same for all companies.
WHY DO THEY COLOUR CODE FIRE EXTINGUISHERS... it's for quick reference... You could appreciate this when you have the chance to stuff up your dose 4 times a day or 1465 times a year...
I bet if the Anonymous Self Righteous Lawyer killed his Kid with the wrong insulin, He/She would be the first too sue...

Posted by beno on 13 March 2008

Totally Agree, with the comment above... Well Said!

Posted by insucozi on 25 March 2008

You might also want to check out our insulin vial covers at INSUCOZI.COM. The cozi's come in different shapes to help identify the type of insulin, provide a firmer grip when drawing up insulin, and protect from breakage if dropped. They are reusable. They were developed to assist all of my family in making insulin injections for my young daughter safer and easier.

Posted by Anonymous on 27 March 2008

Color coding will help, or like the last post, they have the insucozi vial cover (which is cool). However, the insulin manufacturers have way too many colors. We only really need FAST-ACTING insulin to be color coded. Also, if you search the international diabetes association website, you'll find they have already agreed to use a color coding system. However, none of them have been using any of the colors listed.

Posted by Donna on 2 April 2008

Message:
I just received the Feb/March issue of Diabetes Health. After reading the article on accidental overdoses and mix ups of insulin. (which I've done a couple of times in my 22 years as a type 1), I think that the mfg's of these drugs should not only color code them but also put a non slip band around the bottles. I was in a restaurant a couple of months ago and was preparing to take my shot and the bottle slipped out of my hand and fell to the floor. I was fortunate that it did not break, but I had to wait until I got home so that I could disinfect the top of the bottle so that I could take my shot. I think that there is a lot of room for improvement on the packaging of all diabetic supplies and drugs.

Thank you for your wonderful articles and a great magazine. It helps me to know that I'm not alone in the struggles of being a diabetic!

Sincerely,

Donna McCarthy

Posted by Anonymous on 22 April 2008

I am basically a type-II diabetic (but, switched to insulin, because of poor control). Most of the people can READ THE LABEL. Mistakes happen, when one is under some kind of a pressure. I used to inject the basal insulin in the mornings, now switched to evening.

I made the "fatal mistake" as I was hurrying to catch the train (+ drop my child in the school). I spend a half a day in the hospital. Luckily, I live near a big hospital.

Since, then I switched to nightly injection, do not let anyone talk to me/come near me during injection + keep the two injection in separate places + different colors of the pens (red/burgundy for short acting + blue for basal insulin).

The insulin manufacturer do have a responsibility to LISTEN to the end users. After all, changing colours of the pens and insulin syringe is not that difficult.

Posted by Anonymous on 2 May 2008

I had the insulin mix-up problem and was terrified since I was not in my own home, but at a motel. Thank goodness for the vending machines.

You know the large rubber bands that they put with produce? I put one on my Lantus bottle and haven't had a problem since. I really try harder to make sure that I'm using the correct insulin.

Posted by ttrish47 on 20 June 2008

I am a type 2, and there is no trouble keeping my insulins apart. The Levemir (and previously Lantus) bottles are a different shape than the Novolog and they are color coded. Levemir green, Lantus purple, Novolog orange. Just watch what you are doing and it should work out OK. When I first started this, I put the vials into little plastic boxes in the fridge, with the type of insulin written in marker on the outside of the box. You just have to make sure they are in the correct box. Medication errors are common, even in hospitals and clinics. We are no different.

Posted by Anonymous on 20 June 2008

Those of you who feel we diabetics should take full responsibility for our injection errors have a point, but injections become automatic and if you're like me one day runs into the next and sometimes I can't remember if I took my insulin or not much less whether or not I took the balsal or bolus insulin. It stands to reason for manufacturer'as well as patients to do whatever we can to decrease these errors. I've been a diabetic for 28 years and have made these types of mistakes occassionally--it's a very scarey thing. If color coding will help Let's do it...For a while I had a dog with diabetes and we were both on NPH. They were many times when I couln't remember who I gave the insulin to me or the dog...Let's noty worry about blame . let's add whatever cues that will help the incidence of these potentially serious mistakes,

Posted by Anonymous on 15 July 2008

AS Diabetes Health has pointed out, there is a company out there making a vial cover that helps us differentiate between the three different types of Insulin. Check out their website at www.insucozi.com.

Posted by Anonymous on 20 August 2008

First of all, I am disappointed by the tone of many of these responses. Reasonable people can disagree, and there is no need to harshly criticize each other.

I am careful when I mow the lawn, but I am glad the mower has an auto brake as this has proven to reduce accidents. Ditto with seatbelts, airbags and antilock brakes on the car.

I'v been Type 1 for 37 of my 50 years. I have probably taken bolus instead of basal 3 times. I've been able to self treat with lots of quick carbs, but it was not pleasant. I have wondered if the insulin companies could make the bottles more different too. What about a ribbed bottle design, a pebbly texture, or one with a significantly different shape? I will look into buying the covers as that is a great idea, and if it prevents a broken bottle or two that can save money and inconvenience. Event though I am careful, I agree with the person who said if you inject enough times you will make mistakes. I worry about how elderly people cope with all the mental demands of managing the disease. Anything the manufacturers could reasonably do to make the products more fool-proof the better. It's just good design, in my opinion

Several people mentioned keeping their insulin in the fridge. I have been taught not to refigerate open bottles as this is hard on the injection site, and not necessary with modern insulin. I do refrig the unopened bottles. Also, I use a mini cooler in a hot car, or I bring the insulin indoors in a fanny pack. I am told that insulin just needs to be kept above freezing on hunting/ski trips, and below about 90 F. I try to keep insulin cool on summer river trips in the desert, but it probaably gets above 90 F at times. So far I have never noticed a loss of effectiveness after getting it hot, however. In winter the insulin goes in a pocket inside the coat, or inside the sleeping bag with me.

I am interested to learn that some people keep their basal next to the bed. I keep both types together in a kit that travels almost anywhere I go outside the neighbborhood. I have learned the hard way that you never know when a short trip will turn into an overnight or late nighter. I take my basal prior to bed most nights, so I need it with me if I am out and about. I also take a morning basal dose. Many mornings I am out of the house well before it's time to inject, so I have to take it away from home. What works for one person may not work at all for another.

Posted by Anonymous on 4 December 2008

I found out I was diabetic as a kid many moons ago. It was easy...NPH was pretty much all there was. I still call the "cloudy" one NPH. Everyone looks at me with confusion.

The easiest for me is a cloudy insulin for long acting and a clear insulin for short acting. Colors? I can get those confused, too!

The manufacturers seriously need to change at least one name of an insulin. Anyone else have problems keeping Novolog and Novolin straight? Or Humalog and Humulin? Geez! Right now I'm only on Lantus. Yea! Lantus and
Apidra...seems easy enough to keep straight if you need to use both. But my son has the Novalog and Novolin battle going on. Give them names on opposite ends of the spectrum. Not names that are easily confused!

Posted by Anonymous on 26 December 2008

It's funny. Last January I written that I agree with the fact that different bottling and/labeling would be helpful. I now have TWO children with type-1 diabetes and have found that it is all about personal responsibility. Checking, double checking, and sometimes triple checking to make sure I have the correct insulin and dosage. We currently have three different types of insulin in our home and have yet to make a mistake as far as giving incorrect type or dosage. Do whatever you have to do to make it work for you, but don't force others to make a change. No matter what labeling is on those bottles, one CANNOT make up for human error on the part of patients and care givers, especially since we are all-human.

Posted by Anonymous on 27 December 2008

For the writer who doubts 46 units of Lantus - wow. My son is 19 and takes 35 units of Lantus. The dosage is not for you to judge. For the writer who states Rx companies are not responsible to differenciate their labels - I say, baloney to that. Yes, we need to "READ THE LABELS" - but most people take one or two pills if they are sick, in pain that is not insulin related and it is not a potentially legal dose on a daily basis multiple times per day - plus, a huge majority of people with diabetes are young children and teenagers - so please - yes we should read the labels - of course - no brainer there, but Rx companies have the moral obligation to do what they can to make things visually different in addition to reading labels. Until that happens, we use Humalog in a Pen and Lantus in a vial. We wrap many colorful rubber bands around the Lantus vial b/c we do keep Humalog vials as back to pens. 5 years ago, my son used NPH instead of the Lantus - both pens are identical with the grey color cap. The bottom line is, we as parents have to take control and do what is necessary to put the visual differences in front of our children to minimize potential mix ups of insulins. We also need to remind our children to do the same. We triple check insulins and double check amounts dialed or pulled up in a syringe. My son wraps rubber bands around new vials of insulin without even thinking about it anymore. The Rx companies can do more - I agree. But ultimately, it is OUR RESPONSIBILITIES as parents to safeguard our children. Period.

Posted by Anonymous on 29 December 2008

I've had Type 1 diabetes for almost 50 years and of course, have been on insulin all that time. I have never used the wrong insulin, as I double-check myself, since a child. Diabetics and the people assisting them need to be responsible for their own actions. If a doctor injected you with the wrong insulin, you could sue him/her for their negliegence/stupidity. Who are you going to sue for your negliegence/stupidity???? The drug companies can't be held accountable for how you dose yourself, at home or wherever. You have to be responsible and if you can't be responsible, then you need to be supervised!

Posted by Anonymous on 5 January 2009

Thank you for posting this article. My oldest son, soon to be 15, (diagnosed at 19 months), accidently injected 26 units of Novolog for his Lantus. He was 13 years old and we were getting ready to head out to the high school basketball game. We always kept his 2 vials of insulin in the same blue insulin protector bag, but not anymore.... Praise God he realized immediately what happened and instead of going to the game that night, we made pancakes~~~lots of pancakes and he maintained a blood glucose level in the 100's all night long...I know, I got up every 2 hours and checked his blood. This was not the manufacturers problem, the vials were different (Lantus-tall and thin, Novolog shorten and thicker), he was just in a hurry and grabbed the wrong vial. We don't have that problem any more because now we make sure that his insulins are not stored together in the same insulin bag--they are separated and that mistake hasn't been made again. Thank you

Posted by Anonymous on 4 February 2009

Someone commented: "Why are you using vial and syringe - join the 2008 world use color coded pen delivery systems - most accurate , less waste , smaller needles"

I have to use vial and syringe for my Humalog. My dose is so small that I adjust in half unit increments, which is not possible with a pen. (for example, a meal might be 2 and a half units). No more insulin mistakes when I switched to the pen for long-acting.

Posted by Anonymous on 4 February 2009

Another idea on this subject is the insucozi insulin vial covers. They come in three shapes and three different colors.

Posted by noelle on 26 May 2009

Problems in detecting an air bubble in the insulin pump line seems to indicate that tinting the insulin so it is no longer clear is an excellent idea.

Posted by Anonymous on 21 September 2009

Just a note on the enormous recent increases in the cost of humulin U-100 insulins. I use regular and NPH (Lilly brands) and both are now over $56.00 per vial.
In fact, in the space of one (1) week the cost for each vial went up over $4.00. These increases are outrageous since insulin manufacturers put the humulin formulas on the market in the early 1980's so they have more than recouped their research and development costs and production costs have been static for the long term.
This is nothing more than gouging the diabetic marketplace for every penny they can get.


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