Mathematics And Insulin Errors: Mathematics Needed
Dr. Bob suggests that a basic mathematics course be introduced for nurses and medical professionals on a multi-year schedule in well-defined programs with continuous certification as a continuous program in hospitals and certification programs especially if medical errors occur. Medication Errors with the Dosing of Insulin: Problems across the Continuum Pa Patient Saf Advis 2010 Mar;7(1):9-17. ABSTRACT Controlling blood sugars with insulin is essential in the management of hyperglycemia in both diabetic and nondiabetic patients. However, studies have shown that the use of insulin has been associated with more medication errors than any other type or class of drug. From January 2008 to June 6, 2009, Pennsylvania healthcare facilities submitted 2,685 event reports to the Authority that mentioned medication errors involving the use of insulin products. The most common types of medication error associated with insulin were drug omission (24.7%) followed by wrong-drug errors (13.9%). More than 52% of the reported events led to situations in which a patient may have or actually received the wrong dose or no dose of insulin (e.g., dose omissions, wrong dose/overdosage, wrong dose/underdosage, extra dose, wrong rate errors), which could lead to difficulties in glycemic control. Strategies to address these problems include limiting the variety of insulin products on the organization’s formularies, developing standardized protocols and a standard format for prescribing insulin, avoiding the use of abbreviations or other shortcuts when communicating orders for insulin, and requiring an independent double check of all doses before dispensing and administering intravenous insulin. Introduction An estimated 23.6 million Americans (nearly 8% of the U.S. population) have diabetes mel Continue reading >>
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- CBT may help reduce anxiety and depression in people with diabetes, but standardised approach needed
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
Sliding Scale Insulin Therapy
Insulin is the foundation of treatment for many people with diabetes. If you’re a diabetic, your body either can’t produce enough insulin or can’t use insulin efficiently. People with type 1 diabetes, and some with type 2 diabetes, have to take several injections of insulin per day. The insulin keeps blood sugar in a normal range and prevents high blood sugar levels. This can help prevent complications. The amount of insulin you should take can be determined in several different ways: Fixed-Dose Insulin With this method, you take a certain set amount of insulin units at each meal. For example, you may take 6 units at breakfast and 8 at dinner. The numbers don’t change based on your blood sugar readings or the amount of food you eat. While this may be easier for people just starting insulin, it doesn’t account for pre-meal blood sugar levels. It also doesn’t factor in the varying amounts of carbohydrates in a given meal. Carbohydrate to Insulin Ratio In this method, you take a certain amount of insulin for a certain amount of carbohydrates. For example, if your breakfast carb to insulin ratio is 10:1 and you eat 30 grams of carbohydrates, you would take 3 units before breakfast to cover your meal. This method also includes a “correction factor” that accounts for your pre-meal blood sugar. For example, let’s say you want your blood sugar to be under 150 mg/dL before meals, but it’s at 170. If you’ve been told to take 1 unit of insulin for every 50 you’re over, you would take 1 additional unit of insulin before your meal. While this takes a lot of practice and knowledge, people who can manage this method can keep better control of their post-meal blood sugar levels. Sliding-Scale Insulin Therapy (SSI) In the sliding-scale method, the dose is based o Continue reading >>
Glycemic Control With Regular Versus Lispro Insulin Sliding Scales In Hospitalized Type 2 Diabetics.
Abstract PURPOSE: The aim of this study was to compare glycemic control with either regular or lispro insulin sliding scales in hospitalized Type 2 diabetics who were not using insulin as outpatients. METHODS: Forty-three patients with Type 2 diabetes, who were taking oral agents only, were admitted to a medical inpatient service and randomized to receive either regular or lispro insulin sliding scale. Oral agents for diabetes were held upon admission and patients were followed throughout their hospital stay. RESULTS: There was no significant difference (P>.05) between the average finger-stick blood glucose (FSBG) in the regular insulin group (157.78+/-40.16 mg/dl) and the lispro insulin group (152.04+/-27.71 mg/dl). No significant difference was found between the daily dose of insulin (regular, 5.83+/-5.01 units; lispro, 4.27+/-3.40 units), total amount of insulin used during hospitalization (regular, 11.87+/-10.78 units; lispro, 12.77+/-14.39 units), glucose excursion (regular, 110.13+/-25.86 mg/dl; lispro, 106.77+/-52.65 mg/dl), or length of hospital stay (regular, 2.33+/-1.23 days; lispro, 2.69+/-1.59 days). CONCLUSION: No significant difference in glycemic control was found in hospitalized Type 2 diabetic patients who received either regular or lispro insulin sliding scales. Both insulin sliding scales used in this study are inadequate to achieve current recommended glycemic targets in this patient population, when used as the only inpatient treatment for diabetes. Continue reading >>
- The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus
- Association of Glycemic Variability in Type 1 Diabetes With Progression of Microvascular Outcomes in the Diabetes Control and Complications Trial
- Hospitalized with Diabetes
Interactive Dosing Calculator
Lantus® is a long-acting insulin analog indicated to improve glycemic control in adults and pediatric patients with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus. Lantus® should be administered once a day at the same time every day. Limitations of Use: Lantus® is not recommended for the treatment of diabetic ketoacidosis. Contraindications Lantus® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to insulin glargine or one of its excipients. Warnings and Precautions Insulin pens, needles, or syringes must never be shared between patients. Do NOT reuse needles. Monitor blood glucose in all patients treated with insulin. Modify insulin regimen cautiously and only under medical supervision. Changes in insulin strength, manufacturer, type, or method of administration may result in the need for a change in insulin dose or an adjustment in concomitant oral antidiabetic treatment. Do not dilute or mix Lantus® with any other insulin or solution. If mixed or diluted, the solution may become cloudy, and the onset of action/time to peak effect may be altered in an unpredictable manner. Do not administer Lantus® via an insulin pump or intravenously because severe hypoglycemia can occur. Hypoglycemia is the most common adverse reaction of insulin therapy, including Lantus®, and may be life-threatening. Medication errors, such as accidental mix-ups between basal insulin products and other insulins, particularly rapid-acting insulins, have been reported. Patients should be instructed to always verify the insulin label before each injection. Severe life-threatening, generalized allergy, including anaphylaxis, can occur. Discontinue Lantus®, treat and monitor until symptoms resolve. A reduction in the Lantus® dose may be re Continue reading >>
You Clicked On A Page That’s Meant For Healthcare Providers.
Thought leaders discuss the AUTONOMY study These short videos, featuring well-respected leaders from the diabetes community, provide an insightful look at the AUTONOMY study, the study’s implications, and a step-by-step tutorial for the Humalog Self-titration Algorithm. AUTONOMY study author Dr. Steven Edelman reviews the study and discusses how the findings may help patients with type 2 diabetes and the healthcare providers who treat them. Professor and primary care physician Dr. Charles Shaefer discusses the practical application of the Humalog Self-titration Algorithm in the primary care setting. Starting a Patient on the Humalog Self-titration Algorithm Learn how to help your patient start mealtime insulin using the Humalog Self-titration Algorithm. Continue reading >>
Information For Owners Of Canine's With Diabetes Mellitus
Diabetes in animals is very similar to that of humans. Therefore this page may contain links that are about humans or other animals. Background Information about Insulin When we eat, our bodies break food down into organic compounds, one of which is glucose. The cells of our bodies use glucose as a source of energy for movement, growth, repair, and other functions. But before the cells can use glucose, it must move from the bloodstream into the individual cells. This process requires insulin. Insulin is produced by the beta cells in the islets of Langerhans in the pancreas. When glucose enters our blood, the pancreas should automatically produce the right amount of insulin to move glucose into our cells. Canines with type 1 diabetes produce no insulin. Felines with type 2 diabetes do not always produce enough insulin. (Felines can be type 1 or 2 and Canines are always type 1) Insulin Tips: - NPH cannot be mixed with any Lente (L or U) insulin, they are chemically incompatible. - Insulin does not have to be refrigerated if kept at a moderate temp., although it is recommended. - Do not give cold injections, it could cause discomfort. - Popular opinion is to dispose of opened insulin after 30 days or 100 sticks. - To prevent abscesses, infections, and discomfort, only use syringes once. - Rotation of injection sites is recommended. - It is best to feed before the injection to make sure the animal eats. (generally 30 min. before) - Human insulins are shorter acting than animal insulins of the same type. - Never shake "cloudy" insulins. Roll the bottle between the palms of your hands. Duration and Peak Times for the Most Common Insulins There are more than 20 types of insulin products available in four basic forms, each with a different time of onset and duration of action. Continue reading >>
Guide To Starting And Adjusting Insulin For Type 2 Diabetes
Adapted from Guide to Starting and Adjusting Insulin for Type 2 Diabetes, ©2008 International Diabetes Center, Minneapolis, MN. All rights reserved. Many people with type 2 diabetes need insulin therapy. A variety of regimens are available. Here are some tips when discussing insulin therapy:1 Discuss insulin early to change negative perceptions (e.g., how diabetes changes over time; insulin therapy as a normal part of treatment progression). To encourage patient buy-in, it may be more strategic initially to begin with a regimen that will be the most acceptable to the patient even if it may not be the clinician's first choice (e.g., pre-mixed instead of basal-bolus regimen).2 Provide information on benefits (e.g., more “natural” versus pills, dosing flexibility). Consider suggesting a “trial” (e.g., for one month). Compare the relative ease of using newer insulin devices (e.g., pen, smaller needle) versus syringe or vial. Ensure patient is comfortable with loading and working a pen (or syringe). Link patient to community support (e.g., Certified Diabetes Educator [CDE] for education on injections and monitoring; nutrition and physical activity counselling). Show support — ask about and address concerns.2 Consider initiating insulin if…3 Oral agents alone are not enough to achieve glycemic control or Presence of symptomatic hyperglycemia with metabolic decompensation or A1C at diagnosis is ≥ 9%. Timely adjustments to and/or additions of antihyperglycemic agents should be made to attain target A1C within 6 to 12 months.3 Standard target blood glucose (BG) goals for type 2 diabetes:3 Before meals 4 to 7 mmol/L Two (2) hours after meals 5 to 10 mmol/L (5 to 8 mmol/L, if A1C targets are not being met) A1C ≤ 7% (Less stringent A1C goals are appropriate for som Continue reading >>
Helpful Hints For Humalog:
WHAT YOU NEED TO KNOW by John Walsh, P.A., C.D.E., and Ruth Roberts, M.A. Copyright--1996 by Diabetes Services, Inc. The new, fast insulin Humalog, is finally here. Since the introduction of Lilly's new insulin, many people have been switching over. This is the first insulin produced since 1921 that can really cover most meals, and its speed of action offers users more flexibility and control. This article provides helpful hints for safety and success when starting this new product. Almost everyone who is switching to Humalog is doing so to replace their Regular insulin. Regular is often thought of as "meal" Regular or "high blood sugar" Regular, but its action time of five to eight hours more closely resembles a long-acting insulin. After switching from Regular to Humalog, many people have found that fewer units of Humalog are needed to cover the same food. Fewer units may also be needed to lower high blood sugars. Others have discovered that as meal doses are lowered, they need to raise their long-acting insulin to replace some of the lost meal dose. The Regular insulin most people take for breakfast has, in effect, been lowering their after-lunch blood sugars as well. This prolonged action is no longer seen with Humalog. Several of my (John's) patients and several diabetes colleagues have found they need extra long-acting insulin in the morning after switching in order to keep the afternoon and pre-dinner readings down. Another alternative is to use extra Humalog to cover lunch. When given before most meals, Humalog will cover these meals only during the time they are raising the blood sugar. Its action is gone before the next meal begins, and most importantly for many, before going to bed. This eliminates many nighttime lows. But with the loss of the longer action o Continue reading >>
Method Of Food And Insulin Dose Management For A Diabetic Subject
This application claims priority from U.S. Provisional Application No. 60/498,580, filed Aug. 29, 2003; U.S. Provisional Application No. 60/420,289, filed Oct. 23, 2002; and Canadian Application No. 2,409,374, filed Oct. 23, 2002; the entire disclosures of which are incorporated herein by reference. Most foods are carbohydrates, which are converted to sugar by the digestive process. Cells absorb this sugar in order to support life. Insulin, a hormone produced by the pancreas, is key to the absorption of sugar by the cells. Without this hormone being present, the cells will not absorb the sugar, and will die. A diabetic who is dependent on insulin injections typically does not produce his or her own insulin, and therefore needs to take insulin shots to survive. The medical community uses a scale of 0 to 540 mg/dl to represent the amount of sugar in the blood. Low blood sugar is considered to be 0-70. Normal blood sugar is considered 70-126. High blood sugar is in the range 126-200. Very high blood sugar is over 200. Below 70 is a condition known as very low blood sugar (hypoglycemia). This is the level at which brain damage and death can occur if immediate action is not taken to correct the situation. At 200 and above is a condition known as very high blood sugar (hyperglycemia). As the sugar level approaches 540, brain damage and death can occur if immediate corrective action is not taken. At both ends of the spectrum, very high and very low, a diabetic will go into a coma. To correct a very low blood sugar condition, it is necessary to get sugar into the blood immediately, by ingesting sugar or its equivalent: for example a high-sugar fruit juice such as orange juice. In an emergency, a glucose injection can be given. Typically, blood sugar will rise within minutes. No
Perioperative Management Of Diabetes Mellitus Patients Undergoing Surgery
The objective of this protocol is to maintain the safety of all ADULT patients with diabetes when undergoing surgery. This includes patients with Type 1 and Type 2 diabetes. Patients with diabetes should be involved in the management of their blood glucose levels as they manage their condition at home. The following guidance is divided into elective and emergency surgery. The elective section is divided into those with a short period of starvation (1 meal) and those with a longer period (more than 1 meal). Please make sure you are looking at the right section to guide management. All elective patients will have been offered advice and guidance during the pre-op period and will usually be well informed about what to expect. Many patients with type 1 diabetes will adjust their prandial insulin according to the carbohydrate content of their food when eating. If they are well enough and wish to continue to do this on the ward this is encouraged. If a patient is doing this it is important to ask them to note how much insulin they are having and what their blood sugar readings are and to record these on their diabetes treatment chart. If a surgical patient has diabetic ketoacidosis (DKA) this must be managed carefully according to the DKA integrated care pathway and early involvement of the diabetes/medical team is very important. If a patient is on an intravenous variable rate insulin infusion the advice and guidance on the ‘Two Day Diabetes Treatment and Blood Glucose Monitoring Chart for Intravenous variable rate Insulin Infusion’ should be used to guide changes in infusion rates if the capillary blood glucose does not remain within the desired range (ideal 6-10mmol/l, acceptable 4-12 mmol/l) Useful numbers, Anaesthetic department – 2050 Consultant Diabetologist – Continue reading >>
Types Of Insulin
There are different types of insulin and they can be subdivided into: Rapid acting insulin. Rapid-acting insulin starts to work about 15 minutes after injection and works for about 3 to 5 hours.Examples of rapid acting insulin are insulin lispro with brand name of Humalog, insulin glulisine which has brand name of Apidra and aspart insulin which is also called novolog insulin. Short acting insulin. Short-acting insulin starts working in 30 to 60 minutes after injection and works for 5 to 8 hours. Examples of short acting insulin are the regular insulin Humulin R and Novolin R. Intermediate acting insulin: Intermediate-acting insulin starts working in about 1 to 3 hours after the insulin injection and works for about 12 to 16 hours. Example of intermediate acting insulin is NPH insulin. Long acting insulin:Long-acting insulinstarts to work in about 1 hour after injection. It works continuously for about 20 to 26 hours. Examples of long acting insulin are insulin detemir, also called levemir insulin and insulin glargine, which is also called lantus insulin. Pre-mixed NPH (intermediate-acting) and regular (short-acting), Pre-mixed insulin lispro protamine suspension (intermediate-acting) and insulin lispro (rapid-acting. Pre-mixed insulin aspart protamine suspension (intermediate-acting) and insulin aspart (rapid-acting). Sometimes the rapid acting insulin and the short actin insulin are given as insulin sliding scale. This means that the doctor writes the order for the insulin so that the dose increases as the blood sugar increases, up to a certain maximum dose. Insulin sliding scale is used to help the diabetic person to adjust the insulin dose to prevent hypoglycemia or low blood sugar and hyperglycemia or high blood sugar. It is good for the patient to have information Continue reading >>
Types Of Antidiabetic Drugs
Injectable therapies Insulins For all patients starting insulin for the first time please contact a diabetic nurse specialist (most patients are started on twice daily mixed insulin). When prescribing insulin please specify the type and dose on both the drug kardex and insulin prescription chart. The following are some of the insulins available. If you are unsure of the type of insulin the patient is on, contact either your clinical pharmacist to help clarify or your local Diabetes Team for guidance. Short-acting insulin Humalog® (insulin lispro) NovoRapid® (insulin aspart) Humulin S® Actrapid® Intermediate- and Long-acting insulin (basal) Humulin I® Insulatard® Lantus® (insulin glargine) Levemir® (insulin detemir) Abasaglar® (biosimilar insulin glargine) Tresiba® U100 (insulin degludec) Tresiba® U200 (concentrated insulin degludec, 200units/ml) Toujeo® U300 (concentrated insulin glargine, 300units/ml) Mixture of short- and intermediate-acting: Mixed insulin Humulin M3® Humalog® Mix25 Humalog® Mix50 Novomix® 30 The list above reflects the majority of types of insulin used locally. For a complete reference of all insulins, refer to BNF. N.B. Do not give hyperglycaemic patients boluses of SC insulin on an 'as required' basis, adjust their regular therapy instead. Check urine or capillary blood for ketones. If ketones found then follow local guidelines, which may necessitate starting insulin sliding scale. Insulin prescribing - Important points Insulin is an important medication that when prescribed poorly can lead to severe complications and even mortality. Below are four key components to safer insulin prescribing: The right insulin - ensure that the correct insulin is prescribed in full in both the Kardex and the insulin prescription chart. Check with th Continue reading >>
More Like This
Prev post1 of 3Next Diabetes has become a very common heath problem. The main cause is lack of adequate insulin production to manage the level of glucose in your blood. While there is no cure for diabetes, with your blood sugar level under control you can live a totally normal life. There are various natural More like this Continue reading >>
Sliding Scale Humalog 75 25
Author: emconneo Sliding scale humalog 75 25 buy humalog buy humalog insulin generic humalog humalog 50 humalog 50 50 humalog 75 25 pen humalog 75 25 side effects humalog 75 25 sliding scale humalog 75/25 humalog buy humalog. Blood sugars very bad, lows in 20-25 range, highs up to 500-600. See nurse. Humalog sliding scale insulin "I am on Humalog mix 75/25. My MD added R insulin sliding scale When do I test to use my sliding scale? What times? Do I test right before bed ? Humalog/sliding scale? Lantus vs Humalog dosage Formula?? - Diabetes - Juvenile Type I. Mealtime Insulin for Type 2 Diabetes Treatment - Humalog (insulin. Important Safety Information for Humalog, Humalog Mix75/25, and. humalog sliding scale - MedHelp - Health community, health. 1 pv 5551 amp . humalog ® mix75/25. tm. 75% insulin lispro protamine suspension and 25% insulin lispro injection (rdna origin) 100 units per ml (u-100) >>Does anyone inject Humalog on a sliding scale? What is >>your scale? >> >>Polly. Using the Humalog 75/25, testing before meals, my scale was: 200 - 300: 4 units Humalog, Humalog Mix75/25 (75% insulin lispro protamine suspension, 25% insulin lispro injection [rDNA origin]), and Humalog Mix50/50 (50%. Humalog Mix75/25 KwikPen and Humalog Mix50/50 KwikPen >Does anyone inject Humalog on a sliding scale? What is your scale? > >Polly. Using the Humalog 75/25, testing before meals, my scale was: 200 - 300: 4 units Humalog/sliding scale? : Diabetes : Active Low-Carber Forums Humalog 75/25: Humalog Mix 75/25 75% insulin lispro protamine. PV 5551 AMP TM HUMALOG Mix75/25 Humalog, Humalog Mix75/25 (75% insulin lispro protamine suspension, 25% insulin lispro injection [rDNA origin]), and Humalog Mix50/50 (50% insulin lispro. Diabetes Q&A | Insulin | I am on Humalog mix 75/25. My MD added Continue reading >>
Targets For Protective Action Of Insulin
fuel and energy metabolism glucose free fatty acids reactive oxygen species nutritional status coagulation pathway inflammatory pathway endothelium protection against vessel wall inflammatory processes vasodilatory action heart host defenses against infection Noncritically ill Fasting glucose < 126 mg /dL and all random glucoses < 180 - 200 mg /dL Critically ill Blood glucose levels should be kept as close to 110 mg /dL as possible and generally < 140 mg /dL These patients require an intravenous insulin protocol that has demonstrated efficacy and safety in achieving the desired glucose range without increasing risk for severe hypoglycemia Deciding whether to maintain the ambulatory treatment plan in the hospital 8 12 6 10 The Pattern of Insulin Requirement during Normal Health, Meal Plan, and Activity is Not Necessarily Reproduced in the Hospital Scheduled subcutaneous insulin Which pattern of carbohydrate exposure describes the patient ? Discrete meals Negligible carbohydrate Continuous carbohydrate exposure Transitional meal plan / grazing Daytime grazing / overnight enteral feedings Constructing a profile for scheduled subcutaneous insulin …. 6 pm 12 am 6 am 12 pm Glargine NPH SQ Regular Lispro / Aspart / Glulisine Requirement for exogenous insulin during prolonged fasting may disappear in type 2 DM, but even during prolonged fasting it is absolute in type 1 DM type 1 DM type 2 DM requirement for exogenous basal insulin vs time fasting A Bad Practice: 70/30 Insulin plus Sliding Scale Scheduled or routine 0800 & 1700 Q4HRS, or 0200, 0600, 1000, 1400, 1800, 2200 This means 8 shots daily. There is a risk of stacking, & BG tests fail to synchronize: 0200, 0600, 0800, 1000, 1400, 1700, 1800, 2200 Sample “consistent carbohydrate†meal plan order with � Continue reading >>
