Help on the way for insulin pen errors?

The increased use of U-500 insulin, due to an increase in insulin resistance problems in the United States, has led to a high number of medication errors, but there are a few potential solutions, according to the Institute for Safe Medication Practices (ISMP).

Since there is currently no U-500 syringe for patients and practitioners, they have been forced to measure doses with a U-100 syringe. “Too often, patients do not understand the difference between U-100 and U-500, so they inaccurately state the actual dose….Worse, confusion can lead to overdoses,” ISMP wrote in its’ March, 2014, ISMP Medication Safety Alert! Newsletter.

However, there are a few potential solutions to the problem on the horizon. Eli Lilly and Company is working to design a pre-filled pen to deliver HumuLIN R U-500 as well as a dedicated U-500 insulin syringe, according to ISMP. “These dedicated devices, if approved, will allow administration of HumuLIN R U-500 in actual units without dose conversions to non-dedicated syringe markings,” ISMP wrote.

“Given that far fewer patients receive U-500 insulin than U-100 insulin, and given the well known confusion brought about by not having a corresponding U-500 syringe, we believe a U-500 pen would be the best option, despite our recommendation to consider transitioning away from insulin pen use in hospitals,” ISMP wrote.

Until U-500 pens are available, ISMP believes that it would be far less confusing if tuberculin or allergy syringes were used to measure doses by volume using a dosing conversion chart. If U-100 insulin pens are used, it is very important that practitioners explain the amount of HumuLIN R U-500 to be administered in both the actual dose and with specific unit markings on the U-100 syringe.

“It is also important to patients to notify other healthcare professionals of the type of syringe they are using to measure their insulin, especially when treated in an emergency department or admitted to a hospital,” ISMP wrote.