Diabetics have taken the wrong insulin, what should I do?
It was past 23:30 when I suddenly found a message from a diabetic friend: "Is the teacher online?"
There must be a problem, otherwise who would bother in the middle of the night? Thankfully I saw it.
"Tonight, 16 units of long-acting insulin detemir was mistakenly labeled as rapid-acting insulin aspart. What should I do?"
I have encountered this problem more than once...
Urgent, how to deal with this?
Because it is easy to suffer from severe hypoglycemia during sleep, this issue must be addressed.
First reminder: eat
When this happens, it is usually a diabetic who injects 4 injections of insulin a day, because they will have both long-acting and fast-acting (or short-acting).
The insulin we secrete includes basal insulin and mealtime insulin. When using an insulin pump, we set the basal rate and pre-prandial dose to better simulate our own insulin secretion pattern. Using the "three short (speed) and one long" insulin injection plan of four injections a day, one injection of long-acting insulin is also to simulate basal insulin, and the fast-acting or short-acting injection before three meals is to simulate mealtime insulin.
When a diabetic mislabels the long-acting insulin that should be injected before bedtime into a quick-acting (or short-acting), you must know: you have injected another mealtime insulin, but you still can't get it out.
After the insulin injection at meal time, you must eat afterward!
(Nearly 20 years ago, I gave gifts to sugar friends who answered the question correctly----taking pill boxes)
Long-acting before bed often accounts for 40-50% of the total throughout the day. Therefore, for those who use four injections, the quick-acting (or short-acting) dose injected at mealtime is generally significantly less than the long-acting dose before bedtime. For example, 8 units of quick-acting or short-acting drugs are given before three meals, and about 16 units are usually injected for long-term effects.
If the 16 units of long-acting insulin before going to bed are mistakenly typed into 16 units of rapid-acting insulin, that is to say, if the daily dose of rapid-acting insulin is doubled, the subsequent meals cannot be eaten as usual. If the staple food of each meal is 75g in the daily three meals, this matches the daily 8 units of fast-acting insulin before meals. If you mistakenly hit 16 units of fast-acting insulin, you can no longer eat 75g, but eat approximately 150 grams of staple food to deal with.
In the use of insulin pumps, there is a "500 rule", that is, dividing 500 by the total amount of insulin in a day is for everyone to think about "how many carbohydrates can one unit of insulin handle", and everyone can borrow it. It is also possible to divide the number of grams of staple food per meal by the insulin dose before meals, and the conclusion is: how many grams of staple food can 1 unit of insulin counteract. Then look at how many units you hit by mistake, and the result will come out.
For example: daily injection of 8 units of fast-acting insulin before meals, eating rice made of 80 grams of rice. 80 divided by 8 equals approximately 10g. That is to say, 1 unit of insulin can eat 10g of rice, if you inject 16 units, you will eat 16X10=160g of rice.
In our daily diet, in addition to the staple food, each meal also requires a certain amount of meat, eggs, milk, beans (mainly supplying protein) and vegetables (supplying vitamins, trace elements, dietary fiber, etc.). It doesn't seem realistic to cook one more meal before going to bed. If you use bread, biscuits, etc. with the same amount of carbohydrates instead, due to the lack of dietary fiber and protein, eating these foods alone may raise your blood sugar a lot, and even some sugar friends can't eat so much at one time. Here we suggest that you can consider using the meal-sharing method. That is, divide the bread of the same amount of carbohydrates into at least 2 meals, and the time of the second meal can be arranged after the insulin injection (1.5 hours for fast-acting insulin analogs and 2-2.5 hours for short-acting insulin). The goal is to synchronise the effect of food on blood sugar with the timing of insulin action as much as possible.
Many people may be terrified of eating so much at one time, and they are afraid that their blood sugar will not be able to soar, so continue to read: monitoring blood sugar.
Second reminder: measure blood sugar
The main purpose of monitoring blood sugar is to prevent hypoglycemia.
Rapid-acting insulin has a fast onset of action, a short duration of action, and the peak of action generally does not exceed 3 hours. Therefore, it can be monitored at 1, 2, and 3 hours after injection. If the dose is large, it can be measured again for 4 hours. Short-acting insulin has a slow onset and a long duration of action. The peak can last until 4 hours after injection, and the effect can be maintained for 6 hours. Therefore, if the short-acting effect is missed by mistake, the blood glucose should be monitored 2h, 3h, 4h, or even 5h after the injection. The risk of subsequent severe hypoglycemia is lower.
As mentioned above, some people may not dare to eat so much, so they need to actively monitor it. Within the time range of insulin action, the amount of food intake can be appropriately increased or decreased according to the amount of blood sugar.
The injection site for long-acting insulin is usually the buttocks, thighs, or upper arms, where absorption is slow. If a mistyped rapid-acting or short-acting insulin is also injected into these relatively slow-absorbing sites, the duration of action may be prolonged. In that case, blood glucose monitoring 4 hours after injection of rapid-acting insulin and 5 hours after injection of short-acting insulin is more important.
One more sentence to add here. Since this meal is relatively low in dietary fiber and protein, coupled with emotional agitation, postprandial blood sugar may be very high. At this time, it is important not to chase quick-acting or short-acting insulin at will.
The third reminder: long-term still need to fight
Long-acting insulin is designed to simulate basal insulin. Don't dare to inject that long-acting insulin again if it is mistakenly marked as quick-acting. Otherwise, the blood sugar in the next morning and even the next day will rise due to the lack of basal insulin.
Long-acting insulin should not only be used, but also the dose should not be reduced. The reasoning is the same as above. There may be concerns: Will using two injections of insulin increase the risk of hypoglycemia? The risk of hypoglycemia will definitely increase, but the main reason for the increase in the risk of hypoglycemia is the quick-acting (or short-acting) injection. As mentioned in the second reminder above, the risk of hypoglycemia returns after the time of rapid-acting or short-acting action has elapsed.
Fourth reminder: prevention first
Most of the people who get insulin injections wrong are old sugar. What is even more frightening is that the wrong injection may not be known, so the risk of hypoglycemia during sleep is very high, and it is very scary.
In order to avoid this phenomenon, the following measures can be taken:
1), put a tape on the insulin injection pen, and indicate the time to be used on the tape, whether it is before meals or before going to bed. You can also use different colors to distinguish, use white tape before meals during the day, and use black tape at night before bed.
2), placed separately. The insulin in use generally does not need to be stored in the refrigerator. For convenience, the insulin pen before meals is placed on the dining table, and the insulin before bed is placed on the bedside table. Some people inject long-acting insulin not before bedtime, but sometime in the morning or during the day, and it is best to keep them separate.
Develop the habit of taking a look before each injection. Different insulins, the color of the bottle is different, it is relatively easy to distinguish.
To have a diabetes specialist as a friend is not only the need for "doctor-patient integration", but also the patron saint of your health. It is the best that can protect you 24 hours a day! ------What kind of doctor do you need?
How much would you pay (monthly or yearly) if there was a doctor who could answer your emergency calls 24/7?
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