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Journal of Postgraduate Medicine
Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India
ISSN: 0022-3859 EISSN: 0972-2823
Vol. 51, Num. 2, 2005, pp. 152-153

Journal of Postgraduate Medicine, Vol. 51, No. 2, April-June, 2005, pp. 152-153

Letters

Insulin prescription errors

Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu - 632004

Correspondence Address: Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu - 632004, drmathewjohn@yahoo.com

Code Number: jp05059

Sir,

The articles on drug prescription practices in India and the accompanying editorial in the Journal of Postgraduate Medicine were timely. [1],[2],[3] We would like to highlight the medication errors that occur due to faulty practices encountered while prescribing insulin.

In India, there are at least 7 different companies supplying insulin in various forms. Availability of multiple species (bovine, porcine and human), different formulations (regular, NPH, lente, 30/70 and 50/50 combinations) and a variety of insulin analogs and their combinations add to the complexities in prescribing insulin. Errors involved in timing of insulin doses and illegible handwriting (confusing IU or U for 0 etc.) add to the prevalent confusion. For the sake of convenience, several doctors relate to regular insulin as "clear insulin". But in the current scenario, "clear" insulin could mean regular insulin, Lispro, Aspart or Glargine. Further, patients on Lispro (or Aspart) with Glargine combinations will be using two types of clear insulins. Mistaken identity resulting in hypoglycaemia has been reported.[4]

In addition, some physicians prescribe "Insulin L" which could mean either Lente (an intermediate acting insulin) or Lantus (Glargine, a long acting analogue).[5] Another source of confusion is the use of combination-premixed insulin. Patients who remember their insulin as 30/70 may be using either a premixed combination of human insulin (e.g. Huminsulin 30/70) or a premixed analog (e.g. Novomix 30/70). Not mentioning the species of insulin is another error that physicians often make.

Considering the various issues involved, it would be advisable for the physicians to write the prescription in full form mentioning the trade name, generic name as well as the species and also expect the manufacturers to agree upon a common formula to designate insulin and analogs depending upon the species, type of insulin and combinations involved. It is heartening to note that steps are being taken in this direction by adding a suffix like R or N to indicate the type of insulin.

REFERENCES

1.Patel V, Vaidya R, Naik D, Borker P. Irrational drug use in India: A prescription survey from Goa. J Postgrad Med 2005;51:9-12  Back to cited text no. 1    
2.Rataboli PV, Garg A. Confusing brand names: Nightmare of medical profession. J Postgrad Med 2005;51:13-6.   Back to cited text no. 2    
3.Mehta S, Gogtay NJ. From the pen to the patient: Minimising medication errors. J Postgrad Med 2005;51:3-4  Back to cited text no. 3    
4.Adlersberg MA, Fernando S, Spollett GR, Inzucchi SE. Glargine and lispro: two cases of mistaken identity. Diabetes Care 2002;25:404-5.  Back to cited text no. 4    
5.White JR. How can pharmacists help avoid medication errors in the use of insulin Glargine (Lantus)? [Monograph on the Internet] US Pharmacist (cited 2005 May 31) Available from http://www.uspharmacist.com/index.asp? show=article&page=8_1079.htm  Back to cited text no. 5    

Copyright 2005 - Journal of Postgraduate Medicine

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