Reducing Mistakes in Patient Administration of Glargine and Lispro

Adlersberg et al. (1) described two cases of patients who became severely hypoglycemic after mistaking rapid-acting insulins for long-acting insulin glargine (Lantus; Aventis, Parsippany, NJ). Mistakes by patients in administering different kinds of insulin is not a new phenomena. However, any measures taken to prevent confusion would be helpful, including the authors recommendations of improved patient awareness, alternative packaging, and a tinted solution. Although the insulin glargine vial is 1 cm taller and its circumference is smaller than both the lispro (Humalog; Eli Lilly, Indianapolis, IN) and aspart (Novolog; Novo Nordisk, Princeton, NJ) vials, they can still be confused.

A simple solution to this problem, which has been quite effective in my patients, is the implementation of the insulin pen or cartridge in the admnistration of the short-acting insulins. At present, glargine can only be injected using a syringe, and it may be a good idea to continue this method of delivery in patients using two different types of insulin in the future, when glargine will be available in a cartridge or pen form.