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Insulin Wastage in Ambulant Practice

  1. Chiristian Berne, M.D.,
  2. Ingegerd Agenäs, Pharm.D.,
  3. Gunnar Eriksson, Pharm.D. and
  4. Lars Wibell, M.D.
  1. Department of Internal Medicine, University Hospital Uppsala, Sweden
  2. National Corporation of Swedish Pharmacies Stockholm, Sweden
  3. Kronan Pharmacy Uppsala, Sweden
  1. Address reprint requests to Christian Berne, M.D., Department of Internal Medicine, University Hospital, S-751 85 Uppsala, Sweden.

Abstract

The total insulin consumption in 162 insulin-requiring diabetic patients was calculated from the prescriptions of purchased insulin for 1979–80. The mean daily consumption was 58.6 U, whereas the actual dose injected was 41.7 U. A mean of 1.9 doses was injected daily, which yields a loss per dose of 8.9 U (SD ± 7.9). The dose loss was independent of age and sex and only marginally dependent on insulin dose. Visual impairmentincreased the loss. From a direct study of 101 patients while drawing their usual morningdose of insulin into the syringe, the following major factors underlying insulin wastage emerged: (1) expulsion of surplus insulin into the air instead of into the vial, when adjustment of the insulin dose is made; (2) use of syringes with a separate needle instead of new low-dead-space syringes; and (3) unnecessary use of 2-ml syringes for doses of insulin ≤40 U (≤1 ml).

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