Suggestion to Avoid Insulin Overdose

[RBZ5416]

A couple of recent threads by @mmorgan & @Mumpie_olgran have flagged an issue where large doses of bolus have been taken instead of basal. A method to counteract this would be to dial up the next dose on the pen as soon as you've completed the current dose. If you're adjusting bolus for carb counting this obviously won't be accurate, but you can quickly correct at the time of injecting. What it should do is prevent large doses of bolus being taken in error.

Similarly, if you accidentally pick up the basal pen when bolus is due, the pre-dialed (typically) much larger dose should act as a warning flag.

 

[Robin]

That only works if you have a big disparity in basal/bolus doses, though. I take 5-6 units of Levemir in the morning and 3 at night, which is very similar to the sort of bolus dose I need for meals and snacks. I always inject my basal when I’m in bed, either side of sleeping, so I keep my basal pen by my bed.

 

[RBZ5416]

That only works if you have a big disparity in basal/bolus doses

That's the only time it's a dangerous issue though. In your case the worst you could do is inject 6u of bolus in error, which would be fairly easy to counteract. The issues we've seen posted are indeed when there is a large disparity, resulting in very large doses of bolus being administered.

 

[louisew]

A couple of recent threads by @mmorgan & @Mumpie_olgran have flagged an issue where large doses of bolus have been taken instead of basal. A method to counteract this would be to dial up the next dose on the pen as soon as you've completed the current dose. If you're adjusting bolus for carb counting this obviously won't be accurate, but you can quickly correct at the time of injecting. What it should do is prevent large doses of bolus being taken in error.

Similarly, if you accidentally pick up the basal pen when bolus is due, the pre-dialed (typically) much larger dose should act as a warning flag.

Yep I’ve done this a couple of times, took 10 novorapid instead of Tresiba at bedtime. Usually only take 2 rapid for meals. I then had to stay up trying to counteract my blood sugar diving. Great idea about pre dialing

 

[rebrascora]

I have a significant disparity between my daytime basal and my bolus and I mad the mistake once and injected 24 units of bolus insulin instead of basal as soon as I woke up and thankfully noticed as soon as I was putting the pen back in the case. I then injected the actual Levemir and then started eating to mop up the insulin. It was a bit terrifying at first, but if it happened again I would be much more confident in dealing with it much like I am confident of dealing with hypos. 3 hours is plenty of time to eat the amount of carbs you need to to deal with that insulin, it is only the panic which makes it seem very dangerous... and of course it would be more dangerous if you didn't notice your mistake straight away. I put some tape on my Levemir pen so that it feels different.
Dialing up the next dose would just be a waste for me and achieve nothing except confusion for me, firstly because I automatically do a half unit air shot every time and I would waste all that extra insulin I had dialed up and secondly I never look at the display on my pen. I just count the clicks and inject. This way I can inject in daylight or darkness... I check my droplet air shot in the dark by reinverting the pen and dripping the droplet onto the back of my hand. I do look for the droplet in daylight. The reason I inject in the dark is so that I don't disturb my own or my partner's sleep by putting the light on. I can be back to sleep in seconds doing it in the dark but if I put the light on, it takes much longer to go back to sleep. Or in the morning, I inject before I get out of bed otherwise my levels go into orbit but if I am at my partners house, putting the light on to do so, would wake him up.
I am happy that the modification to my pen with the tape and just the lesson learned from making the mistake is good enough to reduce the risk but if it was to happen again, I feel that it would be much less of an issue to deal with it because I managed it really well last time albeit with a large element of panic on that occasion.
Having various doses dialed up on my pens long before I need them just seems like a recipe for confusion and error to me, but it may work for some people whose system of injecting is less entrenched. I find changing a routine particularly challenging and if I don't really concentrate every time for several weeks or months even, I am more likely to make a mistake..... I am still struggling to get used to the controls on my iphone after I changed from my Motorola 4 months ago. I still try to swipe it numerous times a day to switch it on instead of pressing the home button. Arrgh!

 

[helli]

This would not work for my pens - I cannot reduce a dose once it has been dialled up apart from to do a large airshot.
Both my bolus and basal can change from dose to dose.
Unlike @Robin I keep both insulin pens together as I never know when I will be out later tan expected and need to take my basal.

I think the way to avoid it is to double check before injecting. It is not foolproof and we make mistakes. This is why it is as important to know what to do when we make a mistake.

 

[RBZ5416]

Hmm, I wasn’t aware that there are “one way” pen mechanisms. Both my Novorapid & Semglee disposable pens allow a dose to be set & then returned to zero. Also useful for verifying exactly how much is left towards then end.

 

[Satan’s little helper]

Hmm, I wasn’t aware that there are “one way” pen mechanisms. Both my Novorapid & Semglee disposable pens allow a dose to be set & then returned to zero. Also useful for verifying exactly how much is left towards then end.

The pens I had back in the late 1980s could not be dialed back. You were committed if you over dialled.
The early insulin cartridge boxes in that era had a colour coded sticker attached that could be removed and stuck to the pen shaft that used the corresponding insulin. A yellow/orange sticker for bolus. A soft green for the basal.
It was certainly a welcome when the design changed. 🙂

 

[Bruce Stephens]

This would not work for my pens - I cannot reduce a dose once it has been dialled up apart from to do a large airshot.

That sounds like a terrible design choice. I guess you get used to it, though.

 

[Satan’s little helper]

That sounds like a terrible design choice. I guess you get used to it, though.

The only way round it (for me.) with the early Novopen was to remove the cartridge, push out what was missdialled.
Push the ram back a little & reinsert the cartridge? Then re-prime with some tentative dialling.

 

[Bruce Stephens]

The only way round it (for me.) with the early Novopen was to remove the cartridge, push out what was missdialled.
Push the ram back a little & reinsert the cartridge? Then re-prime with some tentative dialling.

Ah. I guess there must have been some engineering reason why they were forced to do that? (I was imagining some reason that they thought it was good that people couldn't reduce a dose, but perhaps that was forced somehow and it took some extra work to permit it.)

 

[helli]

The only way round it (for me.) with the early Novopen was to remove the cartridge, push out what was missdialled.
Push the ram back a little & reinsert the cartridge? Then re-prime with some tentative dialling.

Too much faff for me to dial up the next dose when I have no idea what I am going to eat or how much exercise I am going to do.

 

[Satan’s little helper]

Ah. I guess there must have been some engineering reason why they were forced to do that? (I was imagining some reason that they thought it was good that people couldn't reduce a dose, but perhaps that was forced somehow and it took some extra work to permit it.)

I’ve no idea. Both pens were identical, bar the contents and the coded sticker provided with the insulin?
When the ID sticker went tatty, I reaffixed a fresh one. 🙂

 

[Bruce Stephens]

Both pens were identical,

On the outside they might be, but perhaps they changed something (and tested and got approval). I honestly don't know. It feels odd that anyone would think that disallowing reducing a dose would be a good idea, so I can only imagine there's some mechanical reason why that's easier to do. I'm glad at least some reusable pens no longer have that restriction.

 

[Lucyr]

A couple of recent threads by @mmorgan & @Mumpie_olgran have flagged an issue where large doses of bolus have been taken instead of basal. A method to counteract this would be to dial up the next dose on the pen as soon as you've completed the current dose. If you're adjusting bolus for carb counting this obviously won't be accurate, but you can quickly correct at the time of injecting. What it should do is prevent large doses of bolus being taken in error.

Similarly, if you accidentally pick up the basal pen when bolus is due, the pre-dialed (typically) much larger dose should act as a warning flag.

I’d advise against this.

If you dial up a dose when a needle isn’t present, and the plunger gets pressed when the pen is in your bag, there could be more pressure in the cartridge than there should be.

Potentially when you then dial the dose before the meal and attach a needle this could affect the dose you receive at that time, making it more than expected because of the earlier depressed units?

Not saying that’s guaranteed, maybe they’d just escape when you do the air shot, but feels too risky to me.

 

[RBZ5416]

I’d advise against this.

If you dial up a dose when a needle isn’t present, and the plunger gets pressed when the pen is in your bag, there could be more pressure in the cartridge than there should be.

Potentially when you then dial the dose before the meal and attach a needle this could affect the dose you receive at that time, making it more than expected because of the earlier depressed units?

Not saying that’s guaranteed, maybe they’d just escape when you do the air shot, but feels too risky to me.

Not possible. Any excess pressure would be released through the needle as soon as it was inserted.

 

[Proud to be erratic]

This proposal wouldn't work for me either but @RBZ5416 just airing these things is great. Particularly for for recent new members .

I've done this about 4 months ago. I'd like to pretend that it was because I am genuinely mildly red/blue colour blind, which is an issue for me in low light. But in truth it was broad daylight and I was in a hurry and just allowed myself to become distracted. Luckily I also realised what I'd done AND remembered that @rebrascora had written after her episode with 20+ units of bolus rather than basal. In particular I recalled Barbara's comment that she had the presence of mind to faithfully keep a record of all the extra carbs she had to take and that was a great help in preventing a big swing from low to high. That alone is good reason that we periodically refresh our thoughts and ideas on these inevitable "silly excursions" because we can draw on other people's experiences and navigate a way forward.

I now have a couple of gold star stickers on my blue pen which both changes the feel of it as well as emphasising the different appearance. And it amuses my grandson!

 

[Lucyr]

Not possible. Any excess pressure would be released through the needle as soon as it was inserted.

Why risk it though. Just dial up when you know what dose you need.

 

[RBZ5416]

Why risk it though.

There isn't any "risk" as I've explained to you.

Just dial up when you know what dose you need.

Whoosh! As the whole point of my post whistles over your head...

 

[Lucyr]

There isn't any "risk" as I've explained to you.

Whoosh! As the whole point of my post whistles over your head...

There is no point to your suggestion though. You want me to dial up my breakfast dose of apidra now, but I don’t know what my bg will be in the morning, or what I’ll be eating for breakfast, so I haven’t a clue what dose I will need. How do you suggest I calculate the dose to take? My ratios are 1u to 5g carbs and 1u drops 2mmol. I have between 0 and 40 carbs for breakfast and wake up with a bg between 5-9 usually. What dose would you dial up tonight ready for breakfast tomorrow given these numbers?

I’m also going out tonight so my insulin pen will be in my bag. If I need a correction later before bed I’ll either accidentally take the higher breakfast dose already dialled up or I’ll have to undial the breakfast dose and redial the correction dose. I’d have to undial the breakfast dose either way if I needed to do an airshot so pointless dialling up a guessed dose for tomorrow either way.

Also the insulin might be wasted or too much injected if the plunger gets pressed in my bag. You can’t say there’s no risk of that as that hasn’t been tested.