This letter is in response to the letter of Adlersberg et al. (1). They reported two cases in which patients mistakenly administered a rapid-acting insulin instead of glargine insulin at bedtime, despite the distinct vial shape and purple markings used to differentiate glargine.
In our practice, we have had four similar incidences despite warning patients of the potential for confusion resulting from the similarities in appearance of these clear insulins. Each case we have experienced in our clinic has occurred with patients using a vial and syringe to administer the rapid-acting insulin.
Therefore, we have made it standard practice for patients starting on insulin glargine to use an insulin pen delivery system for bolus doses of short-acting insulin, if possible. This offers the dual benefit of the convenience of using the insulin pen for multiple daily injections as well as almost completely eliminating the possibility of confusing the long- and rapid-acting insulins.
When glargine is eventually marketed in pens, we hope that Aventis will clearly differentiate these pens by color, shape, and markings to prevent future mishaps from occurring.
References
Address correspondence to Wendy Phillips, 8101 Hinson Farm Rd., Ste. 219, Alexandria, VA 22306. E-mail: [email protected].
H.L. has received honoraria for speaking engagements from Eli Lilly, Takeda, Merck, Novo Nordisk, Aventis, and Knoll and holds stock in Pfizer.
