Every time I see a high blood glucose result and my patient tells me it happened because he forgot to take his insulin shot, I feel like screaming (but I never do). The stakes are too high to allow that to occur. Most of the time poor diabetic control has little to do with problems that are outside the control of the person with diabetes and has everything to do with not taking medications, not testing the blood glucose, not following a nutritional plan, and not exercising (all of which I discuss earlier in this chapter). There are all kinds of alarms and monitors you can set up to prompt your child to take his insulin (or to prompt you to give it to him) if he has trouble remembering, but the bottom line is that the best treatments in the world are of little value if your child doesn't use them.
Not only do some people forget to take their insulin entirely, but insulin also is consistently in the list of the top ten medications associated with administration errors. At the present time, all people with T1DM take two kinds of insulin, long-acting and rapid-acting. Almost once a week I get a call from a patient who has taken the rapid-acting when he should have taken the long-acting, and vice versa. What can you do to make sure that you and your child avoid this mistake?
1 One of the great benefits of inhaled insulin is that adult patients who take it never mistake it for something else. Insulin from an inhaler is always rapid-acting insulin and therefore is unlikely to be confused with long-acting insulin from a shot. At the present time, inhaled insulin isn't recommended for children. But if you're an adult patient, you may want to talk to your doctor about this option; see Chapter 10 for more information.
1 Before insulin glargine became the long-acting insulin of choice, patients used intermediate (NPH) insulin. It was cloudy compared to clear rapid-acting insulin, so the two were rarely confused. Glargine, by contrast, is clear, so you can see where there may be confusion. One possible solution is to administer the rapid-acting insulin with an insulin pen and the glargine from a bottle with a syringe.
I explain the particulars of insulin in Chapters 10 and 11, including the kinds of insulin available, calculating insulin doses correctly, and various methods for delivering insulin.
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