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Clinical Review Quiz

  Review Questions: Medication Errors Involving “L Insulins”

Lucy A. Levandoski, PA-C, and Martha M. Funnell, MSN, RN, CDE

Ms. Levandosi is clinical diabetes research coordinator, Washington Univeristy School of Medicine, St Louis, MO. Ms. Funnel is director for administration, Diabetes Research and Training Center, University of Michigan, Ann Arbor, MI.

The questions below are based on the article
Medication Errors Involving “L Insulins”.

Choose the single best answer for each question.

1. M.H., a 28-year-old woman with type 1 diabetes since age 15 years, was switched by her primary care physician from twice daily insulin lispro (Humalog; Eli Lilly, Indianapolis, IN) and NPH (neutral protamine Hagedorn) insulin to a regimen of premeal insulin lispro and 28 units of Lantus (insulin glargine; Aventis Pharmaceuticals Inc., Bridgewater, NJ) at bedtime. She took a prescription for Lantus to her local pharmacy immediately following her visit with her doctor and picked up the prescription later that day. The pharmacist mistakenly read the handwritten prescription as Lente instead of Lantus. The directions were “take as directed.” At 9 pm, M.H. administered 28 units of what she thought was Lantus. What is the most likely consequence of taking 28 units of lente insulin instead of 28 units of Lantus at bedtime?
  1. Diabetic ketoacidosis
  2. Nocturnal hyperglycemia
  3. Nocturnal hyperglycemia
  4. Normoglycemia until the following evening
  5. Postprandial hyperglycemia
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2. How does Lantus insulin differ from all other available intermediate and long-acting insulin preparations?

  1. It contains zinc to extend its duration of action
  2. It has a pH of 7.0
  3. It must be given at room temperature
  4. Its duration of action is enhanced by mixing it with an equal amount of rapid-acting insulin
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3. What classifies a medication as “high-alert” according to the Institute for Safe Medication Practices?

  1. It is administered by non-physician care providers
  2. It is a controlled substance
  3. It is given intravenously
  4. It has a narrow margin of safety
  5. It is self-administered
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4. C.B. is a 42-year-old lawyer in a demanding practice. He has had type 1 diabetes for many years. He has been on a regimen of pre-meal insulin lispro and Lantus insulin for the past 2 years. Despite a hectic lifestyle, his hemoglobin A1c levels are usually in the 5% to 6% range. His fasting glucose levels are generally between 70 mg/dL and 120 mg/dL. He always takes 40 units of Lantus in the morning because his schedule is too unpredictable in the evening. He rarely eats breakfast. He uses a pen to administer his pre-meal doses of insulin lispro while away from home but uses a vial and a syringe for his pre-meal doses at home. Recently, while driving to work, C.B. developed symptoms of hypoglycemia but felt he could delay treatment until he got to his office, where he could check his blood glucose level prior to treating his hypoglycemia. The next thing he remembers is waking up in an Emergency Department where he was taken after being found unresponsive in his car in the parking lot of a fast food restaurant. Emergency medical service personnel reported that his blood glucose level in the field was 23 mg/dL. What is the most likely explanation for this episode of severe hypoglycemia?
  1. Accidentally administering 40 units of insulin lispro instead of 40 units of Lantus
  2. Accidentally administering too much Lantus that morning
  3. Forgetting to eat breakfast that morning
  4. Not checking his blood glucose level before driving
  5. Taking his insulin lispro while in the car at the fast food restaurant before getting his breakfast
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5. Measures to reduce medication errors when prescribing insulin include all of the following EXCEPT:
  1. Avoid using “µ” for units
  2. Include detailed directions for use
  3. Make sure letter abbreviations for insulin are capitalized
  4. Use preprinted or typed prescriptions
  5. Write a separate prescription for each insulin
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6. What percentage of medication errors occur during the drug administration phase of the drug delivery process?
  1. 9%
  2. 14%
  3. 26%
  4. 49%
  5. 63%
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