Insulin - right sort / wrong sort

[Rusty_Sweetbread]

I use NovoRapid fast-acting insulin with meals, and Lantus as my basal insulin.

I recently had a prescription for NovoRapid filled.
But, when I took it out of the fridge a few weeks later, I noticed that the stuff was cloudy.

Annoyed that it had already spoiled, I took it back to the pharmacist.
They informed me that insulin is supposed to be cloudy.
That didn't seem right to me (given that the NovoRapid datasheet that I'd read on day one was emphatic about not using cloudy insulin), and so I told them what I thought was wrong.

They reiterated that it should be cloudy.
But, I explained again, that the advice to use using cloudy insulin was diametrically opposed to what I had been told earlier.

Finally, a second pharmacist came over and established that I'd somehow been given PenMix in error instead of my normal NovoRapid.
(PenMix is a mixture of 30~40% short-acting insulin, and the rest intermediate-acting insulin.) It should, indeed, be cloudy.
But it should not have been given to me.

How dangerous might this mistake have been?
(Have always wondered, but really have no idea)

 

[Antje77]

Finally, a second pharmacist came over and established that I'd somehow been given PenMix in error instead of my normal NovoRapid.
(PenMix is a mixture of 30~40% short-acting insulin, and the rest intermediate-acting insulin.) It should, indeed, be cloudy.
But it should not have been given to me.

How dangerous might this mistake have been?
(Have always wondered, but really have no idea)

If you would have used it instead of your Novorapid you would basically have more long acting in your system and less short acting. How dangerous it would have been would depend on a lot of things, I guess. How good your hypo awareness is, for one, how closely you monitor your bg (big difference between testing 4 times a day or using a CGM in spotting something is off), how aggressively you correct, how much short acting you use, how many carbs you eat.

I suppose If you would eat a high carb meal you would spike pretty high at first, as you'd only would've had 40% of your usual mealtime dose. If you would correct and correct until it came down you may have gone low in the night because of way too much basal sloshing around. With a low carb meal you wouldn't have taken so much extra basal with your corrections.
But should you have taken it with breakfast, chances are you would have noticed something was off way before bedtime. Having just started a new penfill, the insulin would have been the first thing to look at and you would have found out without much trouble and a bit of extra food.

So yes, I'd say it's a potentially dangerous mistake but most likely things wouldn't have gone all wrong.
Still, it's a very good reminder to double check every new pen(fill)/vial before use on name of the insulin, cloudiness and use by date.

Not a bad idea to ask the pharmacist how they plan on preventing such a mistake in the future for safety reasons.

 

[Daibell]

You need to find a different pharmacy if you can. Any pharmacist who prescribes the wrong drug can be sanctioned as it can be very dangerous and should never happen. The pharmacy made the mistake worse by giving you incorrect information about the insulin. NovoRapid is always completely clear.

 

[therower]

Sadly things like this do happen, they shouldn’t but nevertheless they do.
This is why it’s of the upmost importance that we take full responsibility for our own well being.
Never assume or trust anyone else when it comes to medication.
I have been in this situation twice. First time it was test strips. I returned to the pharmacy, they couldn’t and wouldn’t change them. Once you leave the counter/ shop they will not exchange anything.
Second time it was insulin. They gave me pens instead of cartridges. Lesson learned from above and having checked my supplies at the counter, the pharmacist had no choice to correct the mistake. Apologies were accepted.
ALWAYS check your medication asap.

 

[JMK1954]

Clearly, being given the wrong insulin puts you in a dangerous situation. In the UK every pharmacy is instructed to record mistakes like this in an errors book, which is examined when the pharmacy is inspected by someone from the UK General Pharmaceutical Council. My father was a pharmacist, so I grew up knowing this information. The idea of recording the error is to avoid it happening again, by making sure the pharmacy staff change their procedures /tighten up on checking medication before handing over etc.

I don't think anyone can tell you how dangerous the error was. We are all different, so we can't tell you exactly what the effect of the wrong insulin would have been. The fact that it was the wrong insulin was dangerous in itself. Apparently the GPC recommends pharmacies should apologise immediately, contact the customer's GP to inform them if any of the wrong medication has been taken, provide the correct medication etc etc.

All insulins should have a patient information leaflet enclosed, which starts with a description of whether the insulin should be clear or cloudy. You should always ask for an infomation leaflet, if there is none with whatever tablets or insulin is prescribed. It should always start with a physical decription, in the case of tablets, mentioning the colour. If you have the info leaflet you can read it back to the phamacist. You should ask to see whoever it is on duty, not just junior counter staff. The description on the leaflet should be enough to convince the pharmacist with no further delay.

 

[Rusty_Sweetbread]

Good thoughtful answers all. Thanks