Big mistake!

Re: Big mistake!

Hi Beachbag

I don't know much about mixed insulin ie do you vary the amount dependent on how many carbs you have consumed? I would be careful with a low carb diet as I can't see how you vary the insulin requirements. I am also T2 and take insulin (by choice) but I take my bolus and basal separately. I agree that low/medium carbs is the way to go but don't see how you can do this with mixed insulin.

Ask for an appointment to see your practice manager.

You are also entitled to see your medical notes, although you do (I believe) have to pay for this... This may give you more information that you need to be able to see what mistakes have occurred and by whom....

You need to decide whether you ate wanting to pursue this matter as possibly a legal one, or to mo e on and get better medical help now, or both...

Certainly I would if it was me, do my damndest to get better treatment now... And I would suggest that this would be best pursued by asking to be referred immediately as an urgent case to see a diabetic consultant at your hospital.

Re: Big mistake!

Beachbag said:

. I'm now on humalog mix but may swap later. Comments and advice will be most welcome, please!
Geri

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Hi there,
it is a very strange error and needs a formal complaint ( although it is partly your fault of course ).

But Mixed Insulins like Humalog Mix 25 are only intended to be starter regimes for Type 2s ( they are inappropriate for T1s) meant to last a few years.

The insulin you have been on - Humalog Lispro - is said to be the insulin that most approaches the natural human insulin because of its pharmacodynamics and pharmacokinetic properties.

You need to discuss all the options with a proper medical team. Going on to Humalog Mix 25 might be a retrograde step now. Why not ask about keeping the Lispro and adding a long acting insulin like Levemir or Lantus ?
A proper basal/bolus regime like that would probably be better if you are low carbing because you can try to match and adjust insulin more closely to carb intake than on a mix. It might be difficult to get the ratios right if you are low carbing but injecting fixed dollops of unadjustable mixed insulin.

Although as a Type 2 they might want to push you off the top quality modern insulins onto the old, cheap models such as Humalin S and Humalin I.

Have you been on a course ? You should ask to go an "X-Pert Patient Diabetes" course to update on insulin and carb ratios.

Big mistake!

I'm sorry, I don't see why this mistake is beachbags fault, even partly. Yes, she's been off the radar for a while, but I'm not surprised. - wouldn't it knock you off target if, for some reason, you couldn't get your BG. To behave, no matter how hard you tried. She's right. This is the second mistake the surgery have made with her in the last couple of months and the other had a serious impact as well. - The same surgery also screwed up with me in the last month, due to arrogance. (A matter not connected to diabetes) The doctor thought he knew what was going on and didn't feel the need to read my file. The only reason I'm still there is that another doctor stepped in. How many other mistakes are they making??

Doctors are, to be fair, overloaded with targets and dealing with huge patient numbers but they are starting to treat us like numbers, instead of patients. Surely this isn't our fault?

Re: Big mistake!

I think this is the type of medication error where there should be an incident form filled in, when you see the practice manager ask her. The incident then has to be properly investigated with recommendations made as to how this won't happen again. At least it is then on file for the next time the practise fails someone

Re: Big mistake!

I noticed the comment about having to pay to see your medical notes - while some surgeries may try to make you pay they have no right to do so, the information contained is your personal data and as such you have a statutory right to see it. If they give you grief use a freedom of information request.

This was discussed at my eXpert meeting a couple of months ago and the presenter was livid when she heard some surgeries were trying to charge, she sorted it out pretty quickly for the attendees who were being charged.

Re: Big mistake!

Hi. As others have said I would suggest you might want to change over to a Basal/Bolus regime; I'm on Levemir and NovoRapid. It gives you total flexibility and you can vary the Bolus (Rapid) to match the carbs you are having at the meal. An insulin mix is best as a starter regime or for those who want to minimise the number of injections or who have fairly fixed carbs. Think about your own lifestyle and then discuss insulin options with the docs.

I think charges for medical notes is based upon how far back you want to go..

Copied from nhs uk

The fee to get a permanent copy of your health records will be different depending on how the information is stored. The maximum charges are:
£10 for records that are only held on computer
£50 for records that are only held manually, for example, paper records such as letters or hand-written clinical notes, or images such as X-ray film
£50 for records that are held partly on computer and partly manually (e.g. paper)
By law, you're entitled to receive a response no later than 40 days after your application is received and any relevant fee has been paid.
If the records you want are held manually, or partly manually and partly on a computer, and have been created or added to during the 40 days preceding the request; you can request a copy of the preceding 40 days of the health record free of charge.

Re: Big mistake!

Paper record I can understand a charge for, but computer records £10 i can live with if there a lot of printing involved, but some people in my area have been charged £25 just get a copy of their latest blood test details and that stinks. My doctor just prints them straight off and hands them over, no charge at all.

Re: Big mistake!

Beachbag said:

I've been hiding under the radar for a couple of years but have recently come to my senses and am making an effort to regain control of my T2ID by using Low Carb diet. Today I had an appointment with the consultant endocrinologist at a local hospital which has thrown up the fact that for the last three years I have been prescribed the wrong insulin!.... not by him, but by a GP at my health centre who wrongly read the change in the prescription. I've been injecting humalog lispro twice a day instead of a humalog mix! I am very angry especially as when I went to the surgery to get a new script a) the receptionist said it will take two days and b) said that after three years there was no record of who prescribed the wrong insulin. Little wonder I have been having problems. However the dietician, whilst not being in total agreement with my low carb diet offered a compromise. An increase from 30g up to about 90g per day. I will go with that, at least until my insulin is sorted. I'm now on humalog mix but may swap later. Comments and advice will be most welcome, please!
Geri

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Hi Geri

What has happened to you over the wrong insulin being prescribed is common, Lilly should re name Humalog Mix 25 or 50 to being another name then there would be no mistake made by doctors. Its very easy to mistake the word Lispro to mean the bolus version instead of the mixed.

You should find using the mixed insulin much better than just using the bolus to control the bg levels with the food that you eat. If you tend to eat the same breakfast every morning, the same lunch (a sandwich for example) the amount of carb eaten in the evening can be dealt with an increase in the eve dose of mixed insulin so if for example the usual eve dose of mixed insulin will allow you to eat 40g carb and you want to eat 50 or 60g, you can increase the eve dose up a tiny bit or if you want to leave the eve dose alone, you can simply give 1 or 2u of the bolus to add a bit more punch to the mixed. The only thing I would stress on is that when going to bed unless bg levels are up on 10mmol, then eat a carb snack to prevent bg levels falling in the early hours of the morning, but testing bg levels in the night will help guide you on what to do for the best. My bg levels rapidly dropped but yours might not............

Don't move to bolus/basal unless you get some guidance on how to adjust the bolus insulin using a ratio and you will also need to prepare yourself for a lot of bg tests.

Re: Big mistake!

Going on to Humalog Mix 25 might be a retrograde step now.

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No, it would be a step forward: T2s are usually started on basal insulin, so getting her an appropriate insulin (either on its own or mixed or as part of basal/bolus regime) is better than bolus insulin only which is not appropriate for anyone.

Is it really partly my fault?.

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So you have an insulin passport (your consultant should have completed one for you)?

However, one could argue that since you should have been taught to check your insulin prior to injecting (mixed insulin looks cloudy, lispro does not and they have different names) that you are partly to blame - I.e. your doctor is responsible for giving you the wrong prescription but ideally it should have been caught sooner.

The above mentioned insulin passport is supposed to be an extra layer to prevent presciption/dispensing errors by having the pharmacist check the passport as well (I'm not too confident that it will actually do anything unless they make it mandatory - if you remember to bring the passport every time you pick up a presciption then you can also remember what insulin you should be getting)

Re: Big mistake!

I was started on just Basal but after a few weeks the DN and I agreed to add Bolus as well. I've never heard of anyone being on just Bolus as you always need background insulin if your pancreas isn't up to scratch. ? I find Basal/Bolus a doddle. Getting the ratio right took a few days and it's always a bit of guesswork anyway for some meals where you don't know the carbs. My blood sugar tends to be fairly predictable as well so I'm lucky in that respect.

Re: Big mistake!

Medical negligence is very serious no matter how small, it should not be brushed under the carpet by anyone.
Also you should not take any blame yourself for any errors.
I would ask to see the Practice Manager immediately as you are going to seek legal advice on the strength of what you have recently discovered.
(legal advice is really what you should be getting)

best of luck

Roy,

Re: Big mistake!

Hi Geri

The thing with adjusting the carb with the insulin is that no one is able to know exactly what amount of carb can be eaten at a certain time and the effect it will have on bg levels until the person has injected the insulin and eaten the carb and tested their bg levels to find out..... so lots of trial and error will be made along the way and you will know tomorrow morning that eating the amount of carb that the dietician advised for breakfast with the doseage of insulin, hasn't had the desired effect so you will need to adjust a bit more and eat less. There's an awful lot to be said for eating the 'little and often' way with diabetes as that usually gives the best bg control in my opinion. Nothing wrong with eating a lower carb breakfast like a piece of toast and then eating a biscuit mid morning without the bolus as the mixed insulin takes a little while before it reaches its full bg lowering ability so the need to adjust the carb to the action of the insulin but once you have been able to work out exactly how much carb you can eat, you should be able to have a good life. When I used Humalog Mix 25, I just had 1 Weetabix with milk or 1 piece of toast for breakfast and then by testing mid morning I was then able to eat a biscuit otherwise if I didn't eat mid morning and didn't test either, chances are that I would be going towards hypo levels around 11.30am. If I had 2 Weetabix with milk at breakfast, my bg levels would go too high by mid morning (up to above 12mmol) and so didn't eat again until lunchtime but by altering the carb, I was able to be about 8mmol mid morning and also be able to eat the biscuit because of the action of the mixed insulin.

Alex has raised a good point about the insulin passport but many diabetics don't use it or know about it and whats more many pharmacists don't use it either. The real culprit here is Elly Lilly and the fact that two insulins are produced with more or less the same name. When I used Humalog Mix 25, I got it in a pre filled disposable plastic pen but the insulin itself was crystal clear. The Humalog bolus was supplied in cartridges and went in a Lilly silver metal insulin pen but again was crystal clear. Not sure if Lilly has now addressed the problem by making the mixed insulin cloudy????????? It was only that I had my wits about me that I knew what insulin was what and I didn't make a mistake....

You'll be fine with twice daily so give it time before you decide to change to doing bolus basal with a lot more injections..

Re: Big mistake!

Hi iHs,
Many thanks for the detail on mixed insulin. Humalog Mix 25 is what I am on since end October 2013 and I feel that I now have a greater understanding of how it works. After 50g porridge i usually spike at 18ish 2 hours later, I now know why. Less for breakfast and then test . . . .
Again, many thanks