Abstract 129: Errors in insulin administration descriptive study of a common problem

Background: Proper insulin administration technique plays an important role in achieving optimal glycaemic control. Errors in administration can lead to both hypoglycaemia and hyperglycaemia related problems. Objective: To identify the common errors in insulin administration and to associate it with glycaemic control, hypoglycaemic events and relation to insulin injection site complications. Methods: Cross sectional descriptive study was conducted among 100 diabetic patients attending the Endocrinology OPD of a tertiary care hospital over a period of 1 month. A structured and detailed questionnaire was prepared to collect data on patient profile, laboratory parameters and practices of insulin administration. Data was analysed using SAS ODA software. Results: There were a total of 100 patients. There were 50 men and 50 were above the age of 60 years. Mean HbA1c was 8.86 ± 1.84. Fourteen common errors in insulin administration were enquired for in each subject. Most of our patients were well aware of the cold chain (98%) but 55% did not check the expiry date before buying insulin. Though 95% stored insulin correctly 39% were not aware of how to carry insulin while travelling. Insulin was injected into the wrong site (41%) and 84 did not rotate the injection site resulting in injection site complications (40%). Skin fold was not pinched up appropriately by 76 and the wrong angle of injection was used by 58% of our subjects. Insulin syringes and needles were inappropriately recapped by 85% of our patients. 64% of patients did not change insulin syringes / needles at healthy intervals. There were 20 patients who experienced hypoglycemia but severe hypoglycemia was seen in only 4 subjects. There was no difference in the error rates with respect to gender, age or duration of diabetes. Errors being so ubiquitous we were not able to establish any meaningful association with HbA1c levels. Conclusion: Insulin administration is a sure way of controlling hyperglycemia. However inappropriate techniques of insulin administration and storage can negate the glucose lowering efficacy of the drug. Insulin errors are to be looked for and tackled carefully in order to achieve optimal glycemic control.