Safety considerations for insulin use

Use of insulin in hospitals is prone to errors, which can cause significant adverse effects. When prescribing insulin to a hospitalised patient, precautions must be taken to avoid inadvertent overdose. For example, when prescribing insulin always write the dose as ‘units’; abbreviation as ‘U’ has been interpreted as ‘0’ resulting in ten-fold overdoses of insulin. Ensure the correct formulation and strength of insulin are used; for insulin formulations, see Action profiles of insulin formulations.

Do not give rapid- or short-acting insulin doses according to predefined blood glucose concentrations (‘sliding scale’) without basal insulin. Sliding scale insulin regimens used in isolation are associated with pronounced fluctuations in blood glucose concentrations and are prone to causing both significant hyperglycaemia and hypoglycaemia.

Injector pen devices used with standard pen needles pose a risk of needlestick injury if insulin is administered by another person (eg healthcare worker). If the patient cannot safely self-inject, see Specific considerations when insulin is not self-administered for advice.