To print: Select File and then Print from your browser's menu
How to Avoid Errors in Diabetes Care
Medical errors generally make the news only when they are particularly dramatic — the wrong leg is amputated, for example — or tragic — someone dies. But less sensational errors take place every day in numerous settings. Some errors happen in hospitals, some in doctors’ offices, some in pharmacies, and some in people’s homes, when, for example, two drugs are mixed up or a dose is forgotten.
With all of the steps involved in diabetes care, it is perhaps no surprise that about 80% of people with diabetes experience at least one error in their diabetes care over the course of any one year. Knowing about some of the most common sorts of errors in diabetes care can help you learn to avoid them.
Avoiding incomplete care
To get a very good idea of whether you are doing all you can do to prevent a heart attack or stroke, ask your doctor the following questions at your next visit:
If you are able to achieve the recommended goals for blood glucose, blood pressure, blood cholesterol, and smoking cessation and to maintain those goals over a period of five or more years, you can slice your risk of heart attack or stroke by more than half and very likely add several extra “good” years to your life. If you are not currently meeting these goals, ask your doctor what else can be done to lower your risk of heart attack and stroke.
Avoiding medication errors Many medicines can be used to help control blood glucose levels, but not all are appropriate or safe for everyone with diabetes. In fact, it is estimated that about 10% of people with diabetes are on a medicine that may not be the safest choice for them. The table “Avoiding Medication Mistakes” gives some safety guidelines for choosing which drugs to take. Because so many treatment options are now available, and because so many drugs and other substances can interact with one another, it is important that you and your doctor pick out the medicines that are best for you.
To do your part in avoiding medication errors, do the following:
To learn more about the medicines you take, read the information sheets given out with prescriptions by your pharmacist, or talk to your doctor, nurse, or diabetes educator about your medicines. Web sites such as www.webmd.com and www.diabetes.org also offer reliable drug information.
Remember, however, that the information you find on any Web site or book is general information, and that you are an individual with your own personal needs and response to medicines. So talk over what you learn, and your questions, with your doctor.
Even when your blood glucose, blood pressure, and blood cholesterol are at goal levels, you should have regular (annual or as recommended by your health-care provider) eye exams, foot exams, and tests for microalbuminuria (traces of protein in the urine that signal a higher risk for kidney and heart disease) to check for the presence of diabetes complications. When caught early, diabetes complications are much more treatable.
One often-dreaded change to a person’s Type 2 diabetes regimen is the advice to start using insulin. The specific source of dread may be different for different people. Some people, for example, fear needles, while others equate insulin use with more severe disease or fear that the use of insulin may actually lead to complications rather than prevent them. Whatever the cause for resistance, the facts are that many if not most people with Type 2 diabetes eventually require insulin and that the use of insulin can lead to improved control and better quality of life.
Optimal diabetes care typically involves frequent adjustments to your regimen for blood glucose, blood pressure, and blood cholesterol control. If your doctor has not adjusted your medicines or doses recently, ask him to review your medicines with a view to keeping you in good control.
As many tried-and-true medicines go generic, updating your drugs may save you money. Review them with your doctor or pharmacist with a view to lowering costs, and consider using combination tablets that contain more than one drug to reduce your co-pays and the number of pills you take each day. Often, it is both cheaper and safer to use older, proven medicines than to use brand-new ones.
Avoiding insulin errors
Many people who take insulin use more than one type (usually a long-acting insulin and a rapid-acting one), and it’s possible to confuse the two types of insulin and take the wrong one at the wrong time. There are a number of ways to avoid such a mix-up:
Ignoring symptoms of hypoglycemia, on the other hand, can be extremely dangerous, particularly if they occur while you are driving. In that situation, you not only endanger your own life and that of any passengers in your vehicle, but also that of other motorists.
The take-home message is this: If you think your blood glucose level is low, address the problem promptly. Stop what you’re doing, check your blood glucose level with your meter, and have a snack if necessary, even if you have to stop your car or interrupt a conversation to do it. (If you don’t have your meter with you or can’t use it for any reason, go ahead and treat your symptoms of hypoglycemia without checking your blood glucose level first.) Chew and swallow four glucose tablets (containing about 4 grams of carbohydrate each) or drink about 5 ounces of orange juice or a regular (not diet) soft drink. Taking glucose tablets is a good way to treat low blood glucose because it helps you to avoid overtreating.
Sometimes, when people have had consistently higher-than-normal blood glucose levels for a long time, they feel symptoms of low blood glucose when their blood glucose level starts to approach normal. For example, a person who has an average blood glucose level of 200 mg/dl might start to feel symptoms of low blood glucose when his blood glucose level approaches 100 mg/dl. This person is not at risk for serious hypoglycemia. The way to know the difference between a potentially serious low blood glucose level and a false perception of low blood glucose is to check your blood glucose with your meter when you first feel the symptoms. However, as stated earlier, if you are not in a position to check your blood glucose level with your meter, the safest response is to assume it is low and treat it promptly.
Severe hypoglycemia is usually defined as a low blood glucose level that you must have assistance to treat (because, for example, you are too confused to eat or have lost consciousness). If you have ever experienced severe hypoglycemia, it is a good idea to have an emergency glucagon kit in your home or workplace (or both). A friend or family member can learn to give you a life-saving shot of glucagon in case you cannot eat or drink to raise your blood glucose level. However, if neither you nor a companion can deal with your low blood glucose level, instruct your companion to call 911. Paramedics can inject a glucose solution that immediately fixes the problem.
It is a good idea for anyone with diabetes to wear a medical identification bracelet indicating that he has diabetes, just in case he is ever unable to speak for himself.
Avoiding monitoring errors
To provide you with all of this information, however, your meter needs to be in good working order, and you need to know how to use it correctly. Here are some questions to ask yourself to help determine whether you’re using your meter correctly for the most accurate results:
If you have any questions about the correct use of your meter, check your instruction manual, call the meter company’s customer service number, or speak with your diabetes educator or another member of your diabetes care team. Your pharmacist may also be able to answer questions about the correct care and use of your meter.
How often and at what times of day you should check your blood glucose depends on many things, including what medicines you take, how much risk you have for developing hypoglycemia, and whether blood glucose information would be helpful to allow you to self-adjust your insulin doses. Many people who take multiple insulin shots (and their doctors) find that occasionally checking their blood glucose level about two hours after meals, in addition to before meals, can help them match their insulin doses to their eating habits and activity levels. Ideally, your blood glucose level two hours after a meal should be no more than 40 mg/dl higher than it was before the meal.
Some people check far more often than is necessary, while others don’t check often enough. Discuss with your health-care provider how often to check your blood glucose, when to check, and what to do with your results.
Avoiding errors in the hospital
Typically, nurses will check your blood glucose level for you about four times a day. You can participate in your in-hospital diabetes care by knowing what your readings are and by making sure your meals are designed to accommodate your diabetes control plan. If you feel too ill to speak up on your own behalf, ask a friend or family member to speak up for you.
If possible, talk to your doctor ahead of time about which medicines to continue taking and which to stop (and when) before you enter the hospital. If you are having surgery, it’s also a good idea to ask who will be in charge of your diabetes control while you are having surgery and recuperating from it.
If you are in the hospital to give birth, you may be able to retain control over your diabetes management tasks. Depending on the hospital’s rules, some women are able to continue using an insulin pump during their stay and to do their own blood glucose monitoring. It’s important to find out what’s allowed ahead of time, however, so you know what’s possible and what isn’t.
Your diabetes control plan may change after a serious illness, surgery, or childbirth. Before you leave the hospital, make sure you have in writing what your medicines and doses should be when you arrive home. If some of the medicines you were taking before hospitalization are not on the list, ask why. Also, ask your usual pharmacist to check your new combination of medicines for potential drug interactions or anything that you may be allergic to.
Communication is key
Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.