Case Report| Volume 19, ISSUE 3, PB6, March 2018

Hypoglycemia in a Skilled Nursing Facility Resident

      Patients admitted to Skilled Nursing Facilities (SNF) for post-acute care often have complex medication regimens. Frequently the medication schedule is modified during prior hospitalization. SNF patients are vulnerable to adverse drug events (ADE) during these times of transition. Insulin is a medication that is frequently associated with ADE in SNFs. The increasing prevalence of obesity linked to insulin resistance in the United States has created the need to use larger doses of insulin. Since 1994 a Regular insulin U-500 vial, a concentrated form of regular insulin (500 units/ml), is available. The Institute for Safe Medication Practices has advocated for the development of a dedicated U-500 device since 2013. In July 2016 the FDA approved a dedicated syringe for the administration of U-500 insulin. This is now the only device approved for the use and administration of the U-500 insulin vial. Using the wrong delivery device or failure to use the correct conversion factor when using the traditional U-100 syringe can lead to catastrophic episodes of hypoglycemia.
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