By now you may be aware that a common insulin regimen is to take one type of insulin for mealtime (bolus) dosing and another for baseline, all-day insulin needs (basal). The communications professional in me says that before taking another step forward, the industry should adopt a new name for at least one of these to avoid confusion. For the sake of teachers and other caregivers we should be using a more universally-meaningful term than “bolus” for the mealtime dose. I don’t have a suggestion, I just hope that those already in the field are communicating effectively.

In our experience the daily basal dose of long lasting insulin is about twice the bolus, mealtime dose. This creates a dangerous situation, particularly if you use “pen” injectors that have a “dial” to scale the dose. Simply put, if you pick up the bolus insulin pen and give yourself the volume of insulin prescribed for your basal dose, it could be fatal. Folks experienced with diabetes usually catch themselves as their blood glucose falls to dangerous levels, but if the dose was a bedtime dose, you may not be conscious-enough to be sensitive to the low.

In describing this situation to others, they propose pens that are color-coded. This is a great step, and I’d like to see standards for this coloring. The people who propose mere color-coding, however are not as absent-minded as I can be. I have another concrete suggestion.

Not all of the liquid one injects is insulin. Most of it is a suspension solution, and the insulin itself tends to be available in so-called U-100, U-200 and U-500 concentrations, My suggestion is that rather than take twice the volume of the basal insulin, it be simply prescribed at twice the concentration, and the pen dial labeled arbitrarily rather than by actual units of insulin. The goal would be for each of the the pens to be dialed up to a much more similar number each time one injects, and giving yourself the numerical volume of either insulin in the other’s dosage isn’t nearly so dangerous. Alternately, one class of pens could be labeled in numbers and the other in letters, or some other way so that the prescribed dose of one pen simply can’t be fulfilled by the mechanism of the other. Judging by how much pricier pens are than vials, much of the prescription price must be going toward the patented mechanism, itself, so there should be plenty of motivation to improve the situation by some means! I’d be glad to hear your thoughts, as well. In the mean time, be careful!