Humalog, Humulin and Human Error

The use of Humalog with Eli Lilly’s Humulin has created some confusion – especially among the elderly – over the similarities in appearance between the two insulins.

According to a recent newsletter titled Insulin Oversight, published by the United States Pharmacopeial Convention (USP), a federally funded FDA program, mix-ups over Humalog and Humulin have become common.

The two names may seem a world apart to some, but to many there are enough similarities to cause problems. Both begin with h-u-m, have three syllables and contain the letter l in the third syllable. In addition, the products are available in 10 ml vials that are the same size and shape, their labels carry identical logos, and the label information is printed in the same style and color.

What Can You Do?

When notified of the insulin mix-ups, Eli Lilly representative, Laura Stallman commented, “customer services has received some calls, however a review of our safety database did not reveal any reports of adverse events related to the mix-ups.”

However, Stallman says that Eli Lilly is working with the FDA to make insulin bottle changes in order to help older patients and the visually impaired. These changes will not be phased in until sometime in 1998.

In the meantime, the USP recommends these helpful hints to avoid insulin error:

  • Make sure you use the proper insulin syringes to measure your doses.
  • Make sure you can read the calibrated markings on the insulin syringes.
  • Be sure that you understand your insulin regimen – keep a written copy of your regimen with you at all times.
  • Store various insulin preparations in separate sections of the refrigerator. This will reduce the risk of taking the wrong one.

For Humalog Only

  • Remember that Humalog is a clear solution, while the longer acting insulins (except Regular) are cloudy.
  • Be aware of the different color of the crimp and cap on the Humalog vials (magenta). Also, attaching a bright sticker or an elastic band to the Humalog vials makes it easier to distinguish them from others.

Abstracted from USP Quality Review issue number 58. ©1997 US Pharmacopeia. Permission granted.

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