“I Just Injected 46 Units of the Wrong Insulin!”

I have lived with type 2 diabetes for thirteen years, and I know very well howto take care of myself. In fact, I have it down to a routine. The flaw of aroutine activity, however, is that it is so very routine: you go through themotions without thinking. And that, as I learned to my deep chagrin, can bedangerous.

On a recent speaking trip, I was just about to step into the shower when Iremembered that it was time for my Lantus injection. No problem-I stepped awayfrom the shower, prepared the dose, and injected the insulin. As soon as thedeed was done, however, dismay overwhelmed me. I had grabbed the wrong insulinand had just injected 46 units of rapid-acting Apidra instead of slow-releaseLantus. And I was alone in my hotel room, stark naked.

My experience as a diabetes trainer kicked into overdrive as I yanked everythingout of the mini-fridge, desperately counting the carbohydrates available tocounter the quick-acting Apidra. The procedure I teach to treat hypoglycemia(low blood sugar) is to eat fifteen grams of fast-acting carbohydrates, waitfifteen minutes, and then check your blood sugar level. This process shouldcontinue until your blood sugar is over 70 mg/dl. But because I did not knowhow low my blood sugar would plummet on 46 units of Apidra, my overridingthought was to stuff down as many simple carbohydrates as I could, as fast as Icould.

That night, thankfully, the mini-fridge was uncharacteristically full. I sweptup two pieces of leftover bread, two small bunches of grapes, crackers, and areal Coke, in addition to my usual glucose tablets and orange juice. One part ofmy brain began methodically counting the carbohydrates that I was ingesting: thirty-three grams from the orange juice, twenty from the bread, twelve from theglucose tablets.

The other part of my brain was churning with thoughts ofgetting help. Since I was traveling with friends who have diabetes, I made ahasty phone call: "Paula, I just injected 46 units of Apidra! Call Susan andcome quickly!" Without waiting for a reply, I began to guzzle the Coke as Itried to pull on my clothes. I haven't drunk a real Coke in fifteen years, butmy need for sugar overrode any misgivings about the taste.

There I was, drinking, dressing, and running around to collect my cell phone,room key, and wallet in case we decided to go to the emergency room. I was even"with it" enough to prop open the room door so that my friends could reach me ifI became unable to open the door. Within fifteen minutes, they rushed in loadedwith more quick sugar goodies. Piling the food on the desk, Susan said, "Don'tworry, we're going to see you through this. How many carbs have you eaten? What was your last blood sugar reading? We'll take it every fifteen to twentyminutes so we'll know what's happening."

My reading just before the ill-fated injection had been 107, but that had been25 minutes ago, before the 46 units of Apidra and the 130 grams of carbohydratesI'd stuffed down in the form of juice, fruit, sodas, and cookies. I did a fingerstick test, and my result was 124. We decided to follow our training forhypoglycemia, writing down my finger stick reading every twenty minutes andrecording the carbohydrates I had eaten, until we were sure that the Apidra wasout of my system. Because Apidra acts within an hour and is out of the systemwithin four hours, we knew we had awhile to go.

Paula called 911 as soon as she saw me. The 911 dispatcher told Paula to callthe Poison Control Center, and the consensus of both dispatchers was "Go to theER!" Forty-five minutes after I had taken the Apidra, a violent trembling beganin the center of my body, and my arms and legs began to twitch and jerk soviolently that I had to sit down abruptly. As the trembling increased, I felt myfirst twinge of fear and agreed that the ER was the place to be.

A hotel staff person drove us to the hospital. Because the Poison Control Centerhad alerted the hospital, the ER staff admitted me to a room immediately. Thenthey gave me more food and did a finger stick test. My blood sugar was up to142, but, still fearing hypoglycemia, I drank more apple juice and ate the RiceKrispy treats they brought me. My total carb count was now close to 180 grams. Susan stayed with me, and throughout the next four hours, we checked my bloodsugar every twenty minutes.

The results were reassuring, as my blood sugarlevel continued to rise in response to the carbohydrates I had eaten. At 3:15am, a lab tech drew blood to see if the Apidra was out of my system, and I stuckmy finger for the fifteenth and final time. Both finger stick and lab workshowed a blood sugar level of 119. Utterly amazing! Susan had weathered thestorm with me. We could return to the hotel, tired but wiser, and sleep for afew hours before starting our busy day.

For many people with diabetes, injecting two types of insulin is a dailyrequirement. Because the routine is so familiar, we sometimes do it withoutthinking, and that, as I learned the hard way, can lead to dire error. Here arefour tips to prevent an insulin mistake from happening to you:

  1. Use a syringe and vial for your long-acting insulin and an insulin pen for your rapid-acting insulin.
  2. Use color to distinguish the insulins by putting a different-colored tape around each vial or insulin pen.
  3. Keep your insulins in separate places on the kitchen counter or in the refrigerator. That way you won't accidentally pick up the wrong insulin.
  4. Stop, think, and then act. Being in a hurry or relying on a thoughtless routine may cause a serious mistake.

While I certainly don't want to go through such an ordeal ever again, I didlearn three powerful lessons: I can act effectively in a diabetes emergency;patient education is invaluable; and friendship is priceless. May you neverencounter the same situation, but if you do, remember: keep your head, call forhelp, and follow the protocol.

Editor's Note: We hear of this happening often, and we don't think that suchevents are documented sufficiently. If a mix-up in your insulin has happened toyou, please let us know. And for other stories on the same subject, see "My Insulin Overdose" and "Insulin Overdose: A Mom Accidentally Gives Way Too Much Insulin To Her Son".

6 thoughts on ““I Just Injected 46 Units of the Wrong Insulin!””

  1. I was on my way to get the tub and I realized It was time to take my Insulin I’m supposed to take 10 units but I took 50 units of my Humalog. I’m trying not PANIC what should I do?

  2. Just happened to me too.. took 24 Apidra in place of lantus, I mistaken the insulin bottles from the fridge cause my Lantus just run out, I have two different pen systems for the insulins, the ClickStar for Lantus and Autopen 24 for Apidra.

    Happened once before two years ago but that was just about half of year after I got diagnosed with t1d, at that point I was taking just 12 units of Lantus.

    Now it was a bit different, I realised that I took the wrong insulin just when I started feeling the hypo and didn’t know why. But started eating a lot of sugars and now seems fine, it passed 4 hours allready, I even fall a sleep for two hours and my bs are at 4. Added some more sugars so I prevent some late lows, but sure I don’t want to eat sweets for long time from now!!😧

  3. I was going to watch a little TV before going to sleep I was wanting to wait up on my husband to get home from work. I grabbed my Lantus and took it in to the bedroom so I wouldn’t forget to take it before falling asleep. After getting all comfy in bed I thought I should just go ahead and take my Lantus. I take 50 units of Lantus at bed time and 8 units of Novalog with meals. My Blood sugar before going to bed was 136 so I get my Lantus pen dial up 50 units and inject it…… as soon as I withdrew the pin I knew something was wrong, I had just opened that Lantus pin the night before there shouldn’t be much used out of it but the pin was almost all empty. OMG what have I done? That’s my Novalog pin I told myself. I had just injected myself with 50 units of fast acting insulin. I’ve never did anything like that before I was freaking out. I knew this wasn’t good I knew I had to do something and do it quick. I ran to the computer and typed in “I took to much Novalog what do I do?” The first thing I read was call 911. I called my husband he didn’t answer I sent a text ” I need to get to the ER NOW” . I started getting dressed. While I was dressing my husband called I told him what had happened and to hurry I needed him to take me to the ER. I knew I needed to eat or drink something with a lot of sugar. I am a low carb eater and sugar wasn’t something I kept in the house and just then I remember seeing a can of real Coke in the refrigerator that my husband must had bought. I ran in and grabbed it popped it open and starting drinking. My husband arrived home a few minutes later we went to the ER where I spent the next 6 hours getting my finger stuck every 15-30 minutes and drinking sugary drinks and eating chocolate trying to keep my sugar from going to low so the doctor wouldn’t order an IV and keep me there over night. That was a real scar for me and I learned a lot from that mistake and I plan to never make that one again.

  4. Was glad to find this. I just injected 35u of Humalog (rapid) instead of Lantus. Luckily(??) my sugar was over 300 (:-x) so I ate a yogurt and am playing wait and see.

    I’m thinking it was serendipity that my father bought me ‘real’ Pepsi instead of the diet that I requested.

  5. This is exactly what I just did. 46 units of Novalog instead of Lantus. I realized as soon as I went to put my pen back in my case. After a few moments of panic, I downed 8 glucose tablets. My blood sugar was only a 95 to start with. I went down stairs and realized I’ve done a darn good job of getting rid of the stuff that is full of sugar, especially liquid sugar. I ate some leftover mashed potatoes, chicken nuggets, more glucose tablets, a mouthful of honey, a cracker with jelly on it, orange juice and sweet iced tea. I had already had a big dinner with my family earlier in the night so I was pretty full to start with. I got my blood sugar up into the 160s and then it went back into the 150s, and now, 2 and a half hours later it’s back in the 160s. I am checking every 30 minutes. I have a pretty loud timer set on my phone because I was ready to go to sleep at 10:00 and now it’s 1:30. I’m so tired, but I think I’m ok. I’ll keep checking every half hour until around 3:00. Boy am I gonna need a nap tomorrow. I think the fact that I started downing carbs and those fast acting glucose tablets immediately after the injection was a big help. I never even got shakey. I just made myself keep downing juice and sweet iced tea.

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