Background: Severe hypertriglyceridemia (triglyceride >1000 mg/dl) occurs at a rate of 0.4% and is associated with a range of medical complications including severe pancreatitis and its complications like acute kidney injury . Hypertriglyceridemia (HTG) is the third most common cause of acute pancreatitis especially in levels above 1000 mg/dl. It has been suggested that insulin [...]

Background: COVID-19 has placed an unprecedented strain on healthcare systems worldwide, increasing demand for critical care beds1. To address shortage of critical care beds, innovative methods to increase capacity are needed. At our large, urban academic safety-net hospital, patients with diabetic ketoacidosis (DKA) are admitted to critical care units for intravenous (IV) insulin administration and [...]

Background: Over 8 million Americans with diabetes require insulin for disease management. Insulin is a high-risk medication with immense potential for harm. Transitions of care from the hospital to ambulatory settings are particularly prone to error. Studies have suggested a substantial number of insulin prescriptions at hospital discharge contain errors which can result in increased [...]

Background: Correctional insulin is frequently used in the hospital to optimize blood glucose levels before meals or even before bedtime. Dosages are not set and are instead scaled to the blood glucose level obtained just prior to administration. Insulin is considered a high-risk medication as dosing errors can potentially lead to serious adverse events such [...]

Background: At our urban, academic hospital, use of outdated protocols and unnecessary variations in the care of DKA patients treated with ICU requiring IV insulin protocols have led to multiple safety events, delays in care with associated increased costs, and overtreatment of hyperglycemia with ketosis frequently resulting in unnecessary ICU utilization. After multi-disciplinary stakeholder development [...]

Background: The use of IV insulin is one of the primary therapeutic options for the treatment of hyperkalemia. Unfortunately the available literature reports that hypoglycemia is a common occurrence as a result of the treatment of hyperkalemia. During our safety event review process, we identified the same issue within our own institution. Due to reports [...]

Background: Glucose management of hospitalized patients with hyperglycemia has many challenges. One of these challenges is the timing of insulin administration in coordination with meal delivery. The Endocrine Society recommends assessing glucose levels within 60 minutes of prandial insulin administration and that rapid-acting insulin should be administered 15 minutes before or immediately after a meal.1 [...]

Background: Insulin is the preferred agent to manage hyperglycemia in the hospital. However, it is considered a high alert medication due to risk of hypoglycemia and severity of adverse events. In our institution, three hospitals currently use an order for correctional insulin based on a formula, in which the nurse calculates the dosage using the [...]

Case Presentation: Insulin-derived amyloidosis (AIns) is a rare, iatrogenic localized dermatological condition associated with insulin injections that can be a missed diagnosis in those with poorly-controlled diabetes. A 53-year-old caucasian woman with a history of T1DM, Graves’ disease, and a thyroid nodule came to the clinic to establish care. The patient complained of painless, palpable [...]

Background: Diabetes is common, present in up to one third of hospitalized patients and up to 50% of critically ill patients. Studies have shown that hyperglycemia among hospitalized patients leads to worse clinical outcomes and increases readmission rates by over 30% relative to normo-glycemic patients. Insulin is the only medication recommended for treatment of diabetes [...]