Monitoring the patient with diabetes mellitus--how to avoid medication errors

The hospital pharmacist is in a unique position to assist in the management and monitoring of the diabetic patient. He can alert the nurse and physician concerning medication errors involving the use of insulin and oral sulfonylureas. Medication errors may not only jeopardize the metabolic control of a person with diabetes but may also result in the development of significant hypoglycemia. Insulin orders should be written clearly and concisely. The advocation for intensive split-dose regimens and the use of insulin infusion devices require careful attention to technique, administration times and insulin doses. Inappropriate doses of insulin given to patients suffering from diabetic ketoacidosis may lead to significant morbidity. The hospital pharmacist must also carefully survey insulin orders for patients requiring hyperalimentation solutions and those persons requiring reduced caloric intake. The rational use of oral sulfonylureas requires a knowledge of potency differences and appropriate dosage adjustments in order to avoid hypoglycemic reactions.