The Pharmaceutical Journal
Vol 269 No 7225 p742
23 November 2002

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Letters to the Editor

Pharmacy practice

How should dispensed insulin preparations be labelled?

From Mr N. A. Caldwell, MRPharmS

How should insulin preparations ideally be labelled? For example, is it better to label soluble insulin, "Inject 14 units twice daily subcutaneously before meals, as directed", or simply, "Inject subcutaneously as directed"?

Within our hospital trust we supply inpatient insulin to wards without dosing instruction. We wait for the insulin dose to be "stabilised" and a discharge prescription order requested, before we retrieve the supply from the ward and relabel it with "full instructions," or supply a second lot of insulin with "full instructions." The accuracy of "full instructions" is, however, a moot point.

Insulin requirements for individual patients vary depending on diet, physical activity and general health. So while a patient normally takes 14 units twice daily, for a large meal at a restaurant they may increase their short acting preprandial boost to 20 units. Is there, therefore, any point labelling the insulin with the number of units to be injected if dosing varies?

In addition, when patients go home, the insulin dose required to achieve normoglycaemia may be quite different in the home setting compared with that required in the hospital Again, why then label with dose?

Although I am sympathetic to the call for good professional practice where we avoid ambiguous labelling, eg, "Take as directed", with insulin therapy is there any other way to communicate dosing information? Why fool ourselves into thinking we are providing an accurate service, when patients may ignore what is on the label, and do what the diabetes specialist team has trained them to do?

I would welcome comments from colleagues as to how they tackle this dilemma.

Neil Caldwell
Deputy Chief Pharmacist, Clinical Services,
Wirral Hospital NHS Trust
e-mail neil.caldwell@whnt.nhs.uk

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