The Pharmaceutical Journal
Vol 269 No 7228 p845
14 December 2002

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Letters to the Editor

Pharmacy practice

A suggestion for insulin labelling dilemma

From Mr G. A. Miller, MRPharmS

I read with great interest the letter from Neil Caldwell (PJ, 23 November, p742), discussing the dilemma of labelling dispensed insulin preparations. This is an area that the pharmacy department at the Hammersmith Hospitals NHS Trust has recently addressed.

Following discussions with other members of the multidisciplinary health care team and taking into account the product licences of the various preparations, the directions on the pharmacy labels have been amended for the different types of insulin.

The pharmacy labels for long-acting insulins (eg Insulatard) read "Inject the required dose by subcutaneous injection 20 to 30 minutes before food as directed." The term food has been used rather than meals, as this type of insulin may be administered at night before a small snack.

For the short and intermediate acting insulins (eg, Actrapid, Mixtards, Humulins) the label reads "Inject the required dose by subcutaneous injection 20 to 30 minutes before meals as directed."

The "rapid-acting" insulins (eg Novorapid, Humalog, NovoMix and Humalog Mix) are labelled "Inject the required dose by subcutaneous injection immediately before meals as directed." This group of insulins can also be administered shortly after meals. However, to avoid misinterpretation by the patient this has been omitted from the label, and patients are instead counselled on this point.

Insulin requirements for individual patients frequently change, so the number of units to be administered has been omitted from the label. The diabetes nurses at our trust provide patients with a blood glucose monitoring diary, writing the current insulin dosage in this diary. When insulin dosages are altered, this is documented in the diary so that the patient has an updated written record, and the pharmacy label is still applicable because the original dosage has not been stated on the label.

Changing the pharmacy labels for all insulins to include the optimal timing for administration, but not the current dosage, appeared to be the best way around the labelling dilemma for insulins, without causing unnecessary confusion to the patient.

Gavin Miller
Medicines Management Pharmacist
Hammersmith Hospital NHS Trust

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