Monday, August 21, 2006


I got one of my pharmacology books in the mail today. What I always do with new medical textbooks is look up the sections on diabetes and insulin. This book has a lot on insulin, but the content is strangly disappointing.

The section on dosing insulin focuses a lot on mixing insulin. It also mentions Humalog and Lantus as the 2 newest types of insulin. This book was published in 2004, so I realize Apidra and Levemir weren't out yet, but Novolog was. And while it mentions Lantus, it fails to mention Lantus can't be mixed with other insulins. It also shows pictures of pork and bovine insulin, and L and UL- none of which are used in the US anymore. It says Lantus is only availible in a pen. Not only is that not true, but the Lantus pen is new since this book was published!

It doesn't mention a thing about dosing insulin on carbs or blood sugars, only set doses (ie, give 25 units with dinner). It doesn't even mention sliding scales. It does however say that premixed insulins are "popular for the client with diabetes." Oh yes, everyone loves those mixes!

The book continues to say that Humalin is the only brand of Human insulin (has anyone informed Novo Nordisk of this?). It mentions Exubra but calls it an "inranasal insulin." Nope, I have never seen it being squirted up peoples noses.

it has three paragraphs on pumping, which is a tri-fold improvement over last year's nursing book. In those three paragraphs they manage to say that implanted pumps are availible (where?), that R is the only type of insulin used in pumps, and that testing once daily is a minimum when on the pump. ONCE DAILY?!?! Don't tell my insurance. I will give the book credit for explaining basal/bolus use in the pump, and saying a huge advantage is multiple basal rates. But still... It shows a picture of a MiniMed 508.

So, next time you are in the hospital, and wondering how the hell they manage to keep any diabetic alive. Don't blame the nurses- blame the textbooks.


Caro said...

Absolutely! And not even just the textbooks, since they can go out of date rapidly between editions, but the journals and CME/CPD articles and course that do anything but keep anyone up-to-date. Some of the examples you post here are truly shocking. There is a total lack of appropriate information out there, and everyone suffers as a result.

Incidentally, though, implanted pumps are in use in several individuals in France!

George said...

My cousin is a Nurse and she had no idea about what all went into living the "D-Life" with a pump. She was amazed at how much she didn't know. Now i know why! So Scary!

Johnboy said...

That's just wrong. Do these books not have fact-checking editors? I hope you are able to learn something.

Scott K. Johnson said...

Wow - that is scary indeed.

Nicole P said...

Wow. I thought you might be kidding at first.

I had a nurse ask me if my pump was a massager. Yes, I said, it massages me to life. Jeez.

BetterCell said...

Many Healthcare Administrators and Educators including Physicians and Nurses within hospitals have a mind set to maintain the status quo, whereby no one has to think and information is passed along "like a habit". It is of course the responsibility of educators in Medical and Nursing Schools to teach what is relevant and up-to-date. Your experience is further proof, that we as persons with Diabetes are our own best Doctors......if we want to be.

mhunt83471 said...

Heads up! You should all be investigating rDNA insulins.