Search

Background. Inpatient diabetes treatment has become more complicated recently with the introduction of new insulin formulations and a new emphasis on tight blood glucose control. Insufficient knowledge of insulin contributes to errors in its use that may cause adverse patient outcomes. Methods. Seventy-three faculty members, 113 residents, and 191 nurses from four hospitals completed a 20-item multiple-choice questionnaire that assessed knowledge of insulin nomenclature and characteristics and inpatient insulin use. Results. The percentage of knowledge-based questions answered correctly was low: 51% for faculty, 59% for house staff, and 47% for nurses. Scores on questions testing knowledge of insulin nomenclature and characteristics were similar to scores on those addressing inpatient insulin use among faculty and house staff; however, nurses scored better on the former than the latter (60 vs. 34%, P < 0.0001). Knowledge of names and characteristics of newer insulins, such as glargine, aspart, and lispro, was poor compared to knowledge of older insulin formulations among all professional categories (46 vs. 78%, P < 0.0001). House staff performed better than faculty (62 vs. 49%, P = 0.09) and nurses (62 vs. 34%, P < 0.0001) on questions regarding inpatient diabetes management, but all groups frequently missed questions involving sliding-scale insulin use and dosing insulin in patients with type 1 diabetes. Conclusion. Educational programs teaching insulin characteristics and inpatient diabetes management are needed for all categories of health care providers. Increased knowledge may help to improve patient safety in the hospital.

Exenatide is a synthetic peptide that belongs to a new class of antidiabetes agents known as incretin mimetics. Like the endogenous incretin hormone glucagon-like peptide 1 (GLP-1), exenatide effectively lowers blood glucose levels by stimulating insulin release, inhibiting glucagon secretion, and delaying gastric emptying. Nausea and vomiting are the most common adverse reactions, which lead to discontinuation in as many as 14% of patients in one study (1). We report on four patients (three male and one female; age 52–73 years) with exenatide-associated renal failure who presented with nausea, vomiting, or decreased fluid intake. All patients had type 2 diabetes with or without mild microalbuminuria and hypertension. They were taking …