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According to the Institute for Safe Medication Practices (ISMP), IV insulin is considered a “high-alert” medication, meaning that it bears a heightened risk of causing significant patient harm when used incorrectly.

In fact, in a 2014 ISMP survey, pharmacists and nurses ranked IV insulin as the No. 1 drug they were most concerned about out of 39 high-alert medications, directly above anticoagulants and chemotherapeutic agents.

Their concern is well-placed. Mistakes in IV insulin administration can be serious and sometimes deadly, leading to hyperglycemia, hypoglycemia, confusion, seizures, coma or death.

Hospitals take extensive precautions to reduce the risks, unfortunately, when it comes to IV insulin, the risks of harming a patient extend beyond making a mistake between prescription and titration.

Many preventable hypoglycemic incidents happen even when the insulin was titrated exactly according to prescription. It’s the prescription itself that can be unsafe when it’s based on outdated, ineffective methodology.

Medication errors are only part of the story.

Because of IV insulin’s status as a high-alert medication, hospitals take many preventative measures to ensure it is administered safely. A 2019 survey of pharmacists found that common safety precautions for IV insulin include:

  • Using only one standard insulin concentration
  • Having an independent nurse double-check on initiation of IV insulin drips
  • Applying a patient label in the pharmacy
  • Requiring a pharmacist to visually verify a dose of insulin before injection into an IV piggyback
  • Labeling bags with “high-alert medication” in the pharmacy
  • Segregating storage in the pharmacy

Additionally, according to the American Journal of Health-System Pharmacy, pharmacists can further work to reduce errors and risk by focusing on things like proper abbreviations (e.g., not using “U” for “units”), clarifying ambiguous insulin therapy orders in writing and preparing all insulin infusions in the pharmacy.

Such precautions help prevent errors and limit adverse drug events, and they should be practiced in any acute care setting. However, these precautions take for granted that the insulin dose being ordered is safe and accurate. 

And, unfortunately, this isn’t always the case. Many hospitals and providers still rely on paper-based protocols for IV insulin dosing.

An example of a confusing paper-based insulin dosing protocol

Paper-based protocols are confusing and can lead to dosing errors. They often require multiple steps, calculations and other human factor-related concerns leading to dosing delays and errors.

The solution: eGlycemic Management

One solution for improving the safety and effectiveness of IV insulin prescription and administration is implementing an eGlycemic Management System (eGMS®), which replaces paper protocols for insulin dosing in the hospital.

Glytec’s eGMS is a comprehensive, modular platform that centers on Glucommander™, an FDA-cleared software solution that delivers personalized insulin dosing recommendations at the point of care while maximizing workflow efficiency for doctors and nurses, and increasing visibility and oversight for pharmacy. This technology has been proven to decrease time to target blood glucose and reduce the incidence of hypoglycemia and hyperglycemia.

In addition, other parts of Glytec’s eGMS help improve IV insulin administration and decrease the risk of medication errors, including:

  • EMR integration to reduce errors related to data entry
  • Automated reminders for nurses to perform blood glucose checks and administer insulin
  • A Glucose Velocity Warning that alerts nurses about sudden drops in patient blood sugar
  • Centralized dashboards that pharmacists can use to monitor glucose control metrics at the unit and hospital level

Taken together, the features and modules of eGMS offer stakeholders much greater control over the aspects of glycemic management that impact patient safety. And the results are tangible — at one hospital, preventable hypoglycemia-related adverse drug events were reduced by 99.8% after eGMS implementation.


Reducing insulin medication errors between prescription and titration is an important part of patient safety, but it won’t entirely solve the problems of hypoglycemic events and misadministration of IV insulin.

Pharmacy leaders must also consider how to promote the adoption of computerized order entry technologies and standard-of-care dosing decision support among providers.

Glytec’s eGMS is the leading solution in this space, and it has been proven to significantly increase patient safety.

By empowering healthcare providers with the best tools, pharmacy leaders can ensure that all patients receive the quality care they deserve.


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