Errors in the preparation and application of insulin: an integrative review
DOI:
https://doi.org/10.26694/reufpi.v14i1.5657Keywords:
Diabetes Mellitus, Insulin, Medication Errors, Literature ReviewAbstract
Objective: To analyze the scientific literature on errors in the preparation and application of insulin by people with diabetes mellitus and/or their guardians. Methods: This is an integrative literature review, carried out between January and April 2023, in the MEDLINE via PubMed, CINAHL via Ebsco, LILACS, Embase and Scopus databases. Studies published as original articles, in Portuguese, English, and Spanish and published in the last 10 years were included, resulting in a sample of 12 articles. Results: The most prevalent errors in the practice of preparing and applying insulin were: incorrect preparation of doses, above or below those prescribed; incorrect application; failure to rotate application sites; inadequate storage and preservation of insulin vials. Conclusion: Given the errors revealed, diabetes education for patients and those responsible for this practice is a fundamental strategy for avoiding errors in insulin therapy. Nursing can contribute to planning educational actions aimed at this public, making decisions to qualify the care provided.
References
Silva JP, Santos FL, Oliveira PS, Viana AL, Araújo PN, Souza GC, et al. Práticas e desafios da educação em saúde na administração de insulina: um estudo transversal. Rev Caderno Pedagógico. [Internet]. 2023;20(11):5188-5209. doi: https://doi.org/10.54033/cadpedv20n11-013.
Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Diretrizes para o cuidado das pessoas com doenças crônicas nas redes de atenção à saúde e nas linhas de cuidado prioritárias. Brasília (DF): Ministério da Saúde; 2013.
La Banca RO, Marroni MS, Oliveira MC, Sparapani VC, Pascali PM, Oliveira SKP, et al. Técnicas de aplicação de insulina. Diretriz Oficial da Sociedade Brasileira de Diabetes. 2022. doi: https://doi.org/10.29327/557753.2022-4
Mendes KDS, Silveira RCCP, Galvão CM. Uso de gerenciador de referências bibliográficas na seleção dos estudos primários em revisão integrativa. Texto & Cont Enferm. [Internet]. 2019;29(e20170204):1-13. doi: https://doi.org/10.1590/1980-265X-TCE-2017-0204
Tricco AC, Lillie E, Zarin W, Orien KKO, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. [Internet]. 2018;169(7):467-73. doi: https://doi.org/10.7326/M18-0850.
Stetler CB, Morsi D, Rucki S, Broughton S, Corrigan B, Fitzgerald J, et al. Utilization-focused integrative reviews in a nursing service. Appl Nurs Res. [Internet]. 1998;11(4):195-206. doi: https://doi.org/10.1016/s0897-1897(98)80329-7.
Whittemore R, Knafl K. The integrative review: update methodology. J Adv Nurs. [Internet]. 2005;52(5):546-53. doi: https://doi.org/10.1111/j.1365-2648.2005.03621.x.
Geller AI, Shehab N, Lovegrove MC, Kegler SR, Weidenbach KN, Ryan GJ, et al. National Estimates of Insulin-Related Hypoglycemia and Errors Leading to Emergency Department Visits and Hospitalizations. JAMA Intern Med. [Internet]. 2014;174(5):678-86. doi: https://doi.org/10.1001/jamainternmed.2014.136.
Nguyen HT, Nguyen TD, Haaijer-Ruskamp FM, Taxis K. Errors in preparation and administration of insulin in two urban Vietnamese hospitals: an observational study. Nurs Res. [Internet]. 2014;63(1):68-72. doi: https://doi.org/10.1097/NNR.0000000000000010.
Modic MB, Alberto NM, Sol Z, Bena JF, Yager C, Cray T, et al. Does an Insulin Double-Checking Procedure Improve Patient Safety? J Nurs Adm. [Internet]. 2016;46(3):154-60. doi: https://doi.org/10.1097/NNA.0000000000000314.
Donsa K, Peck P, Holl B, Mader JK, Schaupp L, Prancha J, et al. Impact of errors in paper-based and computerized diabetes management with decision support for hospitalized patients with type 2 diabetes. Int J Med Inform. [Internet]. 2016;90:58-67. doi: https://doi.org/10.1016/j.ijmedinf.2016.03.007.
Truong TH, Nguyen TT, Armor BL, Farley JR. Mistakes in the Technique of Administering Insulin Pens: The Result of Insufficient Education. Diabetes Ther. [Internet]. 2017;8(2):221-26. doi: https://doi.org/10.1007/s13300-017-0242-y.
Robb A, Reid B, Laird EA. Insulin knowledge and practice: a survey of district nurses in Northern Ireland. Br J Community Nurs. [Internet]. 2017;22(3):138-45. doi: https://doi.org/10.12968/bjcn.2017.22.3.138.
Pozzuoli GM, Laudato M, Barone M, Crisci F, Pozzuoli B. Mistakes in insulin treatment management and the risk of lipohypertrophy. Acta Diabetol. [Internet]. 2018;55(1):67-73. doi: https://doi.org/10.1007/s00592-017-1066-y.
Wei ET, Koh E, Kelly MS, Wright LA, Tylee TS. Patient errors in use of injectable antidiabetic medications: A need for improved clinic-based education. J Am Pharm Assoc (2003). [Internet]. 2020;60(5):76-80. doi: https://doi.org/10.1016/j.japh.2020.02.030
Krolow MR, Machado KP, Oliveira AT, Soares MU, Volz PM, Elaine T. Qualidade e segurança no uso da insulinoterapia pela população idosa. Rev. Enferm. UFSM. [Internet]. 2021;11(e38):1-19. doi: https://doi.org/10.5902/2179769248098
Zipf N, Grant L, Robinson B, Teasdale T, Grant G, Hattingh HL. Analysis of inpatient and high risk medicine pharmacist interventions associated with insulin prescribing for hospital inpatients with diabetes. Int J Clin Pharm. [Internet]. 2021;43(5):1420-25. doi: https://doi.org/10.1007/s11096-021-01307-1.
Mader JK, Aberer F, Drechsler KS, Pottler T, Lichtenegger KM, Kole W, et al. Medication errors in type 2 diabetes from the patients' perspective. PLoS ONE. [Internet]. 2022;17(4):e0267570. doi: https://doi.org/10.1371/journal.pone.0267570.
Habib MK, Khan MN, Sadiq A, Iqbal Q, Raziq A, Ahmad N, et al. Medication errors and management of type 2 diabetes: a qualitative exploration of the perceptions, experiences, and expectations of physicians in Quetta City, Pakistan. Front Med (Lausana). [Internet]. 2022;28(9):846530. doi: https://doi.org/10.3389/fmed.2022.846530.
Costa AKG, Pereira JVGA, Forte Júnior SS, Costa RRO, Amorim EG. Dificuldades apresentadas por pacientes com diabetes na administração de insulina: revisão de escopo. Rev Med Minas Gerais. [Internet]. 2023;33(e-33203):1-12. doi: https://doi.org/10.5935/2238-3182.2023e33203
Dias IWH, Junqueira V. Aproximação dialógica às necessidades de saúde em usuários de insulina acompanhados no Programa de Automonitoramento Glicêmico. Interface (Botucatu). [Internet]. 2020;24(1):45-59. doi: https://doi.org/10.1590/Interface.190441
Sociedade Brasileira de Diabetes (SBD). Diretrizes da Sociedade Brasileira de Diabetes. São Paulo: Clannad, 2023.
Koch M, Marin MP, Trindade OA, Piva RD. Avaliação sobre o armazenamento da insulina em uma amostragem de usuários. Rev Uningá. [Internet]. 2019;56(1):17-25. doi: https://doi.org/10.46311/2318-0579.56.eUJ2050
Instituto para Práticas Seguras no Uso de Medicamento (ISMP). Prevenção de erros de medicação entre pacientes com diabetes. 2019.
Carvalho GCN, Freitas RWJF, Araújo MFM, Zanetti ML, Damasceno MMC. Acuidade visual no manejo do diabetes mellitus: preparo da dose de insulina. Rev. Acta Paul Enferm. [Internet]. 2017;30(1):25-30. doi: https://dx.doi.org/10.1590/1982- 0194201700005.
Silva FWL, Pinho LL, Silva Filho JD, Leite ACRM, Rodrigues LKN, Linard WM, et al. Fatores que predispõe o uso inadequado de insulinas em diabéticos em uma unidade e saúde do município de Jaguaruana – Ceará. Arq. ciências saúde UNIPAR. [Internet]. 2023;27(7):3448-63. doi: https://doi.org/10.25110/arqsaude.v27i7.2023-012.
Lima MCS, Santos PHF, Cruz KCT, Santos LC, Machado VB, Andrade J. Acesso à insulinoterapia de usuários com diagnóstico de Diabetes Mellitus acompanhados em ambulatório especializado. Enferm Foco. [Internet]. 2020;11(2):120-6. doi: https://doi.org/10.21675/2357-707X.2020.v11.n2.2793.
Lopes FLS, Silva ACS, Linard WM, Pinho LL, Paiva MJG, Leite ACRM, et al. Lipodystrophy in insulin users: a literature review. Brazilian Journal of Implantology and Health Sciences. [Internet]. 2024;6(5):163–74. doi: https://doi.org/10.36557/2674-8169.2024v6n5p163-174.
Santos WP, Sousa MM, Gouveia BLA, Soares MJG, Almeida AM, Oliveira SHS. Fatores relacionados a complicações teciduais decorrentes da insulinoterapia: estudo transversal. Rev Esc Enferm USP [Internet]. 2022;56(e20210249):1-8. doi: https://doi.org/10.1590/1980-220X-REEUSP-2021-0249
Palasson RR, Paz PEA, Marinho GL, Pinto LFS, Teston EF, Gomes MA, et al. Qualidade da assistência à saúde na Atenção Primária: perspectiva de pessoas com Diabetes Mellitus. Rev Bras Enferm. [Internet]. 2023;76(5):1-8. doi: https://doi.org/10.1590/0034-7167-2023-0008pt.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Rev Enferm UFPI

This work is licensed under a Creative Commons Attribution 4.0 International License.
Autores mantém os direitos autorais e concedem à REUFPI o direito de primeira publicação, com o trabalho licenciado sob a Licença Creative Commons Attibution BY 4.0 que permite o compartilhamento do trabalho com reconhecimento da autoria e publicação inicial nesta revista.