Why Should Short Acting Insulin Be Drawn Up First?

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Insulin Administration

Insulin is necessary for normal carbohydrate, protein, and fat metabolism. People with type 1 diabetes mellitus do not produce enough of this hormone to sustain life and therefore depend on exogenous insulin for survival. In contrast, individuals with type 2 diabetes are not dependent on exogenous insulin for survival. However, over time, many of these individuals will show decreased insulin production, therefore requiring supplemental insulin for adequate blood glucose control, especially during times of stress or illness. An insulin regimen is often required in the treatment of gestational diabetes and diabetes associated with certain conditions or syndromes (e.g., pancreatic diseases, drug- or chemical-induced diabetes, endocrinopathies, insulin-receptor disorders, certain genetic syndromes). In all instances of insulin use, the insulin dosage must be individualized and balanced with medical nutrition therapy and exercise. This position statement addresses issues regarding the use of conventional insulin administration (i.e., via syringe or pen with needle and cartridge) in the self-care of the individual with diabetes. It does not address the use of insulin pumps. (See the Amer Continue reading >>

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Popular Questions

  1. hoolahan

    The regular insulin should be drawn up first. It is b/c after you then stick the same syringe into the long-acting, you could accidentally mix insulins (potentially) so if you put rapid acting into long-acting bottle, less problems that if you put long acting into rapid acting bottle. Ex, suppose he needed an in between hit of reg insulin (clear) during the day, he could [i]potentially[i/] get a mix of both insulins ( and so get long-acting insulin which would peak at a diff time and drop his blood sugar) if they are drawn up by using NPH first. The amounts would likely be miniscule, but that is the reasoning behind it, at least that was what I was taught. I hope that made sense.
    It makes no difference as to which insulin hits the subq tissue first. It will all work the way it is supposed to work once it gets there.
    I highly doubt it is your fault his sugars are out of whack b/c of your technique! If diabetics eat sugary foods, this is what sends their sugars out of whack. This happens a lot in older folks. He is probably buying more convenience foods since he can't see to cook. If you want to help him, contact his doc and ask for a visiting nurse referral, they can do an eval, teaching, send an RD if needed, etc. Also, Maybe he would like Meals on Wheels, he can get 2 meals a day for very low cost, one hot and one for later or vice versa. Finally, contact the nearest Association for the Blind in your area, they have some devices that attach to insulin syringes to make drawing up injects easier, and also he may want to consider a talking glucometer. A visiting nurse can help coordinate all this.
    Thanks for caring about your neighbors!! You are a special person :kiss

  2. JMP

    When mixing insulins, inject air equal to the dose into CLOUDY ( long-acting) With the same syringe inject air equal to the dose into CLEAR (short acting) DO NOT remove syringe- withdraw the correct dose. Return to the long acting ( cloudy) and withdraw correct dose. THe objective is not to contaminate the clear (short acting) with the cloudy. The way I remember it, cloudy clear cloudy.
    Adminster the mixture within five minutes of prepartion. Regular (clear) insulin binds with the long acting (cloudy) and the action of the regular insulin is reduced.
    Hope that makes it clear! Sounds to me like you where doing your best, however, it the pt is non-compliant with diet, well, that is not in your control. Other points about insulin- never shake the vial, rotate in your hands approx one minute. Never inject cold insulin, insulin can be stored at room temp for approx one month. The reason the long acting (cloudy) appears cloudy..... a protein which slows absorption has been added......hence the reason we do not want to contaminate the clear with the cloudy. WHEN ALL ESLE FAILS just remember cloudy clear cloudy. Like a weather forecast!

  3. cargal

    I was once told by pharmacy that the rationale behind NOT contaminating the regular is that only regular can be given IV. If IV insulin was needed and it was contaminated, results could be dangerous. Doesn't injecting air into the cloudy first contaminate the regular?

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