diabetestalk.net

Can You Mix Lantus

Page 1 Of 14 Nda 21-081 Draft Package Insert (sponsor Revision #5) Date Of Submission: April 20, 2000

Page 1 Of 14 Nda 21-081 Draft Package Insert (sponsor Revision #5) Date Of Submission: April 20, 2000

Draft1 Prescribing Information as of April 20002 LANTUS®3 (insulin glargine [rDNA origin] injection)4 LANTUS® must not be diluted or mixed with any other insulin or solution.5 DESCRIPTION6 LANTUS® (insulin glargine [rDNA origin] injection) is a sterile solution of insulin glargine for use7 as an injection. Insulin glargine is a recombinant human insulin analog that is a long-acting (up to 24-8 hour duration of action), parenteral blood-glucose-lowering agent (see CLINICAL9 PHARMACOLOGY). LANTUS is produced by recombinant DNA technology utilizing a non-10 pathogenic laboratory strain of Escherichia coli (K12) as the production organism. Insulin glargine11 differs from human insulin in that the amino acid asparagine at position A21 is replaced by glycine12 and two arginines are added to the C-terminus of the B-chain. Chemically, it is 21A-Gly-30Ba-L-13 Arg-30Bb-L-Arg-human insulin and has the empirical formula C267H404N72O78S6 and a molecular14 weight of 6063. It has the following structural formula:15 Ile Val Glu Gln Cys Cys Thr Ser Ile Cys Ser Leu Tyr Gln Leu Glu Asn Tyr Tyr 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Cys Gly Leu 19 20 21 Leu Val Cys GlySer LeuAlaGluVal Glu HisGlyCysLeu Arg HisGlnAsnValPhe Phe Phe GlyTyrArg Lys Pro ThrThrArg B - chain 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 2223242526272829303132 S S S S S S Gly A - chain 16 LANTUS consists of insulin glargine dissolved in a clear aqueous fluid. Each milliliter of LANTUS17 (insulin glargine injection) contains 100 IU (3.6378 mg) insulin glargine, 30 mcg zinc, 2.7 mg m-18 cresol, 20 mg glycerol 85%, and water for injection. The pH is adjusted by addition of aqueous19 solutions of hydrochloric acid and sodium hydroxide. LANTUS has a pH of approximately 4.20 Page 2 of 14 NDA 21-081 Continue reading >>

Injecting Lantusâ® With A Vial And Syringe

Injecting Lantusâ® With A Vial And Syringe

BEFORE YOU GET STARTED: • Wash your hands. • Make sure the insulin is clear and colorless. Do not use it if it is cloudy or if you see particles; throw it away. • Do not mix or dilute Lantus® with any other insulin or solution. It will not work as intended, and you may lose blood sugar control. • Do not share needles, insulin pens, or syringes with others. Do NOT reuse needles. Always use a new syringe. • Relax. STEP 1: PREPARE THE DOSE • Remove the cap—If you are using a new vial, remove the protective cap. Do not remove the stopper. • Sterilize the top—Wipe the top of the vial with an alcohol swab. • Inject air into the vial—Draw air into the syringe that is equal to your insulin dose. • Put the needle through the rubber top of the vial and push the plunger to inject the air into the vial. • Draw up the dose—Leave the syringe in the vial and turn both upside down. Hold the syringe and vial firmly in one hand. Make sure the tip of the needle is in the insulin. With your free hand, pull the plunger to withdraw the correct dose into the syringe. STEP 2: REMOVE AIR BUBBLES • Check for bubbles—Before you take the needle out of the vial, check the syringe for air bubbles. • Tap to release—If bubbles are in the medicine, hold the syringe straight up and tap the side of the syringe until the bubbles float to the top. • Eject the air—Push the bubbles out with the plunger and draw insulin back in until you have the correct dose. • Remove the needle—Remove the needle from the vial. Do not let the needle touch anything. You’re now ready to inject. Please see additional Important Safety Information for Lantus® on the next page. Pl Continue reading >>

Early Pharmacokinetic And Pharmacodynamic Effects Of Mixing Lispro With Glargine Insulin

Early Pharmacokinetic And Pharmacodynamic Effects Of Mixing Lispro With Glargine Insulin

Go to: Clinicians who treat children with type 1 diabetes often try to minimize the number of daily injections to reduce treatment burden and improve compliance. Despite the manufacturer's cautions against mixing glargine with rapid-acting insulin analogs, clinical studies have failed to demonstrate deleterious effects of mixing on glucose excursions or A1C levels. However, no formal glucose clamp studies have been performed to determine whether mixing with glargine has an adverse effect on the early pharmacodynamic action of rapid-acting insulin in humans. To examine this question, euglycemic glucose clamps were performed twice, in random order, in 11 youth with type 1 diabetes (age 15.1 ± 3 years, A1C 7.6 ± 0.6%) with 0.2 units/kg lispro and 0.4 units/kg glargine, given either as separate or as a single mixed injection. Mixing the two insulins shifted the time action curve to the right, with significantly lower glucose infusion rate (GIR) values after the mixed injections between 60 and 190 min and significantly higher values between 270 and 300 min, lowered the GIRmax (separate 7.1 ± 1 vs. mix 3.9 ± 1, P = 0.03), and markedly delayed the time to reach GIRmax (separate 116 ± 8 min vs. mix 209 ± 15 min, P = 0.004). The GIR area under the curve was significantly lower after the mixed injections. Mixing had similar effects on plasma insulin pharmacokinetics. These data demonstrate that mixing lispro with glargine markedly flattens the early pharmacodynamic peak of lispro and causes a shift to the right in the GIR curve changes that might lead to difficulties in controlling meal-related glucose excursions. Pharmacokinetic profiles. Insulin concentration, measured by ELISA with a reported cross-reactivity of 44% for insulin glargine, for separate and mixed injections Continue reading >>

Indications And Usage For Apidra® (insulin Glulisine [rdna Origin] Injection)

Indications And Usage For Apidra® (insulin Glulisine [rdna Origin] Injection)

Prescription Apidra® is for adults with type 2 diabetes or adults and children (4 years and older) with type 1 diabetes to improve blood sugar control. Apidra® given by subcutaneous injection is usually used with a longer-acting insulin. When used as a mealtime insulin, Apidra® should be given within 15 minutes before or within 20 minutes after starting a meal. Apidra® may be infused subcutaneously by external insulin infusion pumps. Do not use Apidra® during a low blood sugar reaction (hypoglycemia) or if you are allergic to any of the ingredients in Apidra®. Do not share needles, insulin pens or syringes with others. Do NOT reuse needles. You must test your blood sugar levels while using insulin, such as Apidra®. Do not make any changes to your dose or type of insulin without talking to your healthcare provider. Any change of insulin should be made cautiously and only under medical supervision. Apidra® must only be used if the solution is clear and colorless with no particles visible. Apidra®, when given by injection under the skin, should not be mixed with insulins other than NPH. Do not mix Apidra® with any insulin when used in the pump or for intravenous administration. The most common side effect of insulin, including Apidra®, is low blood sugar (hypoglycemia), which may be serious. Some people may experience symptoms such as shaking, sweating, fast heartbeat, and blurred vision. Severe hypoglycemia may be serious and life threatening. It may cause harm to your heart or brain. Other possible side effects may include low blood potassium, injection site reactions, such as changes in fat tissue at the injection site, and allergic reactions, such as itching and rash. Less common, but potentially more serious or life-threatening, is generalized allergy to in Continue reading >>

Mixing Long And Short Acting Insulins In Same Syringe Does Not Compromise Long-t

Mixing Long And Short Acting Insulins In Same Syringe Does Not Compromise Long-t

Mixing Lantus and rapid-acting insulins as Humalog or Novolog does not compromise glycemic control. Similar to what has been shown in short-term studies, rapid-acting insulin analogues (RAI) can be mixed with insulin glargine without compromising long-term glycemic control in children with type 1 diabetes, new research shows. The ability to give RAIs and insulin glargine in the same syringe has the potential to decrease the number of daily injections and increase use of insulin glargine, lead author Dr. Rosanna Fiallo-Scharer, from the University of Colorado in Denver, and colleagues note. As reported in the Journal of Pediatrics for April, the researchers compared glycemic control in 55 children who mixed insulin glargine and a RAI with that seen in 55 children who took separate injections. The ability to give rapid-acting insulin analogues (such as Apidra, NovoRapid) and long-acting insulin glargine (Lantus) in the same syringe has the potential to decrease the number of daily injections and increase use of insulin glargine, Dr. Rosanna Fiallo-Scharer, from the University of Colorado in Denver, and colleagues note in the Journal of Pediatrics The researchers compared blood sugar control in 55 children who mixed insulin glargine and a rapid-acting insulin analog with that seen in 55 children who took separate injections. Low and high blood sugar complications were uncommon and occurred with similar frequency in each group, the report indicates. After 6 months, HbA1c levels were nearly the same in each group, at 8.54 and 8.61. Likewise, the groups were comparable in terms of the percentages of blood glucose values that fell outside the target range. Hypoglycemic events and diabetic ketoacidosis events were uncommon and occurred with similar frequency in each group, the Continue reading >>

High-alert Medications - Humalog (insulin Lispro)

High-alert Medications - Humalog (insulin Lispro)

Extra care is needed because Humalog is a high-alert medicine. High-alert medicines have been proven to be safe and effective. But these medicines can cause serious injury if a mistake happens while taking them. This means that it is very important for you to know about this medicine and take it exactly as directed. Top 10 List of Safety Tips for Humalog When taking your medicine 1. Know your insulin. Humalog is a rapid-acting form of insulin that should be injected below the skin within 15 minutes before or immediately after a meal. Have food ready before injection. After injecting the insulin, do not skip a meal or delay eating. 2. Prepare your insulin. An intermediate- or long-acting insulin is often prescribed with Humalog. Humalog can be mixed with insulin NPH (intermediate-acting insulin), but always draw Humalog into the syringe first. Never mix Humalog with Lantus. Do not mix Humalog with other insulins if using an insulin pen or external pump. Do not vigorously shake insulin before use. 3. Don't reuse or recycle. Dispose of used syringes/needles, pens, and lancets in a sealable hard plastic or metal container (e.g., empty detergent bottle, special sharps container from your pharmacy). When the container is full, seal the lid before placing it in the trash. Do not reuse or recycle syringes/needles or lancets. 4. Don't share. Even if you change the needle, sharing an insulin pen or syringe may spread diseases carried in the blood, including hepatitis and HIV. To avoid serious side effects 5. Avoid mix-ups. If you use more than one type of insulin, make each vial or pen look different by putting a rubber band around one type of insulin. 6. Check your medicine. Humalog can be confused with NovoLog or Humulin (other insulins). When you pick up your insulin at the ph Continue reading >>

Mixing Lantus | Allnurses

Mixing Lantus | Allnurses

I know you are not supposed to mix Lantus with any thing else and never do. Lately I have been wondering why as I was never taught in school yet I can not find anything online or in books that explains why it can not be done. Anyone know out there?? Specialty:4 year(s) of experienceinNursing Ed, Ob/GYN, AD, LTC, Rehab Other insulins inactivate the lantus. I can't give you a big chemical reason for that, although we did learn the overall why in organic chem years ago. Not mixing lantus with things is in the paperwork (long microscopic words)that comes with the vial in the box from the manufacturer. But I have an easier solution for it... Just don't mix lantus at all...memorize it and just go with it as second nature. I do...it is as second nature to me as 'date/time/sign'...LOL! I like simple, and not mixing it is simple... I have had patients at home mix it...and it doesn't do anything! Their sugars are out of whack..and they are just "well...I can only take one shot"...and I typically reply "and that is why you are hear getting more shots than you imagined huh? Please don't mix it, it becomes inactive and thus...you are here and feeling horrible! I don't want you to feel horrible! You have a condition that is inside your body, and sadly the solution must too go inside your body, and this particular solution is fragile itself, so it has to go more direct than mouth to be damaged by the stomach. Please try to help yourself by not mixing the solution and having to come here...I don't like to see you feeling cruddy!". It would be interesting to know how it is inactivated Hey, you can talk to a pharmasist if you have one that has the time! I have a great staff of them, and they love to share thier info and enjoy the fact a nurse is interested! I actually did this once when Continue reading >>

Insulin Types

Insulin Types

What Are the Different Insulin Types? Insulin Types are hormones normally made in the pancreas that stimulates the flow of sugar – glucose – from the blood into the cells of the body. Glucose provides the cells with the energy they need to function. There are two main groups of insulins used in the treatment of diabetes: human insulins and analog insulins, made by recombinant DNA technology. The concentration of most insulins available in the United States is 100 units per milliliter. A milliliter is equal to a cubic centimeter. All insulin syringes are graduated to match this insulin concentration. There are four categories of insulins depending on how quickly they start to work in the body after injection: Very rapid acting insulin, Regular, or Rapid acting insulins, Intermediate acting insulins, Long acting insulin. In addition, some insulins are marketed mixed together in different proportions to provide both rapid and long acting effects. Certain insulins can also be mixed together in the same syringe immediately prior to injection. Rapid Acting Insulins A very rapid acting form of insulin called Lispro insulin is marketed under the trade name of Humalog. A second form of very rapid acting insulin is called Aspart and is marketed under the trade name Novolog. Humalog and Novolog are clear liquids that begin to work 10 minutes after injection and peak at 1 hour after injection, lasting for 3-4 hours in the body. However, most patients also need a longer-acting insulin to maintain good control of their blood sugar. Humalog and Novolog can be mixed with NPH insulin and are used as “bolus” insulins to be given 15 minutes before a meal. Note: Check blood sugar level before giving Humalog or Novalog. Your doctor or diabetes educator will instruct you in determini Continue reading >>

Can You Mix Lantus And Regular Insulin - Medhelp

Can You Mix Lantus And Regular Insulin - Medhelp

Common Questions and Answers about Can you mix lantus and regular insulin There are days when I'm taking over 6 shots a day between the various types of insulin and the Symlin. You can't mix it with insulin and actually they tell you not to inject it near where you inject insulin because they can't be mixed. If you're trying to cut down the amount of injections, then this isn't the right med for you. But if you want to find some relief from after-meal blood sugar spikes and don't mind the inconvenience of more injections, then this is something to consider. Completely agree with you slobbery. my daughter uses regular insulin since 9 years old now she is 20 and was put on Humalog 25 mix pen and the thing about the aggresive behavoir is true. last week we had to take her to a hospital with a descompensation almost commatose. I check another forum and it appears the pen humalog works well for adults over 30, 40 50 etc or so but by reading your case I believe it is not suitable for kids with diabetes type I. There are days when I'm taking over 6 shots a day between the various types of insulin and the Symlin. You can't mix it with insulin and actually they tell you not to inject it near where you inject insulin because they can't be mixed. If you're trying to cut down the amount of injections, then this isn't the right med for you. But if you want to find some relief from after-meal blood sugar spikes and don't mind the inconvenience of more injections, then this is something to consider. I would also encourage you to find friends who are OK with you being with them even if you don't smoke or drink and they do. You can still have as much fun as long as you are with people who like you and don't care what you do or don't do. Once you learn to drive, you can always offer to Continue reading >>

How To Mix Insulin Clear To Cloudy

How To Mix Insulin Clear To Cloudy

Learn how to mix insulin clear to cloudy. Drawing up and mixing insulin is a skill that nurses will utilize on the job. Insulin is administered to patients who have diabetes. These type of patients depend on insulin so their body can use glucose. Therefore, nurses must be familiar with how to mix insulin. The goal of this article is to teach you how to mix insulin. Below are a video demonstration and step-by-step instructions on how to do this. How to Mix Insulin Purpose of mixing insulin: To prevent having to give the patient two separate injections (hence better for the patient). Most commonly ordered insulin that are mixed: NPH (intermediate-acting) and Regular insulin (short-acting). Important Points to Keep in Mind: Never mix Insulin Glargine “Lantus” with any other type of insulin. Administer the dose within 5 to 10 minutes after drawing up because the regular insulin binds to the NPH and this decreases its action. Check the patient’s blood sugar and for signs and symptoms of hypoglycemia to ensure they aren’t hypoglycemic …if patient is hypoglycemic hold the dose and notify md for further orders. Key Concept for Mixing Insulin: Draw up CLEAR TO CLOUDY Remember the mnemonic: RN (Regular to Nph) Why? It prevents contaminating the vial of clear insulin with the cloudy insulin because if contaminated it can affect the action of the insulin. Why does this matter because they will be mixed in the syringe? You have 5 to 10 minutes to give the insulin mixed in the syringe before the action of the insulins are affected Demonstration on Drawing Up Clear to Cloudy Insulin Steps on How to Mix Insulin 1. Check the doctor’s order and that you have the correct medication: Doctor’s order says: “10 units of Humulin R and 12 units of Humulin N subcutaneous before b Continue reading >>

Insulin: How To Give A Mixed Dose

Insulin: How To Give A Mixed Dose

Many people with diabetes need to take insulin to keep their blood glucose in a good range. This can be scary for some people, especially for the first time. The truth is that insulin shots are not painful because the needles are short and thin and the insulin shots are placed into fatty tissue below the skin. This is called a subcutaneous (sub-kyu-TAY-nee-us) injection. In some cases, the doctor prescribes a mixed dose of insulin. This means taking more than one type of insulin at the same time. A mixed dose allows you to have the benefits of both short-acting insulin along with a longer acting insulin — without having to give 2 separate shots. Usually, one of the insulins will be cloudy and the other clear. Some insulins cannot be mixed in the same syringe. For instance, never mix Lantus or Levemir with any other solution. Be sure to check with your doctor, pharmacist, or diabetes educator before mixing. These instructions explain how to mix two different types of insulin into one shot. If you are giving or getting just one type of insulin, refer to the patient education sheet Insulin: How to Give a Shot. What You Will Need Bottles of insulin Alcohol swab, or cotton ball moistened with alcohol Syringe with needle (You will need a prescription to buy syringes from a pharmacy. Check with your pharmacist to be sure the syringe size you are using is correct for your total dose of insulin.) Hard plastic or metal container with a screw-on or tightly-secured lid Parts of a Syringe and Needle You will use a syringe and needle to give the shot. The parts are labeled below. Wash the work area (where you will set the insulin and syringe) well with soap and water. Wash your hands. Check the drug labels to be sure they are what your doctor prescribed. Check the expiration date o Continue reading >>

Effects Of Mixing Glargine And Short-acting Insulin Analogs On Glucose Control

Effects Of Mixing Glargine And Short-acting Insulin Analogs On Glucose Control

Intensive insulin management improves glycemic control and lowers the risks of long-term microvascular complications (1). Several new insulin analogs (2) are in use to improve glycemic control in type 1 diabetes. Glargine in particular is a “basal insulin” (3) and found to be relatively peakless. Glargine is thought to provide glucose profiles similar to insulin pumps (4). Although some clinical studies suggest that glargine lasts 24 h in children with diabetes (5), to date there have been no formal pharmacokinetic and pharmacodynamic data to make that claim in the pediatric population. In fact, clinical observations in pediatric type 1 diabetes suggest that glargine action may be <24 h. This would entail twice-daily glargine dosing and short-acting insulin analogs (SAIs), such as lispro and aspart, given separately three to four times per day, resulting in improved glycemic control but compromising compliance and increasing complexity of management (6). In this study, we tested the hypothesis that mixing glargine with SAIs and dividing the dose of glargine into twice- versus once-daily dosing would not adversely affect glycemic control as assessed by a continuous glucose monitoring system (CGMS). RESEARCH DESIGN AND METHODS The protocol was approved by the institutional review board of the Baylor College of Medicine, and consent was obtained before each study. Subjects were recruited from Texas Children’s Hospital Diabetes Care Center, Houston, Texas. Subjects had type 1 diabetes for at least 1 year with no other chronic illness and were on no additional medications (except for insulin and synthroid for hypothyroidism). All subjects were using insulin glargine as a once- daily injection at bedtime or before supper or breakfast, with three or more injections of SA Continue reading >>

Insulin Basics | Diabetesnet.com

Insulin Basics | Diabetesnet.com

Thu, 11/18/2010 - 15:14 -- Richard Morris Store insulin you are not using in a refrigerator. It is a protein dissolved in water, sort of like a soup stock, so keep it cold to prevent it from spoiling. Keep it between 36º and 46º F. If it gets colder it will freeze. If the insulin freezes, when it thaws it will separate and clump and will no longer be usable. If it gets warmer it will be ok for awhile but will eventually spoil. If it starts to spoil, bacteria growing in it breaks down the insulin. It won't hurt you to use this. However, its not as effective so your blood sugar will be higher than you expect even though you took the right amount of insulin at the right time. It is ok to keep a bottle of insulin you are using at room temperature for up to 28 days (room temperature is 59º to 86º F). The preservative in insulin keeps it from spoiling this long. Insulin at room temperature injected into the skin is more comfortable for many people. Also, it may be easier to get rid of air bubbles in the syringe when it is at room temperature. If you live in a hot climate and your room temperature is above 80º, keep your insulin in the refrigerator. Insulin in a pen can only be kept at room temperature for 2 weeks before it begins to spoil. Check with your pharmacist, the package insert or the manufacturer's websites. Insulin used past 28 days at room temperature or past the expiration date on the box may still be good. However, using it may cause control problems and is not recommended. Lantus, Humalog and Novolog seem to spoil faster than Regular and NPH. If you can't afford to buy insulin and insurance does not cover it, you may be able to get it free. Check the website www.helpingpatients.org or call 202-835-3400. The doctor who prescribes your insulin can help you g Continue reading >>

Insulin Analogs

Insulin Analogs

Insulin analogs mimic the body’s natural pattern of insulin release. Once absorbed, they act on cells like human insulin, but are absorbed from fatty tissue more predictably. An analog refers to something that is “analogous” or similar to something else. Therefore, “insulin” analogs are analogs that have been designed to mimic the body’s natural pattern of insulin release. These synthetic-made insulins are called analogs of human insulin. However, they have minor structural or amino acid changes that give them special desirable characteristics when injected under the skin. Once absorbed, they act on cells like human insulin, but are absorbed from fatty tissue more predictably. In this section, you will find information about: Rapid-acting injected insulin analog The fastest working insulins are referred to as rapid-acting insulin. They include: These insulin analogs enter the bloodstream within minutes, so it is important to inject them within 5 to 10 minutes of eating. They have a peak action period of 60-120 minutes, and fade completely after about four hours. Higher doses may last slightly longer, but will last no more than five or six hours. Rapid acting insulin analogs are ideal for bolus insulin replacement. They are given at mealtimes and for high blood sugar correction. Rapid-acting insulins are used in insulin pumps, also known as continuous subcutaneous insulin infusion (CSII) devices. When delivered through a CSII pump, the rapid-acting insulins provide the basal insulin replacement, as well as the mealtime and high blood sugar correction insulin replacement. The insulins that work for the longest period of time are referred to as long-acting insulin. They provide relatively constant insulin levels that plateau for many hours after injection. Some Continue reading >>

Can Lantus And Regular Insulin Be Taken Together?

Can Lantus And Regular Insulin Be Taken Together?

Community Answers Lantus is a sterile solution of insulin glargine that is used in injection form. The main thing that makes Lantus stand out from other insulins is that is long-acting with a duration of up to 24 hours. Regular insulin tends to be more short lived and is better used for controlling spikes in your blood sugar levels. While you are taking Lantus it is perfectly safe to use regular insulin to control spikes in your blood sugar. However as with any other medication be sure to consult your doctor before mixing drugs. Too much insulin can cause an unsafe drop in BG levels. It is important to follow your prescribed dosing schedule to ensure you maintain the proper insulin levels. I want to add to that last part , although insulin may be taken " together," as in you may take the long lasting Lantus Insulin and then LATER, when your blood sugar spikes, (usually after meals) you may take Regular insulin and Inject the insulin in a different area. Ex: If giving a subcutaneous injection in the stomach works for you, give the second injection in another part of the stomach. The reason for this is because different parts of your body will absorb the insulin differently.For instance the absorption rate injected in to your arm would be different the the absorption rate in your thigh. So, you may take Insulin Lantus and Regular Insulin "together," However, you can not put Insulin regular and insulin Lantus in the same syringe and give it in one dose. Simplified: You will have 2 insulin's and 2 injections. Continue reading >>

More in diabetes