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How To Mix Insulin

Pre-mixed Insulin

Pre-mixed Insulin

Pre-mixed insulin requires only one injection. Pre-mixed insulin may be right for you if you're older, have vision trouble, or are just starting insulin therapy. Pre-mixed insulins are usually prescribed for patients needing a simple insulin treatment plan, and sliding scale therapy. You may be in this category if you: Have diminished vision or trouble with dexterity Are just starting insulin therapy NPH insulin may be mixed with both rapid-acting insulin analogs and fast-acting human Regular insulin. These mixtures include various combinations: In the United States, rapid-acting insulin, Lyspro (humalog) is mixed with NPH in a 50:50 (50% NPH and 50% insulin Lyspro) and 75:25 (75% NPH and 25% insulin Lyspro) ratio. Insulin/Aspart (Novolog) combinations also are available as 70:30 mixtures (70% NPH, 30% insulin aspart). The traditional NPH ratio of Regular pre-mixed insulin 70:30 (70% NPH, 30% Regular) is still available. These insulins are available as vials, and as insulin pens. The disadvantage is that NPH, which has a relatively unpredictable action, is the only long-acting insulin that can be used. Also, when the doses in a mixture is increased or decreased, the amount both of the short acting insulin and long-acting insulin changes, which increases the risk of both high and low blood sugars. Mixtures also don’t allow a separate correction to be made for high blood sugars. (You may wonder why there are NO pre-mixed insulins using Lantus and detemir. This is because insulin glargine (Lantus®) and detemir (Levemir®) cannot be mixed in the same syringe with other insulins!) Pre-mixed insulins are usually prescribed for patients needing a simple insulin treatment plan, and sliding scale therapy. You may be in this category if you: Are older, with regular meal and ac Continue reading >>

Giving Yourself An Insulin Shot For Diabetes

Giving Yourself An Insulin Shot For Diabetes

For those with diabetes, an insulin shot delivers medicine into the subcutaneous tissue -- the tissue between your skin and muscle. Subcutaneous tissue (also called "sub Q" tissue) is found throughout your body. Please follow these steps when using an insulin syringe. Note: these instructions are not for patients using an insulin pen or a non-needle injection system. Select a clean, dry work area, and gather the following insulin supplies: Bottle of insulin Sterile insulin syringe (needle attached) with wrapper removed Two alcohol wipes (or cotton balls and a bottle of rubbing alcohol) One container for used equipment (such as a hard plastic or metal container with a screw-on or tightly secured lid or a commercial "sharps" container) Wash hands with soap and warm water and dry them with a clean towel. Remove the plastic cap from the insulin bottle. Roll the bottle of insulin between your hands two to three times to mix the insulin. Do not shake the bottle, as air bubbles can form and affect the amount of insulin withdrawn. Wipe off the rubber part on the top of the insulin bottle with an alcohol pad or cotton ball dampened with alcohol. Set the insulin bottle nearby on a flat surface. Remove the cap from the needle. If you've been prescribed two types of insulin to be taken at once (mixed dose), skip to the instructions in the next section. Draw the required number of units of air into the syringe by pulling the plunger back. You need to draw the same amount of air into the syringe as insulin you need to inject. Always measure from the top of the plunger. Insert the needle into the rubber stopper of the insulin bottle. Push the plunger down to inject air into the bottle (this allows the insulin to be drawn more easily). Leave the needle in the bottle. Turn the bottle an 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 >>

Steps For Preparing A Mixed Dose Of Insulin

Steps For Preparing A Mixed Dose Of Insulin

Steps for Preparing a Mixed Dose of Insulin slide 1 of 9, Rolling the bottles gently, Step 1. Roll the insulin bottles (vials) gently between your hands. Roll the cloudy insulin bottle until all the white powder has dissolved. Rolling the bottle warms the insulin if you have been keeping the bottle in the refrigerator. The order in which you mix the clear (rapid- or short-acting) and cloudy (long-acting) insulin is important. slide 2 of 9, Cleaning the lids of the bottles, Step 2. Wipe the rubber lid of both insulin bottles with an alcohol wipe or a cotton ball dipped in alcohol. Let the alcohol dry. Note: If you are using a bottle for the first time, remove the protective cover from the rubber lid before cleaning. Drawing air into the syringe for the cloudy insulin dose slide 3 of 9, Drawing air into the syringe for the cloudy insulin dose, Step 3. Remove the plastic cap that covers the needle on your insulin syringe. Step 4. Pull the plunger back on your insulin syringe and draw air into the syringe equal to the number of units of cloudy insulin to be given. Forcing air into the cloudy insulin bottle slide 4 of 9, Forcing air into the cloudy insulin bottle, Step 5. Push the needle of the syringe into the rubber lid of the cloudy insulin bottle. Step 6. Push the plunger of the syringe to force the air into the bottle. This equalizes the pressure in the bottle when you later remove the dose of insulin. Step 7. Remove the needle from the bottle. Drawing air into the syringe for the clear insulin dose slide 5 of 9, Drawing air into the syringe for the clear insulin dose, Step 8. Pull the plunger of the syringe back and draw air into the syringe equal to the number of units of clear insulin to be given. Forcing air into the clear insulin bottle slide 6 of 9, Forcing air i Continue reading >>

Using Insulin Lispro

Using Insulin Lispro

What is insulin lispro, and how can it help control my blood sugar levels? Insulin lispro (brand name: Humalog) is the newest type of insulin on the market. It's a fast-acting insulin that starts working sooner than other insulins. It also reaches peak activity faster and goes away sooner. Insulin lispro helps keep your blood sugar levels from going too high after you eat. Studies show that insulin lispro may do this better than regular insulin. In fact, insulin lispro may replace regular insulin for many patients with diabetes mellitus. The medicines your doctor has prescribed are very important in keeping your diabetes under control. To keep your blood sugar level steady, your doctor will probably prescribe either a longer-acting insulin or another drug for you to take each day in addition to the insulin lispro. When and how do I take insulin lispro? Insulin lispro should be injected under the skin within 15 minutes before you eat. Your doctor will tell you how much insulin lispro to inject. Remember, you must eat 15 minutes after you take this insulin shot. Insulin lispro is a little easier to take than regular insulin. If you've been using regular insulin, you've had to inject the insulin and then wait 30 to 45 minutes before eating. Many people find it hard to time regular insulin injections and mealtimes. Sometimes they end up eating too early or too late. Then they don't get the best blood sugar control. Since insulin lispro is taken so close to meals, it may help you get the best possible blood sugar control. Can I mix insulin lispro with other insulins? It's best that you mix insulin lispro only with Humulin U or Humulin N, which are brand names for certain longer-acting insulins. Insulin lispro should always be drawn into the syringe first. This will keep the Continue reading >>

Steps To Mix Insulin

Steps To Mix Insulin

Steps to mix insulin 1. Wash hands 2. Gently rotate NPH insulin bottle 3. Wipe off tops of insulin vials with alcohol wipe 4. Draw back amount of air into the syringe that equals total dose 5. Inject air equal to NPH dose into NPH vial. 6. Inject air equal to regular dose into regular vial 7. Invert regular insulin bottle and withdraw regular insulin dose 8. Without adding more air to NPH vial, carefully withdraw NPH dose. Continue reading >>

How To Mix Nph And Regular Insulin For A Patient

How To Mix Nph And Regular Insulin For A Patient

This how to video demonstrates how to mix two different types of insulin for a patient. Watch and learn how to properly prepare a mixture of regular insulin and neutral protamine hagedorn (NPH) insulin. Make sure you do the proper order of draw. Note that this instructional video is intended for medical students and professionals. Change a gown on a patient with an IV pump in nursing Prepare an insulin syringe to inject a diabetic cat Perform fundoscopy or opthalmoscopy on a patient Administer a subcutaneous injection on a patient Draw medication up from a vial for an injection Administer an intramuscular Z-track injection Administer an intradermal injection on a patient Give your diabetic cat an insulin injection Insert a proper PICC line into your patient Administer medication through a running IV Administer medication through a saline lock Perform a general eye exam on a patient Intubate a patient (endotracheal intubation procedure) Evaluate a patient with knee pain Draw blood with a standard venepuncture procedure Administer an intramuscular injection Use proper suture technique with your patient Place an abductor pillow on a THR patient in nursing Do passive range of motion on a patient in nursing Perform a HEENT exam (head, ears, eyes, nose & throat) Perform a cardiovascular exam on a patient Examine a patient for vital signs Perform a saline sinus flush Assess thyroid status & perform a thyroid gland exam Perform a full chest exam on a patient Put sterile gloves on properly Listen to a patient's lungs Take someone's blood pressure Use subdermal interrupted suturing on a patient Inject local anesthetic into a wound Communicate with children through play in nursing Access a port-a-cath in nursing Do open heart surgery on a patient simulator safely Become an Anesthe Continue reading >>

Comparative Effectiveness Review Summary Guides For Consumers [internet].

Comparative Effectiveness Review Summary Guides For Consumers [internet].

Go to: Fast Facts When people have type 2 diabetes, their body either does not make enough insulin or does not use insulin as well as it should. Many people with type 2 diabetes need to take insulin shots. Premixed insulin combines two kinds of insulin. The first kind helps the body control blood sugar (blood glucose) all through the day. The second kind helps the body control blood sugar at meal times. There are different types of premixed insulin. The different types of premixed insulin work equally well to lower your A1c. The A1c is a blood test that shows your average blood sugar over the past 2 to 3 months. The chance of your blood sugar dropping too low is the same with the different types of premixed insulin. Go to: What Does This Guide Cover? The information in this guide comes from a government-funded review of research about premixed insulin. This guide compares the benefits, side effects, and costs of a newer type of premixed insulin with other kinds of insulin and pills for diabetes. Has your doctor or nurse told you that you need insulin for your type 2 diabetes? There are many kinds of insulin and many different ways to take insulin. This guide can help you learn about them. It can help you talk with your doctor or nurse about whether premixed insulin may be a good choice. Go to: What Is Not Covered in This Guide? This guide does not cover all the possible ways to treat type 2 diabetes. It does not include information on diet and exercise. It does not cover using insulin in pumps or non-insulin shots like exenatide (Byetta®) or pramlintide (Symlin®). It does not cover the use of insulin by children, pregnant women, or people with type 1 diabetes. If your doctor has recommended pills for your type 2 diabetes, the Agency for Healthcare Research and Quality Continue reading >>

Why Is Insulin Drawn Clear To Cloudy?

Why Is Insulin Drawn Clear To Cloudy?

I have a question for my fellow nurses, one I have had since nursing school. A question I have asked fellow nurses throughout my nursing career with no answer to my question. A simple question of why, when drawing up two different insulin's is the clear(regular) drawn up before the cloudy (nph, lantus, etc.)? Is there any evidence based reasoning to this practice? From what I can understand, it is done so that the regular insulin is not contaminated by the cloudy insulin. IMO however, cloudy should be drawn up first. If I contaminate the clear insulin I will actually be able to visually tell because the bottle of clear insulin will turn cloudy. Yes, this means the bottle is now contaminated & must be disposed of but I much rather dispose of a bottle of insulin than give my patient the wrong dosage of medicine or NPH that was contaminated by regular insulin that I am unable to tell since I could pump a whole syringe full of regular into NPH & no-one would ever be able to tell. Also, regular is rapid onset & hits the body much harder & faster than the longer acting NPH. If a patient was to get a few extra units of NPH, likely the patient would be no worse for wear. At best, I might have to babysit them for a shift & monitor their levels. However, depending on a patients insulin sensitivity. 1-3 units of regular can drop a patient by 50-150. Maybe another nurse can help me out, because the best answer I have gotten is "its just the way it is done" I would really like to know the reasoning behind it. Thank's Continue reading >>

Twice Daily Insulin Regimen

Twice Daily Insulin Regimen

Tweet A twice daily insulin regimen, sometimes referred to as conventional insulin therapy, may be suitable for people with type 1 and type 2 diabetes. Twice daily regimens work on the assumption that you will have 3 meals each day. What is a twice daily insulin regimen? On a twice daily insulin regimen, you will inject a mixture of a shorter acting insulin and intermediate acting insulin at two different times of the day, before breakfast and before dinner. The shorter acting may be either short acting insulin or a rapid acting insulin. Mixing insulin The mixture of a shorter acting insulin and intermediate insulin may be achieved in one of two ways. Either by using a pre-mixed insulin or by mixing the insulin manually. Pre-mixed insulin Pre-mixed insulin will state the ratio of the mix of short and intermediate acting insulin. For example, Insuman Comb 25 is a pre-mixed insulin which is 25% short acting insulin and 75% intermediate acting insulin. Pre-mixed insulin may be administered using a syringe or with an insulin pen. Manually mixed insulin If you need to mix the insulin manually, this will be done using a syringe. You will need to draw up the shorter acting insulin first before drawing up the intermediate insulin. Your health team will fully instruct you on how to draw up the insulin. Read more on injecting with syringes Twice daily insulin regimen in type 1 diabetes A twice daily regimen in type 1 diabetes may be suitable if someone has a regular daily routine that includes three main meals at similar times each day. A twice daily regimen may be appropriate for school children as injections can be given before and after school without the need for an injection during lunch. For people that follow a less regular daily routine, a basal-bolus insulin regimen may Continue reading >>

Mixing Insulin

Mixing Insulin

License Here How Do You Mix Insulin? Your doctor or diabetes educator may ask you to mix a short-acting or clear insulin with an intermediate or long acting cloudy insulin in the same syringe so that both can be given at the same time. Keep in mind: The only insulin that cannot be mixed is insulin Glargine. Mixing Insulin In this example, the doctor has asked you to mix 10 units of regular, clear, insulin with 15 units of NPH cloudy insulin, to a total combined dose of 25 units. Always, draw “clear before cloudy” insulin into the syringe. This is to prevent cloudy insulin from entering the clear insulin bottle. Always do this procedure in the correct order, as shown in the following sequence. Roll the bottle of the cloudy insulin between your hands to mix it. Clean both bottle tops with an alcohol wipe. Pull back the plunger of the syringe to the dose of the long-acting (cloudy) insulin in this example 15 units. You now have 15 units of air in the syringe. Check the insulin bottle to ensure you have the correct cloudy type of insulin. With the insulin bottle held firmly on a counter or tabletop, insert the needle through the rubber cap into the bottle. Push the plunger down so that the air goes from the syringe into the bottle. Remove the needle and syringe. This primes the bottle for when you withdraw the insulin later. Pull back the plunger of the syringe to the dose of the shorter acting clear insulin in this example 10 units. You now have 10 units of air in the syringe. Check the insulin bottle to ensure you have the correct clear type of insulin. With the insulin bottle held firmly on a counter or tabletop, insert the needle through the rubber cap into the bottle. Push the plunger down so that the air goes from the syringe into the bottle. Turn the bottle upsid Continue reading >>

Mixing Insulin Glargine With Rapid-acting Insulin: A Review Of The Literature

Mixing Insulin Glargine With Rapid-acting Insulin: A Review Of The Literature

Purpose. To review the literature examining the mixing of insulin glargine with rapid-acting insulin (RAI). Methods. A literature search was conducted via PubMed and Medline (from 1948 to August 2012) using the search terms “diabetes,” “insulin glargine,” “short acting insulin,” “rapid acting insulin,” and “mixing.” Literature was limited to English-language articles reporting on human studies. Studies with data describing mixing glargine with any short-acting insulin or RAI were included. Four studies met inclusion criteria. Results. Of the four studies assessing mixing glargine, one was a pharmacokinetic study. The other three assessed clinical outcomes in “real-world” settings. All of these studies were conducted in pediatric patients with type 1 diabetes. Two of the clinical outcomes studies did not report significant differences in A1C levels or preprandial, postprandial, or nocturnal blood glucose levels from mixing glargine and RAI. One of the clinical outcome studies reported improved blood glucose control (A1C and fasting blood glucose) with RAI mixed with glargine compared to RAI mixed with NPH insulin. There were no significant differences in hypoglycemia in any of the clinical outcome trials at any time measured. Conclusion. Initial small clinical trials indicate that there are no significant changes in clinical outcomes (blood glucose levels, A1C levels, and hypoglycemia) when mixing glargine with RAI. Additional studies with larger patient populations and longer trial durations are needed before mixing glargine with RAI can be recommended on a routine basis in clinical practice. Methodology A literature search was conducted via PubMed and Medline (articles published from 1948 to January 2012) using the search terms “diabetes,” 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 >>

General Guidelines For Mixing Insulin In A Syringe

General Guidelines For Mixing Insulin In A Syringe

To mix two kinds of insulin in the same syringe Pull the plunger down until the tip of the plunger is at the line for the number of units you need and inject air equal to the amount of insulin you require into the cloudy vial. Pull the needle out without taking insulin out then inject air into the clear vial. Turn the vial of clear insulin upside down. Slowly push plunger up and down and then pull plunger down until you have your correct dose of insulin. (N.B. If insulin is being withdrawn from a cartridge, air is not to be injected into the cartridge.) Check that you have the correct amount of insulin and that there are no large air bubbles in the syringe. Remove the syringe. Carefully insert needle into vial of cloudy insulin and turn the vial upside down. Slowly pull the plunger down until you have the right total dose (the clear plus the cloudy). _____units + ______units = ____units Remove syringe Pinch skin up gently and push needle into the skin at a 90° angle. Push the plunger down to inject insulin Continue reading >>

Insulin Injection: Two Bottle Injection Instructions

Insulin Injection: Two Bottle Injection Instructions

Wash your hands. Pick up the CLOUDY bottle and turn it upside down. Roll the bottle gently between your hands to mix the insulin. Wipe the top of both (clear and cloudy) bottles with alcohol. Remove the caps from the top and bottom of the syringe. Pull the plunger down to the correct unit mark for your CLOUDY insulin dose as ordered. Insert the needle into the CLOUDY bottle. Push the plunger down to inject air into the CLOUDY bottle. Withdraw the empty syringe from the bottle. Set the bottle aside. Pull the plunger down to the correct unit mark for the CLEAR insulin dose as ordered. Insert the needle into the CLEAR bottle. Push the plunger down to inject air into the CLEAR bottle. Leave the needle in the bottle. Turn the bottle upside down with the needle in it. Pull the plunger down to the correct unit mark for the CLEAR insulin dose. Look for air bubbles in the syringe. If you see air bubbles in the syringe, push the insulin back into the bottle, and repeat steps 17 and 18. Pull the bottle away from the needle, and set aside the CLEAR bottle. Pick up the CLOUDY bottle of insulin. Turn the CLOUDY bottle upside down and push the needle into the bottle. Be very careful not to move the plunger. Pull the plunger down and withdraw the correct number of units for the CLOUDY insulin. The plunger should now be on the unit mark showing the total units of both the CLEAR and CLOUDY types of insulin. For example, 6 units of CLEAR insulin are already in the syringe. Add 14 units of CLOUDY insulin for a total of 20 units in the syringe. Pull the bottle away from the needle. Set both bottles on the table. Look for air bubbles in the syringe. If you see air bubbles, discard the dose and begin again. Set the syringe down. Do not let the needle touch anything. Pinch or spread the skin a Continue reading >>

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