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Can Lantus Be Mixed With Other Insulins

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 >>

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 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 >>

What Would Happen If I Mixed Lantus With Novolog?

What Would Happen If I Mixed Lantus With Novolog?

What would happen if I mixed Lantus with Novolog? Registration is fast, simple and absolutely free so please, join our community today to contribute and support the site. This topic is now archived and is closed to further replies. What would happen if I mixed Lantus with Novolog? I take both insulins by syringe and I almost used the same syringe for both. My syringes are the orange type and brand name is ReliOn. Is there a way that I can get diffient color for each syringe so I don't get these syringes mixed up and don't have to waste them by useing them only one time. Doctor told me I could use them more then one time. I would suggest you switch to the Lantus Solostar pen and eliminate this problem. I don't, but others that use the Lantus Solostar pen, or other pens, reuse their pen needles. In this way any cross contamination is virtually impossible. The possibility also exists that even though you might try using different color syringes...that system can also be compromised. You retinas cannot see the difference in colors in low light. Oops, forgot to answer your question: If you mix Lantus and Novolog together...your body will swell up twice its size and explode. If you're going to do this I suggest you do it in the bathroom. Less forensic clean up. The doctor told me to never mix the insulins together but I forgot to ask why not? The cost for me with insurance is 699.00 for five pens out of pocket. This is why I use insulin vial instead of the flexpens. The doctor told me to never mix the insulins together but I forgot to ask why not? The cost for me with insurance is 699.00 for five pens out of pocket. This is why I use insulin vial instead of the flexpens. If you accidentally inject lantus (from a used syringe) into the novolog, you're going to cause precipi 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 >>

Insulin Glargine (rdna Origin) Injection

Insulin Glargine (rdna Origin) Injection

Insulin glargine is used to treat type 1 diabetes (condition in which the body does not produce insulin and therefore cannot control the amount of sugar in the blood). It is also used to treat people with type 2 diabetes (condition in which the body does not use insulin normally and, therefore, cannot control the amount of sugar in the blood) who need insulin to control their diabetes. In people with type 1 diabetes, insulin glargine must be used with another type of insulin (a short-acting insulin). In people with type 2 diabetes, insulin glargine also may be used with another type of insulin or with oral medication(s) for diabetes. Insulin glargine is a long-acting, manmade version of human insulin. Insulin glargine works by replacing the insulin that is normally produced by the body and by helping move sugar from the blood into other body tissues where it is used for energy. It also stops the liver from producing more sugar. Over time, people who have diabetes and high blood sugar can develop serious or life-threatening complications, including heart disease, stroke, kidney problems, nerve damage, and eye problems. Using medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), and regularly checking your blood sugar may help to manage your diabetes and improve your health. This therapy may also decrease your chances of having a heart attack, stroke, or other diabetes-related complications such as kidney failure, nerve damage (numb, cold legs or feet; decreased sexual ability in men and women), eye problems, including changes or loss of vision, or gum disease. Your doctor and other healthcare providers will talk to you about the best way to manage your diabetes. Insulin glargine comes as a solution (liquid) to inject subcutaneously (under the 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 >>

Insulin (and Other Injected Drugs)

Insulin (and Other Injected Drugs)

Diabetes is a disease affecting the body's production of insulin (type 1) or both the body's use and its production of insulin (type 2). Injectable insulin is a lifesaver for people who can no longer produce it on their own 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 >>

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 >>

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 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 >>

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 >>

The Effects Of Mixing Different Insulin Analogues

The Effects Of Mixing Different Insulin Analogues

Frequently doctors, specialist nurses and patients are unaware of the interaction between different insulins. We reviewed a needle phobic patient using a subcutaneous cannula device. The patient was using insulin glargine (Lantus) and insulin aspart (Novorapid). He had been advised to use two separate devices to keep the insulins apart. However, he was using the one device to give both insulin types and had experienced no problems. Unlike most other insulins which are soluble at a neutral pH, insulin glargine is soluble at a pH of 4. The slightly acidic nature of glargine is the reason it can sting when injected. The manufacturer (Sanofi-Aventis) advises that it is never diluted or mixed with other insulins and that it should only be used if it is clear and colourless with no particles visible. We demonstrate the effects of mixing insulin glargine with short acting insulin analogues. In each of six 1ml syringes we mixed 50 units of a long acting insulin analogue, either glargine (Lantus) or detemir (Levemir), with 50 units of a short acting analogue: aspart (Novorapid), lispro (Humalog) or glulisine (Apidra). All of the short acting insulins mixed with insulin glargine immediately formed a cloudy white precipitate which gradually settled at the bottom of the syringe. In contrast, no precipitate was seen with the same short acting analogues mixed with detemir (see Figure 1). Adding an insulin with a slightly acidic pH on to an insulin with a neutral pH results in a solution with a pH part-way between the two (depending on the proportions of the two insulins). At the new pH, neither insulin will now be soluble. The insulin molecules form crystals which precipitate out of solution. This reduces the effectiveness of the insulin dose. Subcutaneous cannulae can be useful devi Continue reading >>

You Have Other Sanofi Options To Help Meet Your Patients’ Blood Sugar Lowering Needs

You Have Other Sanofi Options To Help Meet Your Patients’ Blood Sugar Lowering Needs

Lantus® is a long-acting insulin analog indicated to improve glycemic control in adults and pediatric patients with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus. Lantus® should be administered once a day at the same time every day. Limitations of Use: Lantus® is not recommended for the treatment of diabetic ketoacidosis. Contraindications Lantus® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to insulin glargine or one of its excipients. Warnings and Precautions Insulin pens, needles, or syringes must never be shared between patients. Do NOT reuse needles. Monitor blood glucose in all patients treated with insulin. Modify insulin regimen cautiously and only under medical supervision. Changes in insulin strength, manufacturer, type, or method of administration may result in the need for a change in insulin dose or an adjustment in concomitant oral antidiabetic treatment. Do not dilute or mix Lantus® with any other insulin or solution. If mixed or diluted, the solution may become cloudy, and the onset of action/time to peak effect may be altered in an unpredictable manner. Do not administer Lantus® via an insulin pump or intravenously because severe hypoglycemia can occur. Hypoglycemia is the most common adverse reaction of insulin therapy, including Lantus®, and may be life-threatening. Medication errors, such as accidental mix-ups between basal insulin products and other insulins, particularly rapid-acting insulins, have been reported. Patients should be instructed to always verify the insulin label before each injection. Severe life-threatening, generalized allergy, including anaphylaxis, can occur. Discontinue Lantus®, treat and monitor until symptoms resolve. A reduction in the Lantus® dose may be re Continue reading >>

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