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Can You Mix Regular Insulin With Humulin N?

Update On Insulin Treatment For Dogs And Cats: Insulin Dosing Pens And More

Update On Insulin Treatment For Dogs And Cats: Insulin Dosing Pens And More

Authors Thompson A, Lathan P, Fleeman L Accepted for publication 19 February 2015 Checked for plagiarism Yes Peer reviewer comments 3 1School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia; 2College of Veterinary Medicine Mississippi State University, Starkville, MS, USA; 3Animal Diabetes Australia, Melbourne, VIC, Australia Abstract: Insulin therapy is still the primary therapy for all diabetic dogs and cats. Several insulin options are available for each species, including veterinary registered products and human insulin preparations. The insulin chosen depends on the individual patient's requirements. Intermediate-acting insulin is usually the first choice for dogs, and longer-acting insulin is the first choice for cats. Once the insulin type is chosen, the best method of insulin administration should be considered. Traditionally, insulin vials and syringes have been used, but insulin pen devices have recently entered the veterinary market. Pens have different handling requirements when compared with standard insulin vials including: storage out of the refrigerator for some insulin preparations once pen cartridges are in use; priming of the pen to ensure a full dose of insulin is administered; and holding the pen device in place for several seconds during the injection. Many different types of pen devices are available, with features such as half-unit dosing, large dials for visually impaired people, and memory that can display the last time and dose of insulin administered. Insulin pens come in both reusable and disposable options. Pens have several benefits over syringes, including improved dose accuracy, especially for low insulin doses. Keywords: diabetes, mellitus, canine, feline, NPH, glargine, porcine lente Introduction Insulin the 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 >>

Insulin And Syringe Facts

Insulin And Syringe Facts

Insulin Basics Types Absorption Onset Peak Duration Onset, Peak, Duration chart for pets Insulin Web Resources Syringes References Insulin Basics: what is insulin Insulin is a protein produced by the pancreas, a small organ located in the abdomen. Insulin is made by the pancreatic islet cells (also called the beta cells), then secreted into the blood where it travels throughout the body and helps regulate blood sugar. Insulin is also called a hormone because it is produced in one location (the pancreas) and travels to other cells and regulates their function. Insulin plays a key role in the body's ability to use and store glucose. There's often a discussion about the differences between cat, dog, human, cow, and pig insulins. Above, you read that insulin is a protein. This protein consists of building blocks called amino acids. There are two chains of amino acids; the A chain and the B chain which are linked together in two locations. Think of two strands of pearls hooked together in two spots. The amino acid sequence of the two chains of bovine (cow) insulin and their cross-linkages can be seen in this image, along with the differences (or similarities) in the amino acid sequences between various species. These amino acid differences give each species' insulin a slightly different structure and activity because the whole insulin protein folds around on itself and has very specific locations where it interacts with the insulin receptor on the cell (remember the lock and key mechanism). Because of this very specific structure-activity relationship, a substitution of one amino acid in a critical location may make the protein deform or not work as well in another species. Think of a string of pearls that you can twist up into a ball. If you use all one size of tiny pearls, Continue reading >>

Preferred Step Therapy Policy

Preferred Step Therapy Policy

Insulin (Other) Preferred Medications  Humulin® N (NPH, human insulin isophane suspension [recombinant DNA origin] injection [vials, pen, and KwikPen])  Humulin® R (Regular insulin human injection, USP [rDNA origin] U-100 only [vials])  Humulin ® 70/30 (70% NPH, human insulin isophane suspension and 30% regular, human insulin injection [recombinant DNA origin] [vials, pen, and KwikPen]) Non-Preferred Medications  Novolin® N (NPH, human insulin isophane suspension [recombinant DNA origin] injection [vials])  Novolin® R (Regular, human insulin injection [recombinant DNA origin] solution for subcutaneous or intravenous use)  Novolin® 70/30 (70% NPH, human insulin isophane suspension and 30% regular, human insulin injection [recombinant DNA origin]) OVERVIEW Insulin is an anabolic and anticatabolic hormone and plays a major role in protein, carbohydrate, and fat metabolism. Humulin and Novolin are lines of human insulin indicated for to improve glycemic control in adults and children with diabetes mellitus. These products substitute for inadequate endogenous insulin secretion and partially correct the disordered metabolism and inappropriate hyperglycemia of diabetes mellitus, which are caused by either a deficiency or reduction in the biologic effectiveness of insulin. POLICY STATEMENT This step therapy program encourages the use of Humulin products prior to the use of Novolin products. If the preferred step therapy rule is not met for a non-preferred agent at the point of service, coverage will be determined by the preferred step therapy criteria below. All approvals are provided for 1 year in duration. Automation: Patients 18 years of age and older will be targeted in this preferred step therapy program. Regular Continue reading >>

Humulin N

Humulin N

HUMULIN® N (human insulin [rDNA origin]) isophane) Suspension DESCRIPTION HUMULIN N (human insulin [rDNA origin] isophane) suspension is a human insulin suspension. Human insulin is produced by recombinant DNA technology utilizing a non-pathogenic laboratory strain of Escherichia coli. HUMULIN N is a suspension of crystals produced from combining human insulin and protamine sulfate under appropriate conditions for crystal formation. The amino acid sequence of HUMULIN N is identical to human insulin and has the empirical formula C257H383N65O77S6 with a molecular weight of 5808. HUMULIN N is a sterile white suspension. Each milliliter of HUMULIN N contains 100 units of insulin human, 0.35 mg of protamine sulfate, 16 mg of glycerin, 3.78 mg of dibasic sodium phosphate, 1.6 mg of metacresol, 0.65 mg of phenol, zinc oxide content adjusted to provide 0.025 mg zinc ion, and Water for Injection. The pH is 7.0 to 7.5. Sodium hydroxide and/or hydrochloric acid may be added during manufacture to adjust the pH. Continue reading >>

Short-acting Insulins

Short-acting Insulins

Rapid-Acting Analogues Short-Acting Insulins Intermediate-Acting Insulins Long-Acting Insulins Combination Insulins Onset: 30 minutes Peak: 2.5 - 5 hours Duration: 4 - 12 hours Solution: Clear Comments: Best if administered 30 minutes before a meal. Mixing NPH: If Regular insulin is mixed with NPH human insulin, the Regular insulin should be drawn into the syringe first. Aspart - Novolog ®: Compatible - but NO support clinically for such a mixture. Draw up Novolog first before drawing up Regular Insulin. Lispro - Humalog ®: Compatible - but NO support clinically for such a mixture. Draw up Humalog first before drawing up Regular Insulin. Mixtures should not be administered intravenously. When mixing insulin in a syringe, draw up the quickest acting insulin first (e.g. draw up Humalog or Novolog before drawing up Regular Insulin, or draw up Regular insulin before Novolin N (NPH) or Lente insulin. CLINICAL PHARMACOLOGY Insulin is a polypeptide hormone that controls the storage and metabolism of carbohydrates, proteins, and fats. This activity occurs primarily in the liver, in muscle, and in adipose tissues after binding of the insulin molecules to receptor sites on cellular plasma membranes. Insulin promotes uptake of carbohydrates, proteins, and fats in most tissues. Also, insulin influences carbohydrate, protein, and fat metabolism by stimulating protein and free fatty acid synthesis, and by inhibiting release of free fatty acid from adipose cells. Insulin increases active glucose transport through muscle and adipose cellular membranes, and promotes conversion of intracellular glucose and free fatty acid to the appropriate storage forms (glycogen and triglyceride, respectively). Although the liver does not require active glucose transport, insulin increases hepatic gl Continue reading >>

Proper Use

Proper Use

Drug information provided by: Micromedex Make sure you have the type (beef and pork, pork, or human) and the strength of insulin that your doctor ordered for you. You may find that keeping an insulin label with you is helpful when buying insulin supplies. The concentration (strength) of insulin is measured in USP Insulin Units and USP Insulin Human Units and is usually expressed in terms such as U-100 insulin. Insulin doses are measured and injected with specially marked insulin syringes. The appropriate syringe is chosen based on your insulin dose to make measuring the dose easy to read. This helps you measure your dose accurately. These syringes come in three sizes: 3/10 cubic centimeters (cc) measuring up to 30 USP Units of insulin, ½ cc measuring up to 50 USP Units of insulin, and 1 cc measuring up to 100 USP Units of insulin. It is important to follow any instructions from your doctor about the careful selection and rotation of injection sites on your body. There are several important steps that will help you successfully prepare your insulin injection. To draw the insulin up into the syringe correctly, you need to follow these steps: Wash your hands with soap and water. If your insulin contains zinc or isophane (normally cloudy), be sure that it is completely mixed. Mix the insulin by slowly rolling the bottle between your hands or gently tipping the bottle over a few times. Never shake the bottle vigorously (hard). Do not use the insulin if it looks lumpy or grainy, seems unusually thick, sticks to the bottle, or seems to be even a little discolored. Do not use the insulin if it contains crystals or if the bottle looks frosted. Regular insulin (short-acting) should be used only if it is clear and colorless. Remove the colored protective cap on the bottle. Do not Continue reading >>

Insulin Injection

Insulin Injection

Insulin injection is used to control blood sugar in people who have type 1 diabetes (condition in which the body does not make insulin and therefore cannot control the amount of sugar in the blood) or in people who have type 2 diabetes (condition in which the blood sugar is too high because the body does not produce or use insulin normally) that cannot be controlled with oral medications alone. Insulin injection is in a class of medications called hormones. Insulin injection is used to take the place of insulin that is normally produced by the body. It works 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. All of the types of insulin that are available work in this way. The types of insulin differ only in how quickly they begin to work and how long they continue to control blood 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 comes as a solution (liquid) and a suspension (liquid with particles that will settle on standing) to be injected subcutaneousl Continue reading >>

Types Of Insulin

Types Of Insulin

Topic Overview Insulin is used to treat people who have diabetes. Each type of insulin acts over a specific amount of time. The amount of time can be affected by exercise, diet, illness, some medicines, stress, the dose, how you take it, or where you inject it. Insulin strength is usually U-100 (or 100 units of insulin in one millilitre of fluid). Short-acting (regular) insulin is also available in U-500. This is five times more concentrated than U-100 regular insulin. Long-acting insulin (glargine) is also available in U-300. This is three times more concentrated than U-100 long-acting insulin. Be sure to check the concentration of your insulin so you take the right amount. Insulin is made by different companies. Make sure you use the same type of insulin consistently. Types of insulinfootnote 1 Type Examples Appearance When it starts to work (onset) The time of greatest effect (peak) How long it lasts (duration) Rapid-acting Apidra (insulin glulisine) Clear 10-15 minutes 1-1.5 hours 3-5 hours Humalog (insulin lispro) Clear 10-15 minutes 1-2 hours 3.5-4.75 hours NovoRapid (insulin aspart) Clear 10-15 minutes 1-1.5 hours 3-5 hours Short-acting Humulin R, Novolin ge Toronto (insulin regular) Clear 30 minutes 2-3 hours 6.5 hours Intermediate-acting Humulin N, Novolin ge NPH(insulin NPH) Cloudy 1-3 hours 5-8 hours Up to 18 hours Long-acting Lantus (insulin glargine) Clear 1.5 hours Does not apply Up to 24 hours Levemir (insulin detemir) Clear 1.5 hours Does not apply 16 to 24 hours Toujeo (insulin glargine U-300) Clear Up to 6 hours Does not apply Up to 30 hours Rapid-acting insulins work over a narrow, more predictable range of time. Because they work quickly, they are used most often at the start of a meal. Rapid-acting insulin acts most like insulin that is produced by 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 >>

Human Insulin

Human Insulin

Tweet Human insulin is the name which describes synthetic insulin which is laboratory grown to mimic the insulin in humans. Human insulin was developed through the 1960s and 1970s and approved for pharmaceutical use in 1982. Before human insulin was developed animal insulin, usually a purified form of porcine (pork) insulin, was used. How is human insulin produced? Human insulin is laboratory created by growing insulin proteins within E-coli bacteria (Escherichia coli). What types of human insulin are available? Human insulin is available in two forms, a short acting (regular) form and an intermediate acting (NPH) form. NPH (Neutral Protamine Hagedorn) insulin, also known as isophane insulin, is a suspension meaning that the insulin vial should be rolled or repeatedly turned upside down to ensure the solution is uniformly cloudy. Some examples of human insulin: Regular (short acting): Humulin S, Actrapid, Insuman Rapid NPH (intermediate acting): Humulin I, Insuman basal, Insulatard Premixed human insulins: Humulin M2, M3 and M5, Insuman Comb 15, 25 and 50 What are premixed human insulins? Premixed insulins consist of a mix of regular and NPH insulin. The premixed insulins are available in a number of different ratios of mixing. For example Humulin M3 is a mix of 30% short acting to 70% intermediate whereas Humulin M5 is made up of 50% of both short and intermediate acting. In recent years there has been a trend to replace human insulins with newer premixed analogue insulins. How quickly do human insulins act? Short acting (regular) insulin starts to act from about 30 minutes after injecting, with their peak action occurring between 2 and 3 hours after injecting. The duration is up to 10 hours. Intermediate acting (NPH) insulin takes about 2 to 4 hours to start acting, h Continue reading >>

When You Can't Afford The Insulin That You Need To Survive | How To Use The Cheap

When You Can't Afford The Insulin That You Need To Survive | How To Use The Cheap "old-school" Insulin

Note: BootCamp for Betics is not a medical center. Anything you read on this site should not be considered medical advice, and is for educational purposes only. Always consult with a physician or a diabetes nurse educator before starting or changing insulin doses. Did you know that all type 1 diabetics and some type 2 diabetics need injectable insulin in order to live? Put another way, if a diabetic needs insulin in order to live, and the diabetic does not get insulin, the diabetic will die. Diabetic death from Diabetic Ketoacidosis is a grisly process, during which acid starts running through your bloodstream, searing your vessels and organs while your body shrivels up in dehydration as it tries to push the acid out of your body through your urine and lungs, and, left untreated, the condition shuts down your organs one by one until you are dead. If you're lucky, your brain will be the first thing to swell itself into a coma and you'll be unconscious for the remainder of the organ failures. In some cases, this grisly diabetic death can take a few days or weeks to complete its process. Or, if you're one of the luckier less-resistant insulin-dependent type 2 diabetics, you may actually get away with staying alive for quite a few years and suffer only some heart disease, stroke, kidney damage/failure, neuropathy, limb amputations and blindness. (my intent in describing how lack of insulin leads to death is not to cause fear in people with diabetes or their loved ones; rather, my intent is to make clear the reality that injectable insulin is absolutely vital to diabetics who depend on injectable insulin to live) While I'd love to go off on a political rant about how insulin should be a basic human right for all insulin-dependent diabetics (and why the hell isn't it?), that' Continue reading >>

Diabetes Management

Diabetes Management

There are four main types of insulin, as well as insulin combination medications. The four main types are: Insulin was once obtained exclusively from pig or cow pancreas. Today, regular and intermediate-acting insulins are referred to as human insulins, because they are manufactured to be identical to the insulin produced by the human pancreas. Rapid- and long-acting insulins are chemically modified forms of human insulin. Most individuals need to use more than one type of insulin, so they either mix two types of insulin together or buy prepared (premixed) insulin mixtures. The insulin types differ in three ways: Onset—the length of time it takes for the insulin to reach the bloodstream and begin lowering blood glucose. Peak activity—the period of time during which insulin has its maximum effect in lowering blood glucose. Duration—the amount of time the insulin continues to lower blood glucose. Regular or short-acting insulin This type of insulin is manufactured to be similar to the insulin produced in the human body. Popular brands have an "R" (for regular) in their names, for example, Humulin R and Novolin R. Regular insulin is typically injected 30–60 minutes before meals and usually reaches the bloodstream within 30 minutes, in time to cover the rise in blood glucose that begins after food is eaten. Insulin action peaks one and a half to two hours after injection and the effects last about eight to 10 hours. Rapid-acting insulin Insulin aspart (Novolog), insulin lispro (Humalog), and insulin glulisine (Apidra) are called insulin analogues, because their chemical structure is a modified form of human insulin that is designed to work more quickly and peak faster than regular insulin. These manufactured insulins are safer to use because they work more closely t Continue reading >>

How To Prepare Two Types Of Insulin In One Syringe

How To Prepare Two Types Of Insulin In One Syringe

A step-by-step guide to combine two types of insulin in a single syringe ​People with diabetes may be prescribed two types of insulin to be taken at the same time. To reduce the number of insulin injections, it is common to combine two types of insulin in a single syringe using r​apid-acting (clear) insulin with either an intermediate or a long-acting (​​cloudy) insulin.​ ​ ​ ​​ ​ ​ ​ ​ ​ ​Follow These Steps to Prepare the Injection: Prepare your supplies and remove the insulin vials from the fridge half an hour before your injection. Check their expiry dates. Discard the vial six weeks after opening or as per the manufacturer’s guide. Roll the vial of cloudy insulin (intermediate or long-acting insulin) until the white powder has dissolved. Do NOT shake the vial. Clean the rubber stopper of the insulin vials with an alcohol wipe or a cotton ball dipped in alcohol. Draw air into the syringe by pulling the plunger down. The amount of air drawn should be equal to the dose of cloudy insulin that you require. With the vial standing upright, insert the needle into the vial containing the cloudy insulin. Inject air into the vial and remove the needle. Repeat the steps with clear insulin. Draw air into the syringe that is equal to the dose of clear insulin you require. Insert the needle into the vial containing the clear insulin and inject air into the vial. Do NOT remove the needle. With the needle in the vial, turn the syringe and insulin vial upside down, and draw out your dose of clear insulin. Read the line markings on the syringe to make sure you have drawn the correct amount of insulin. Insert the needle back into the vial containing the cloudy insulin. Do NOT push the plunger. Turn the syringe and insulin vial upside down, and draw out y Continue reading >>

Novolog Mix 70/30 Confusion

Novolog Mix 70/30 Confusion

When prescribing NovoLog® Mix 70/30 analog insulin, health care professionals may write an unclear prescription, or if using an EMR system, inadvertently select Novolin® 70/30 human insulin instead. Be on the lookout for these errors. Read on for a breakdown of the key differences between these 2 types of insulin. Before the new “insulin pens” came out, there were four types of insulin: rapid-acting, short-acting, intermediate-acting, and long-acting. When it comes to the pre-mixed insulins, like Novolog 70/30, there are fewer differences between the brands (for example, Novolog versus Novolin)…. Whether contained in a bottle or in a pen, the premixed insulins all contain a combination of both an intermediate-acting insulin and a short-acting insulin. The numbers on the bottle or pen refer to the percentage of each type of insulin contained in the mixture. That means both Novolin 70/30 and Novolog 70/30 contain a mixture that is 70% intermediate-acting insulin with 30% short-acting insulin. However, Novolin 70/30 takes slightly longer to begin working than Novolog 70/30, which has a rapid onset. Both Novolin 70/30 and Novolog 70/30 may last up to 24 hours in the system. Novolin® 70/30 is not available in a pen. Novolin is the brand name given to all human insulins made by Novo Nordisk. Under this brand are specific types of insulin such as regular, nph, and 70/30. Novolog insulin is a synthetic recombinant insulin that is very rapid acting. You may often get this question because novolog is more expensive than any of the novolins. However, they cannot be substituted for each other. Two euglycemic clamp studies assessed glucose utilization after dosing of healthy volunteers. NovoLog Mix 70/30 has an earlier onset of action than human premix 70/30 in studies of n Continue reading >>

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