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List The Steps For Mixing A Short Acting And Long Acting Insulin In The Same Syringe

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 >>

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 >>

Special Article New Insulin Delivery Recommendations

Special Article New Insulin Delivery Recommendations

Correct technique in insulin delivery is critical for optimal control of diabetes. This article reviews the most recent studies in the field and then offers new injection and infusion recommendations for insulin users. It is meant to complement and extend the injection recommendations published in 2010.1 These latest recommendations were based on the results of the fourth Injection Technique Questionnaire (ITQ) survey (published elsewhere in this issue). From February 2014 through June 2015, 13,289 insulin-injecting patients with diabetes from 42 countries participated in the ITQ survey, one of the largest multinational studies of its kind. A smaller Infusion Technique Questionnaire survey was undertaken concurrently with the ITQ in 356 patients using continuous subcutaneous insulin infusion (CSII) in four countries and informed the drafting of the new infusion recommendations. The ITQ survey results (fo 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 >>

Intermittent Insulin Injections Insulin Overview

Intermittent Insulin Injections Insulin Overview

Insulin is the cornerstone of therapy in the management of type 1 diabetes. Insulin therapy also has a clear role in type 2 diabetes mellitus in patients with long-standing or poorly controlled disease. Since the discovery of insulin approximately 80 years ago, insulin therapy has undergone various changes in formulations with different pharmacokinetics. In the 1930s, protamine zinc insulin, the first long-acting preparation, was introduced. In the 1950s, the neutral protamine hagedorn (NPH) and insulin zinc (lente) were introduced. [1] Newer formulations have since been developed, allowing insulin to be provided in more physiologically appropriate ways. These provide more flexibility in dosing, mimic endogenous production of insulin, and lower the incidence of nocturnal hypoglycemia. [2, 3, 4] When used as monotherapy, oral hypoglycemic drugs generally lower glycated hemoglobin (HgbA1C) by only 0.5%-1.5%. Most patients with type 2 diabetes eventually require multidrug therapy or insulin. Some guidelines encourage early use of insulin if HgbA1C remains poorly controlled on maximal-dose, single-drug therapy. Insulins have varying pharmacokinetics that allow for specific products from which to choose. Table 1 provides a comparison between insulins for onset of action and duration of action. Table 2 provides a list of combination insulin products. Insulin Category Onset of Action Duration of Action Insulin aspart (NovoLog) Rapid-acting 5-15 minutes 3-5 hours Insulin aspart (Fiasp) Rapid-acting 16-20 minutes 5-7 hours Insulin lispro (Humalog) Rapid-acting 5-15 minutes 4-5 hours Insulin glulisine (Apidra) Rapid-acting 5-15 minutes 3-4 hours insulin regular (Humulin R, Novolin R) Short-acting 30-60 minutes 8-10 hours Insulin NPH (Humulin N, Novolin N) Intermediate-acting 2-4 Continue reading >>

7.3 Intradermal And Subcutaneous Injections

7.3 Intradermal And Subcutaneous Injections

Intradermal injections (ID) are injections administered into the dermis, just below the epidermis. The ID injection route has the longest absorption time of all parenteral routes. These types of injections are used for sensitivity tests, such as TB (see Figure 7.13), allergy, and local anesthesia tests. The advantage of these tests is that the body reaction is easy to visualize, and the degree of reaction can be assessed. The most common sites used are the inner surface of the forearm and the upper back, under the scapula. Choose an injection site that is free from lesions, rashes, moles, or scars, which may alter the visual inspection of the test results (Lynn, 2011). Equipment used for ID injections is a tuberculin syringe calibrated in tenths and hundredths of a millilitre, and a 1/4 to 1/2 in., 26 or 27 gauge needle. The dosage of an ID injection is usually under 0.5 ml. The angle of administration for an ID injection is 5 to 15 degrees. Once the ID injection is completed, a bleb (small blister) should appear under the skin. Checklist 56 outlines the steps to administer an intradermal injection. Disclaimer: Always review and follow your hospital policy regarding this specific skill. Do not aspirate. It is not necessary to aspirate because the dermis is relatively without vessels. Always take steps to eliminate interruptions and distractions during medication preparation. If the patient expresses concerns about the medication or procedure, stop and explore the concerns. Re-verify order with physician if appropriate. Steps Additional Information 1. Prepare medication or solution as per agency policy. Ensure all medication is properly identified. Check physician orders, Parenteral Drug Therapy Manual (PDTM), and MAR to validate medication order and guidelines for admin 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 >>

What Are The Possible Side Effects Of Insulin Glargine (lantus, Lantus Opticlik Cartridge, Lantus Solostar Pen)?

What Are The Possible Side Effects Of Insulin Glargine (lantus, Lantus Opticlik Cartridge, Lantus Solostar Pen)?

LANTUS® (insulin glargine) Injection DESCRIPTION LANTUS (insulin glargine injection) is a sterile solution of insulin glargine for subcutaneous use. Insulin glargine is a recombinant human insulin analog that is a long-acting, parenteral blood-glucose-lowering agent [see CLINICAL PHARMACOLOGY]. Insulin glargine has low aqueous solubility at neutral pH. At pH 4 insulin glargine is completely soluble. After injection into the subcutaneous tissue, the acidic solution is neutralized, leading to formation of microprecipitates from which small amounts of insulin glargine are slowly released, resulting in a relatively constant concentration/time profile over 24 hours with no pronounced peak. This profile allows oncedaily dosing as a basal insulin. LANTUS is produced by recombinant DNA technology utilizing a non-pathogenic laboratory strain of Escherichia coli (K12) as the production organism. Insulin glargine differs from human insulin in that the amino acid asparagine at position A21 is replaced by glycine and two arginines are added to the C-terminus of the B-chain. Chemically, insulin glargine is 21A-Gly-30Ba-L-Arg-3030b-L-Arg-human insulin and has the empirical formula C267H404N72O78S6 and a molecular weight of 6063. Insulin glargine has the following structural formula: LANTUS consists of insulin glargine dissolved in a clear aqueous fluid. Each milliliter of LANTUS (insulin glargine injection) contains 100 Units (3.6378 mg) insulin glargine. The 10 mL vial presentation contains the following inactive ingredients per mL: 30 mcg zinc, 2.7 mg m-cresol, 20 mg glycerol 85%, 20 mcg polysorbate 20, and water for injection. The 3 mL prefilled pen presentation contains the following inactive ingredients per mL: 30 mcg zinc, 2.7 mg m-cresol, 20 mg glycerol 85%, and water for inje Continue reading >>

What Is Rapid Or Fast-acting Insulin?

What Is Rapid Or Fast-acting Insulin?

You may take rapid acting or fast acting insulin (also known as insulin analogues) for your diabetes, either through injections prior to your meals, or in your insulin pump. You may use it alone, or in combination with other insulins and diabetes medications, including injections and pills. In a person without diabetes, the pancreas puts out small amounts of insulin, continuously bringing down blood sugars to a normal level with no difficulty. When a person has diabetes, they may not make any insulin, as occurs in Type 1 Diabetes. They may make some insulin, but it’s not working well, and it’s just not enough to bring blood sugars into a normal range, as occurs in Type 2 Diabetes. When there is no insulin, or not enough insulin, the goal is to try to simulate what the body normally does to bring down blood sugars through injections of insulin, inhaled insulin, or via an insulin pump. To do this, rapid or fast acting insulin must be taken in relation to food that is eaten in many cases. Not everyone with diabetes must take insulin to control their blood sugars, though. Let’s learn how Christie uses rapid acting insulin… Christie’s story Christie has had Type 1 Diabetes for 24 years. She uses a Medtronic insulin pump. Every day, Christie’s pump gives her fast or rapid acting insulin. This is all that insulin pumps need to control blood sugar. For Christie, she uses Humalog lispro insulin. She gets a little bit of this rapid or fast acting insulin continually through her pump via a basal. She also gets some of this insulin through her pump, in a bolus dose every time she eats a meal. In a pump, the same insulin is used all the time, and it is always rapid insulin. Christie also has a new Continuous Glucose Monitor, CGM. She has found with this new technology, s Continue reading >>

Diabetes: Giving Yourself An Insulin Shot

Diabetes: Giving Yourself An Insulin Shot

Introduction Insulin is used for people who have type 1 diabetes. It's also used if you have type 2 diabetes and other medicines are not controlling your blood sugar. If you have gestational diabetes, you may need to take insulin if diet and exercise have not helped to keep your blood sugar levels within your target range. With little or no insulin, sugar (glucose) in the blood can't enter your cells to be used for energy. This causes the sugar in your blood to rise to a level that's not safe. When your blood sugar rises past about 180 mg/dL, your kidneys start to release sugar into the urine. This can make you dehydrated. If that happens, your kidneys make less urine, which means your body can't get rid of extra sugar. This is when blood sugar levels rise. Taking insulin can prevent symptoms of high blood sugar. It can also help to prevent emergencies such as diabetic ketoacidosis (in type 1 diabetes) and hyperosmolar coma (in type 2 diabetes). Insulin can help lower blood sugar too. This can prevent serious and permanent health problems from long-term high blood sugar. Remember these key tips for giving insulin shots: Make sure you have the right dose of insulin, especially if you are giving two types of insulin in the same syringe. Practice how to give your shot. Store the insulin properly so that each dose will work the way it should. How to prepare and give an insulin injection Your health professional or certified diabetes educator (CDE) will help you learn to prepare and give your insulin dose. Here are some simple steps that can help. To get ready to give an insulin shot, follow these steps. Wash your hands with soap and running water. Dry them well. Gather your supplies. Most people keep their supplies in a bag or kit so they can take them wherever they go. You Continue reading >>

Intermittent Insulin Injectionsinsulin Overview

Intermittent Insulin Injectionsinsulin Overview

Instructions for Patients Receiving Insulin Insulin is the cornerstone of therapy in the management of type 1 diabetes . Insulin therapy also has a clear role in type 2 diabetes mellitus in patients with long-standing or poorly controlled disease. Since the discovery of insulin approximately 80 years ago, insulin therapy has undergone various changes in formulations with different pharmacokinetics. In the 1930s, protamine zinc insulin, the first long-acting preparation, was introduced. In the 1950s, the neutral protamine hagedorn (NPH) and insulin zinc (lente) were introduced. [ 1 ] Newer formulations have since been developed, allowing insulin to be provided in more physiologically appropriate ways. These provide more flexibility in dosing, mimic endogenous production of insulin, and lower the incidence of nocturnal hypoglycemia. [ 2 , 3 , 4 ] When used as monotherapy, oral hypoglycemic drugs generally lower glycated hemoglobin (HgbA1C) by only 0.5%-1.5%. Most patients with type 2 diabetes eventually require multidrug therapy or insulin. Some guidelines encourage early use of insulin if HgbA1C remains poorly controlled on maximal-dose, single-drug therapy. Insulins have varying pharmacokinetics that allow for specific products from which to choose. Table 1 provides a comparison between insulins for onset of action and duration of action. Table 2 provides a list of combination insulin products. Table 2. Insulin Combination Products (Open Table in a new window) Rapid-acting insulins with a short duration of action include insulin aspart (NovoLog), insulin lispro (Humalog), and insulin glulisine (Apidra). Their onset of action is approximately 5-15 minutes, peak action is between 30 and 90 minutes, and duration of action is approximately 4-6 hours. Regular insulin (Humul Continue reading >>

Withdrawing Solution From A Vial

Withdrawing Solution From A Vial

Vials are plastic or glass containers in which liquid or powdered medication is packaged in an airtight and sterile environment. They are sealed with a rubber stopper. You access the medication by pushing a sterile needle through the center of the stopper. Vials may be single-use, or, if a preservative has been added to the solution, multidose. When you are the first user of a multidose vial, follow your agency’s policy for labeling the vial for subsequent users. When you are a subsequent user of a multidose vial, follow your agency’s policy for determining whether the vial is acceptable to use or should be discarded. Many agencies require that a multidose vial be discarded one month after it is opened, no matter how much medication remains in the vial. Withdrawing solution from a vial To withdraw a solution from a vial, you must first pressurize the vial. To achieve this, draw air into the syringe. The amount of air should be the same as the amount of solution you’ll withdraw from the vial. For example, if you plan to draw up 1.3 mL of fluid, draw up 1.3 mL of air into the syringe. After cleansing the rubber stopper with an antimicrobial wipe and allowing it to dry, insert the needle into the center of the rubber stopper and inject all of the air into the air space inside the vial. Invert the vial and, keeping the needle below the fluid, gently draw up the solution. Tap or flick the syringe as needed to move any air bubbles to the top of the syringe so that you can eject them from the syringe. It is important to remove all air bubbles to ensure accurate measurement of the medication. Be sure to avoid bending the needle during this process. Return the vial to the upright position, withdraw the needle from the vial, and recap the needle with one hand. This “one-h Continue reading >>

My Doctor Says I Need To Mix Insulins...

My Doctor Says I Need To Mix Insulins...

Mixing Insulins BD Getting Started ™ My Doctor Says I Need to Mix Insulins... How Do I Begin? When your doctor tells you to use two types of insulin for an injection, they can be mixed in the same insulin syringe so that you will need only one injection. Using two types of insulin can help you keep your blood sugar levels in your target range. When you mix two insulins in one syringe, one type of insulin is always clear and short or rapid-acting, while the other type is cloudy and long-acting. Check that you have the right syringe size. Match your dose to the syringe size that is just right for you. It is an easy way to assure the accuracy of your dosage. Two types of Insulin BD™ Insulin Syringe BD™ Alcohol Swabs To mix your insulins, you will need:To mix your insulins, you will need: Also check that you have the right brand and type of insulin. Make sure that the expiration date on the insulin bottle has not passed. Between 30 and 50 units Between 50 and 100 units Use a 3/10 cc BD INSULIN SYRINGE Use a 1/2 cc BD INSULIN SYRINGE Use a 1 cc BD INSULIN SYRINGE Less than 30 units at one time - - - 1 2 3 if you inject:if you inject: ml ml ml 1 2 3 •Roll the bottle between your hands. •Never shake a bottle of insulin. •Wipe the top of both the insulin bottles with a BD™ ALCOHOL SWAB. step one...step one... step two...step two... step three...step three... •Wash your hands. 4 •Pull the plunger down to let _____ units of air in your syringe. •You need air in the syringe equal to the amount of cloudy insulin you will take. step four...step four... 5 6 7 8 •Push the air into the cloudy insulin bottle. •Pull the needle out of the cloudy insulin bottle. •You are not going to draw out any of the cloudy in Continue reading >>

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 >>

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 >>

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