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Which Insulins Should Never Be Mixed

Humalog 50-50

Humalog 50-50

HUMALOG® Mix50/50™ 50% Insulin Lispro Protamine Suspension and 50% Insulin Lispro Injection (Rdna Origin) 100 Units Per Ml (U-100) DESCRIPTION Humalog® Mix50/50™ [50% insulin lispro protamine suspension and 50% insulin lispro injection, (rDNA origin)] is a mixture of insulin lispro solution, a rapid-acting blood glucose-lowering agent and insulin lispro protamine suspension, an intermediate-acting blood glucose-lowering agent. Chemically, insulin lispro is Lys(B28), Pro(B29) human insulin analog, created when the amino acids at positions 28 and 29 on the insulin B-chain are reversed. Insulin lispro is synthesized in a special non-pathogenic laboratory strain of Escherichia coli bacteria that has been genetically altered to produce insulin lispro. Insulin lispro protamine suspension (NPL component) is a suspension of crystals produced from combining insulin lispro and protamine sulfate under appropriate conditions for crystal formation. Insulin lispro has the following primary structure: Insulin lispro has the empirical formula C257H383N65O77S6 and a molecular weight of 5808, both identical to that of human insulin. Humalog Mix50/50 vials and Pens contain a sterile suspension of insulin lispro protamine suspension mixed with soluble insulin lispro for use as an injection. Each milliliter of Humalog Mix50/50 injection contains insulin lispro 100 units, 0.19 mg protamine sulfate, 16 mg glycerin, 3.78 mg dibasic sodium phosphate, 2.20 mg Metacresol, zinc oxide content adjusted to provide 0.0305 mg zinc ion, 0.89 mg phenol, and Water for Injection. Humalog Mix50/50 has a pH of 7.0 to 7.8. Hydrochloric acid 10% and/or sodium hydroxide 10% may have been added to adjust pH. Continue reading >>

10 Steps To Prepare A Mixed Dose Of Insulin

10 Steps To Prepare A Mixed Dose Of Insulin

Many individuals that have diabetes need to take insulin in order to keep their blood sugar in a proper range. For certain individuals that can be scary, particularly the first time. You should know that insulin shots are actually not painful since the needles are thin and short. Also, the insulin shots are usually placed in the fatty tissue found below the skin. This is known as a subcutaneous injection. There are cases when the doctor prescribes a mixed insulin dose. This means that you need to take more than 1 type of insulin and you need to do that at once. With mixed dose, you will get the benefits of both longer-acting insulin and short-acting insulin without having two separate shots. In general, one of the insulin is clear and the other cloudy. Also, you should know that certain insulins cannot be mixed in one syringe. For example, you should never mix Levemir or Lantus with other solution. Always make sure to consult your diabetes educator, doctor or pharmacist before mixing. The steps below explain how to mix 2 different insulin types into one single shot properly. 10 Steps to Prepare the Injection Step #1 The first thing you need to do is prepare the supplies and remove the insulin vials from the refrigerator at least 30 minutes before the injection. Also, make sure to check the expiry dates. According to the guide of the manufacturer, you need to discard the vial 6 weeks after its first opening. Step #2 Then, the next thing you need to do is to wash your hands properly and thoroughly with soap and water. Step #3 You need to roll the vial of the cloudy insulin (long-acting or intermediate insulin) and do that until the white power dissolves. Remember, you should not shake the vial. Step #4 Dip a cotton ball in alcohol or take an alcohol wipe an clean the rubb Continue reading >>

About Fast-acting Mealtime Insulin

About Fast-acting Mealtime Insulin

What is mealtime insulin? Mealtime insulins are fast-acting insulins that are taken immediately before or after meals. As you eat, your blood sugar naturally goes up, or “spikes.” Humalog® (a fast-acting insulin) works to manage those blood sugar spikes and may help keep your sugar levels in balance. Humalog should be taken within 15 minutes before eating or right after eating a meal. People who take Humalog will usually continue to take longer-acting insulin to help manage blood sugar levels at night and between meals. Taking mealtime insulin in addition to longer-acting insulin may help to control blood sugar levels throughout the day. Low blood sugar (hypoglycemia) is the most common side effect of Humalog that may be severe and cause unconsciousness (passing out), seizures, and death. Test your blood sugar levels as your doctor instructs. Talk to your doctor about low blood sugar symptoms and treatment. The orange area shows how blood sugar levels typically rise after meals. The pattern of insulin action may vary in different individuals or within the same individual. Comparing types of insulin Take a look at our overview below to find out about the different types of insulin. You’ll notice that there are differences in when the types of insulin reach your bloodstream, when they “peak” in your body, and how long they can last (length of time the insulin keeps lowering your blood sugar). Fast-acting insulin (also called rapid-acting) is absorbed quickly and starts working in about 15 minutes to lower blood sugar after meals. Humalog fast-acting insulin should be taken 15 minutes before eating or right after eating a meal. Depending on the type of diabetes you have, you may need to take Humalog with a longer-acting insulin or oral anti-diabetes medication. Continue reading >>

Giving An Insulin Injection

Giving An Insulin Injection

Your health care provider or a certified diabetes educator (CDE) will teach you all of these steps, watch you practice, and answer your questions. You may take notes to remember the details. Know the name and dose of each medicine to give. The type of insulin should match the type of syringe: Standard insulin contains 100 units in 1 mL. This is also called U-100 insulin. Most insulin syringes are marked for giving you U-100 insulin. Every notch on a standard 1 mL insulin syringe is 1 unit of insulin. More concentrated insulins are now available. These include U-500 and U-300. Because U-500 syringes may be difficult to find, your provider may give you instructions for using U-500 insulin with U-100 syringes. Insulin syringes or concentrated insulin are now widely available. DO NOT mix or dilute their concentrated insulin with any other insulin. Some types of insulin can be mixed with each other in one syringe, but many cannot be mixed. Check with your provider or pharmacist about this. Other general tips: Always use the same brands and types of supplies. DO NOT use expired insulin. Insulin should be given at room temperature. If you had it in the refrigerator or cooler bag, take it out 30 minutes before the injection. Once you have started using a vial of insulin, it can be kept at room temperature for a month. Gather your supplies: insulin, needles, syringes, alcohol wipes, and a container for used needles and syringes. To fill a syringe with one type of insulin: Wash your hands with soap and water. Dry them well. Check the insulin bottle label. Make sure it is the right insulin. Make sure it is not expired. The insulin should not have any clumps on the sides of the bottle. If it does, throw it out and get another bottle. Intermediate-acting insulin (N or NPH) is cloudy Continue reading >>

Levemir®(insulin Detemir [rdna Origin] Injection)

Levemir®(insulin Detemir [rdna Origin] Injection)

LEVEMIR - insulin detemir injection Novo Nordisk Inc. DESCRIPTION LEVEMIR® (insulin detemir [rDNA origin] injection) is a sterile solution of insulin detemir for use as an injection. Insulin detemir is a long-acting basal insulin analog, with up to 24 hours duration of action, produced by a process that includes expression of recombinant DNA in Saccharomyces cerevisiae followed by chemical modification. Insulin detemir differs from human insulin in that the amino acid threonine in position B30 has been omitted, and a C14 fatty acid chain has been attached to the amino acid B29. Insulin detemir has a molecular formula of C267H402O76N64S6 and a molecular weight of 5916.9. It has the following structure: LEVEMIR is a clear, colorless, aqueous, neutral sterile solution. Each milliliter of LEVEMIR contains 100 U (14.2 mg/mL) insulin detemir. Each milliliter of LEVEMIR 10 mL Vial contains the inactive ingredients 65.4 mcg zinc, 2.06 mg m-cresol, 30.0 mg mannitol, 1.80 mg phenol, 0.89 mg disodium phosphate dihydrate, 1.17 mg sodium chloride, and water for injection. Each milliliter of LEVEMIR 3 mL PenFill® cartridge, FlexPen® and InnoLet® contains the inactive ingredients 65.4 mcg zinc, 2.06 mg m-cresol, 16.0 mg glycerol, 1.80 mg phenol, 0.89 mg disodium phosphate dihydrate, 1.17 mg sodium chloride, and water for injection. Hydrochloric acid and/or sodium hydroxide may be added to adjust pH. LEVEMIR has a pH of approximately 7.4. CLINICAL PHARMACOLOGY Mechanism of Action The primary activity of insulin detemir is the regulation of glucose metabolism. Insulins, including insulin detemir, exert their specific action through binding to insulin receptors. Receptor-bound insulin lowers blood glucose by facilitating cellular uptake of glucose into skeletal muscle and fat and 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 >>

What You Need To Know About Insulin

What You Need To Know About Insulin

Toxicologists, scientists, and pharmaceutical researchers have developed different types of insulin derived from and formulated with other compounds. Doctors and patients have many different types of insulin drugs to choose from including delivery methods and devices. In the past, bovine (cow) and/or porcine (pig) insulin was extracted and used to develop different classifications of insulin. While bovine and porcine (sometimes combined) insulin is similar to human insulin, their composition is a little different. Because of this, some patients’ immune systems produce antibodies making bovine and/or porcine preparations ineffective. This led researchers to investigate human insulin synthesis by developing a chemically identical drug with the help of DNA recombinant (rDNA) technology. Today, almost all insulin prescribed is recombinant DNA human. While only a brief overview of where insulin comes from is presented, it is important for you to know there are many types. Your doctor makes his or her recommendation based on your diabetes, blood glucose (blood sugar) levels, and lifestyle, and from his or her experience with the insulin. Whatever type of insulin your doctor prescribes, keep in mind that it is regulated and approved by the US Food and Drug Administration (FDA), who oversees medication safety and efficacy. Possible Insulin Complications As with any drug or treatment, side effects and complications are possible. Your doctor understands the possible risks (associated with insulin and other medications he or she prescribes. This is another reason to share your complete medical history including allergies, daily medications, and supplements (e.g., vitamins, herbs) with your doctor. Types of Insulin Considering your body’s glucose levels change in response to fo Continue reading >>

Insulin: Types

Insulin: Types

Last week, we started to take a closer look at insulin, a hormone that helps to lower blood sugar levels and a hormone that everyone needs. Insulin works much like a key, unlocking receptors that are located on cells, allowing glucose to enter and be used for energy. When the pancreas works as it should, insulin helps to regulate, or balance out, blood sugar levels. If there is more sugar in the blood than the body currently needs, the sugar gets stored in the liver as glycogen (or, if glycogen stores are full, as fat). Then, when the body needs more sugar, say, for physical activity, the liver will release glucose to provide additional fuel for the body. Types of insulin If you have Type 1 diabetes, you very likely take two types of insulin: rapid-acting or short-acting, also known as mealtime or bolus insulin, and longer-acting, also known as basal insulin. People who have Type 2 diabetes may take just one type or both types. Rapid-acting insulin. This type of insulin starts to work about 15 minutes after you inject it. It will peak about 1 hour later, but it keeps working for 2 to 4 hours. Rapid-acting insulin is generally taken right before eating a meal to “cover” the carbohydrate consumed at that meal. Rapid-acting insulin is generally the only type of insulin used in an insulin pump (longer-acting insulins are never used in a pump). Examples: aspart (brand name NovoLog), lispro (Humalog), glulisine (Apidra) Short-acting insulin. Also a type of mealtime insulin, short-acting insulin is taken about 30 minutes before a meal. It starts to work about 30 minutes after injecting, peaks 2–5 hours later, and lasts up to 12 hours. With the newer rapid-acting insulins now available that offer more flexibility, short-acting insulin isn’t used as much as it used to be Continue reading >>

Insulin Administration

Insulin Administration

Insulin is necessary for normal carbohydrate, protein, and fat metabolism. People with type 1 diabetes mellitus do not produce enough of this hormone to sustain life and therefore depend on exogenous insulin for survival. In contrast, individuals with type 2 diabetes are not dependent on exogenous insulin for survival. However, over time, many of these individuals will show decreased insulin production, therefore requiring supplemental insulin for adequate blood glucose control, especially during times of stress or illness. An insulin regimen is often required in the treatment of gestational diabetes and diabetes associated with certain conditions or syndromes (e.g., pancreatic diseases, drug- or chemical-induced diabetes, endocrinopathies, insulin-receptor disorders, certain genetic syndromes). In all instances of insulin use, the insulin dosage must be individualized and balanced with medical nutrition therapy and exercise. This position statement addresses issues regarding the use of conventional insulin administration (i.e., via syringe or pen with needle and cartridge) in the self-care of the individual with diabetes. It does not address the use of insulin pumps. (See the American Diabetes Association’s position statement “Continuous Subcutaneous Insulin Infusion” for further discussion on this subject.) INSULIN Insulin is obtained from pork pancreas or is made chemically identical to human insulin by recombinant DNA technology or chemical modification of pork insulin. Insulin analogs have been developed by modifying the amino acid sequence of the insulin molecule. Insulin is available in rapid-, short-, intermediate-, and long-acting types that may be injected separately or mixed in the same syringe. Rapid-acting insulin analogs (insulin lispro and insulin a Continue reading >>

Insulin (medication)

Insulin (medication)

"Insulin therapy" redirects here. For the psychiatric treatment, see Insulin shock therapy. Insulin is used as a medication to treat high blood sugar.[3] This includes in diabetes mellitus type 1, diabetes mellitus type 2, gestational diabetes, and complications of diabetes such as diabetic ketoacidosis and hyperosmolar hyperglycemic states.[3] It is also used along with glucose to treat high blood potassium levels.[4] Typically it is given by injection under the skin, but some forms may also be used by injection into a vein or muscle.[3] The common side effect is low blood sugar.[3] Other side effects may include pain or skin changes at the sites of injection, low blood potassium, and allergic reactions.[3] Use during pregnancy is relatively safe for the baby.[3] Insulin can be made from the pancreas of pigs or cows.[5] Human versions can be made either by modifying pig versions or recombinant technology.[5] It comes in three main types short–acting (such as regular insulin), intermediate–acting (such as NPH insulin), and longer-acting (such as insulin glargine).[5] Insulin was first used as a medication in Canada by Charles Best and Frederick Banting in 1922.[6] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[7] The wholesale cost in the developing world is about US$2.39 to $10.61 per 1,000 iu of regular insulin and $2.23 to $10.35 per 1,000 iu of NPH insulin.[8][9] In the United Kingdom 1,000 iu of regular or NPH insulin costs the NHS 7.48 pounds, while this amount of insulin glargine costs 30.68 pounds.[5] Medical uses[edit] Giving insulin with an insulin pen. Insulin is used to treat a number of diseases including diabetes and its acute complications such as diabetic ketoacid Continue reading >>

High-alert Medications - Levemir (insulin Detemir)

High-alert Medications - Levemir (insulin Detemir)

The leaflets are FREELY available for download and can be reproduced for free distribution to consumers. Or, if you are a facility or organization, you can order professional pre-printed leaflets shipped directly to you. Extra care is needed because Levemir 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 Levemir When taking your medicine 1. Know your insulin. Levemir is a long-acting insulin that should be injected below the skin once or twice daily. (When taken in smaller doses, Levemir may be considered an intermediate-acting insulin.) When Levemir is taken once daily, inject the insulin with the evening meal or at bedtime. When taken twice daily, the evening dose should be taken with the evening meal, at bedtime, or 12 hours following the morning dose. 2. Prepare your insulin. A rapid- or short-acting insulin is often prescribed with Levemir. However, Levemir should never be mixed in the same syringe with other insulins before injection. Do not vigorously shake insulin before use. 3. Don't reuse or recycle. Discard used syringes/needles, pens, and lancets in a sealable hard plastic or metal container (e.g., empty detergent bottle, sharps container from your pharmacy). When the container is full, seal the lid before placing it in the trash. Don't 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. t Avoid mix-ups. If you use more t 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 >>

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: 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 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 >>

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