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Which Insulins Should Never Be Mixed

The Abcs Of Insulin Care

The Abcs Of Insulin Care

Differing opinions about how to best care for insulin are stirring up a whirlwind of confusion. Over the last few months readers have been sending their questions and concerns to DIABETES HEALTH. The questions are simple enough: What is the best temperature to keep my insulin? Is it okay to use insulin past the expiration date? How should I mix my insulin? But answers to these questions can vary, making it hard to be sure one is doing the right thing. Here the questions and comments of insulin users will be presented with the recommendations of the companies who produce insulin. Too Hot or Too Cold? Brian Leslie, a DIABETES HEALTH on-line reader, writes: “I have had great results keeping my vial of insulin at work in my desk … However, I would imagine that taking a vial of medication and constantly fluctuating its temperature would tend to degrade its effectiveness faster.” According to Wayman Wendell Cheatham, MD, medical director at Novo Nordisk, it is okay to keep insulin in and out of the refrigerator while the vial is in use. But prior to being opened, a vial of insulin should be stored in a refrigerator. “As long as the insulin is kept away from high temperatures and freezing, a change in temperature (while in use) is not a problem,” says Dr. Cheatham. He adds that insulin should not be left in the car during the summer months even if only for a short period of time. Laura Stallman, a spokesperson for Eli Lilly and Company, agrees that moving a vial of insulin in and out of the refrigerator while in use does not affect its potency – assuming that it is used before the expiration date. Best If Used By… Eli Lilly and Novo Nordisk, the only two companies who market insulin in the United States, provide directions and expiration dates with their product. 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 >>

Novolog® Mix 70/30 Ifu

Novolog® Mix 70/30 Ifu

NovoLog® Mix 70/30 (insulin aspart protamine and insulin aspart injectable suspension) 100 U/mL Indications and Usage NovoLog® Mix 70/30 (insulin aspart protamine and insulin aspart injectable suspension) 100 U/mL is an insulin analog indicated to improve glycemic control in patients with diabetes mellitus. NovoLog® Mix 70/30 is not recommended for the treatment of diabetic ketoacidosis. The proportions of rapid-acting and long-acting insulins are fixed and do not allow for basal versus prandial dose adjustments. Important Safety Information NovoLog® Mix 70/30 is contraindicated during episodes of hypoglycemia and in patients hypersensitive to NovoLog® Mix 70/30 or one of its excipients. Never Share a NovoLog® Mix 70/30 FlexPen® Between Patients, even if the needle is changed. Patients using NovoLog® Mix 70/30 vials must never share needles or syringes with another person. Sharing poses a risk for transmission of blood-borne pathogens. Changes in insulin strength, manufacturer, type, or method of administration may affect glycemic control and predispose to hypoglycemia or hyperglycemia. Changes should be made cautiously under close medical supervision and the frequency of blood glucose monitoring should be increased. Hypoglycemia is the most common adverse effect of insulin therapy. The timing of hypoglycemia may reflect the time-action profile of the insulin formulation. Glucose monitoring is recommended for all patients with diabetes. To avoid medication errors and accidental mix-ups between NovoLog® Mix 70/30 and other insulin products, instruct patients to always check the insulin label before injection. Severe, life-threatening, generalized allergy, including anaphylaxis, may occur with insulin products, including NovoLog® Mix 70/30. As with all insulins, Continue reading >>

Humalog Mix

Humalog Mix

Generic Name: insulin lispro and insulin lispro protamine (IN soo lin LISS pro and IN soo lin LISS pro PRO ta meen) Brand Names: HumaLOG Mix 50/50, HumaLOG Mix 50/50 KwikPen, HumaLOG Mix 75/25, HumaLOG Mix 75/25 KwikPen What is Humalog Mix? Humalog Mix contains a mixture of insulin lispro and insulin lispro protamine. Insulin is a hormone that works by lowering levels of glucose (sugar) in the blood. Insulin lispro is a fast-acting insulin. Insulin lispro protamine is an intermediate-acting insulin. This combination insulin starts to work within 10 to 20 minutes after injection, peaks in 2 hours, and keeps working for up to 24 hours. Humalog Mix is used to improve blood sugar control in adults with diabetes mellitus. This medicine may be used for type 1 or type 2 diabetes. Humalog Mix may also be used for purposes not listed in this medication guide. Important information Use Humalog Mix within 15 minutes before eating a meal. Never share a Humalog Mix injection pen, cartridge, or syringe with another person, even if the needle has been changed. Sharing injection pens or cartridges can allow disease such as hepatitis or HIV to pass from one person to another. You should not use Humalog Mix is injected under the skin. if you are allergic to insulin, or if you are having an episode of hypoglycemia (low blood sugar). Before taking this medicine You should not use Humalog Mix if you are allergic to insulin lispro, or if you are having an episode of hypoglycemia (low blood sugar). Humalog Mix is not approved for use by anyone younger than 18 years old. To make sure Humalog Mix is safe for you, tell your doctor if you have: liver or kidney disease; or low levels of potassium in your blood (hypokalemia). Tell your doctor if you also take pioglitazone or rosiglitazone (sometime 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 (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 >>

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 >>

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 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 >>

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

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 >>

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 >>

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 >>

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