Which Insulins Should Never Be Mixed

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 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 >>

Steps For Preparing A Mixed Dose Of Insulin

XIAFLEX® is a prescription medicine used to treat adults with Dupuytren's contracture when a "cord" can be felt. It is not known if XIAFLEX® is safe and effective in children under the age of 18. Do not receive XIAFLEX® if you have had an allergic reaction to collagenase clostridium histolyticum or any of the ingredients in XIAFLEX®, or to any other collagenase product. See the end of the Medication Guide for a complete list of ingredients in XIAFLEX®. XIAFLEX® can cause serious side effects, including: Tendon rupture or ligament damage. Receiving an injection of XIAFLEX® may cause damage to a tendon or ligament in your hand and cause it to break or weaken. This could require surgery to fix the damaged tendon or ligament. Call your healthcare provider right away if you have trouble bending your injected finger (towards the wrist) after the swelling goes down or you have problems using your treated hand after your follow-up visit Nerve injury or other serious injury of the hand. Call your healthcare provider right away if you get numbness, tingling, increased pain, or tears in the skin (laceration) in your treated finger or hand after your injection or after your follow-up visit Hypersensitivity reactions, including anaphylaxis. Severe allergic reactions can happen in people who receive XIAFLEX® because it contains foreign proteins. Call your healthcare provider right away if you have any of these symptoms of an allergic reaction after an injection of XIAFLEX®: hives swollen face breathing trouble chest pain low blood pressure Increased chance of bleeding. Bleeding or bruising at the injection site can happen in people who receive XIAFLEX®. Talk to your healthcare provider if you have a problem with your blood clotting. XIAFLEX® may not be right for you. Befor Continue reading >>

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 >>

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 >>

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 >>

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

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 >>

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 >>

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 >>

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 >>

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 >>

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 >>

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 >>

Long-Acting Insulins Useful Tools in Type 1 and Type 2 Diabetes

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 >>