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Why Do You Draw Up Short Acting Insulin Before Long Acting?

​insulin Syringe Preparation: How To Mix Short- And Intermediate-acting Insulin

​insulin Syringe Preparation: How To Mix Short- And Intermediate-acting Insulin

​Nurses from the Department of Specialty Nursing, Singapore General Hospital, a member of the SingHealth group, share the right way of mixing short-acting (clear) and intermediate-acting (cloudy) insulin for injection. How to mix short-acting (clear) insulin and intermediate-acting (cloudy) insulin Step 1: Roll and clean ​ Wash and dry your hands. Roll the cloudy (intermediate-acting) bottle of insulin between your palms 10 times gently. Do not shake vigorously. Clean the top of vial with an alcohol swab. Step 2: Add air to cloudy (intermediate-acting) insulin ​ Draw the required amount of air (equal to the dosage of cloudy insulin) into the insulin syringe. Inject air into the cloudy insulin vial. Do not draw out any insulin, and remove the syringe and needle. Step 3: Add air to clear (short-acting) insulin ​ Using the same syringe and needle, draw the required amount of air (equal to the dosage for clear insulin) into the insulin syringe. Inject air into the clear insulin vial. Step 4: Withdraw clear (short-acting) insulin first, then cloudy (intermediate-acting) insulin ​ With the insulin syringe and needle attached, turn the clear insulin bottle upside down, with the needle bevel within the insulin, withdraw the required amount of clear insulin into the syringe. Then do the same with the cloudy insulin. Always withdraw clear insulin first before withdrawing cloudy insulin. Ensure the total dose of clear and cloudy insulin is correct. If overdrawn, discard and repeat. "Not all types of insulin are suitable to be mixed. If in doubt, please check with your pharmacist or diabetes nurse educator," say nurses from the Department of Specialty Nursing, Singapore General Hospital (SGH), a member of the SingHealth group. Reminders: Look out for the expiry date on th 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 >>

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 >>

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 >>

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 >>

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 Therapy

Insulin Therapy

Why do I need to take insulin? When you digest food, your body changes most of the food you eat into glucose (a form of sugar). Insulin allows this glucose to enter all the cells of your body and be used as energy. When you have diabetes, your body doesn’t make enough insulin or can’t use it properly, so the glucose builds up in your blood instead of moving into the cells. Too much glucose in the blood can lead to serious health problems. All people who have type 1 diabetes and some people who have type 2 diabetes need to take insulin to help control their blood sugar levels. The goal of taking insulin is to keep your blood sugar level in a normal range as much as possible so you’ll stay healthy. Insulin can’t be taken by mouth. It is usually taken with injections (shots). It can also be taken with an insulin pen or an insulin pump. How often will I need to take insulin? You and your doctor will develop a schedule that is right for you. Most people who have diabetes and take insulin need at least 2 insulin shots a day for good blood sugar control. Some people need 3 or 4 shots a day. Do I need to monitor my blood sugar level? Yes. Monitoring and controlling your blood sugar is key to preventing the complications of diabetes. If you don’t already monitor your blood sugar level, you will need to learn how. Checking your blood sugar involves pricking your finger to get a small drop of blood that you put on a test strip. You can read the results yourself or insert the strip into a machine called an electronic glucose meter. The results will tell you whether or not your blood sugar is in a healthy range. Your doctor will give you additional information about monitoring your blood sugar. When should I take insulin? You and your doctor should discuss when and how you Continue reading >>

Everything You Ever Wanted To Know About Injecting Insulin…

Everything You Ever Wanted To Know About Injecting Insulin…

But Didn’t Know to Ask Just take your shot. What could be easier, right? Well, you’d be surprised how many errors are made by “veteran” insulin users. It turns out there’s nothing basic about the basics of insulin injections. However, you can improve your technique. This article takes a look at the nitty-gritty details behind successful insulin delivery, why they matter, and how to avoid common pitfalls. The gear Realistically, there are two delivery systems when it comes to injecting insulin: syringes and pens. Yes, there are pumps, but that’s a whole other subject. And yes, there are jet injectors, but they are not widely used. Syringes. The first-ever human insulin shot was delivered by syringe in 1922, and here in the United States, more than half of all insulin is still delivered via syringe. Syringes used to be made of glass, had to be sterilized between uses, and had long, thick, steel surgical needles that could be resharpened on a kitchen whetstone. (No kidding.) But syringes have come a long way since then. Syringes are now disposable, the barrels are made of plastic, and the needles are thin, high-tech, multi-beveled, and coated with lubricants to make them enter the skin smoothly. (Bevels are the slanted surfaces on a needle that create a sharp point.) In the old days, the needle and the syringe were separate components. Nowadays most insulin syringes come with the needle attached. People who use syringes almost always purchase insulin in vials. Vials are glass bottles that generally hold 1,000 units of insulin. Pens. Insulin pens date from the mid-1980s, and while syringes still predominate in the United States, much of the rest of the world has traded in syringes for insulin pens. Pens currently come in two varieties: disposable, prefilled pens Continue reading >>

Giving An Insulin Injection

Giving An Insulin Injection

GENERAL INFORMATION: What are the types of insulin syringes? Insulin syringes come in different sizes depending on the dose of insulin you need. Use the correct size syringe to make sure you get the right dose of insulin. Your caregiver or pharmacist will help you find the right size syringe for you. The following are general guidelines: If your dose is 50 to 100 units, use a 1 mL syringe. If your dose is 30 to 50 units, use a 1/2 mL syringe. If your dose is less than 30 units, use a 3/10 mL syringe. Where do I inject insulin? Inject insulin into the fat layer just under your skin. If the insulin is injected into the muscle, it gets absorbed into the blood stream too fast. You can inject insulin into your abdomen, outer upper arm, buttocks, hip, and the front and side of the thigh. Insulin is absorbed quickest when it is given in the abdomen. Use a different spot each time you give yourself an injection. This helps prevent changes to your skin such as lumps, swelling, or thickened skin. Do not inject insulin into areas where you have skin changes. It may not be absorbed well in these areas. If you use only 1 type of insulin at a time, do the following: Gather your insulin supplies: Get your insulin bottle, syringe, and alcohol pads. Check the insulin label to make sure it is the right kind of insulin. Rapid and short-acting insulin should be clear with no particles. Do not use the insulin if there are clumps or particles in it. Gently mix intermediate or long-acting insulin: These must be mixed before they are given. Turn the bottle on its side and roll it between the palms of your hands. Do not shake the bottle because shaking can make the insulin clump together. You do not need to mix the short-acting insulin. Prepare the insulin bottle: If the insulin bottle is new, Continue reading >>

Proper Use

Proper Use

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

Insulin

Insulin

Sources There’s pork insulin which is almost nonexistent at this point. Pork insulin differs from human insulin by only two amino acids. Most of the insulin is now bio-genetic insulin (“human insulin”) which comes from E. coli bacteria. Human insulin is now cheap enough to drive pork insulin out of the market although it’s still available. Reactions: Lipodystrophy can develop, which is a fat bump under the skin that occurs from constantly injecting from the same place. To prevent this you must rotate the injection sites. Varieties U-100: When we administer insulin, we administer it in units. Insulins can come in a variety of unit concentrations but most of them are U-100 insulin. That means 100 units per milliliter. If you look at an insulin syringe, it has number markings on it. Those numbers indicate the units. 1 unit is a tenth of a cc. (1 unit = 0.01cc) U-500: There’s another type of insulin you may see a couple times a year in your patients which is a U-500 insulin. That’s 500 units per ml. These patients have a severe form of diabetes that requires more than 100 units of injection. If the patient needs 150 units of insulin, you don’t want to use two injections, so you would use U-500 insulin, which is five times more concentrated and can fit into one syringe. When a pharmacy sends a U500 vial to the nursing floor and it goes in the refrigerator, they put fluorescent stickers all over this vial to warn you that this is U500 insulin. If you draw up 30 units for a patient and it’s accidentally U500 instead of U100, that’s 150 units of insulin and they can become hypoglycemic and die. Ultra-short acting insulin: Lispro (Humalog) works in a matter of minutes and just for an hour or two. Rapid/Short acting insulin: Regular insulin works in a matter of 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 >>

How To Prepare Two Types Of Insulin In One Syringe

How To Prepare Two Types Of Insulin In One Syringe

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

Giving Yourself An Insulin Shot For Diabetes

Giving Yourself An Insulin Shot For Diabetes

For those with diabetes, an insulin shot delivers medicine into the subcutaneous tissue -- the tissue between your skin and muscle. Subcutaneous tissue (also called "sub Q" tissue) is found throughout your body. Please follow these steps when using an insulin syringe. Note: these instructions are not for patients using an insulin pen or a non-needle injection system. Select a clean, dry work area, and gather the following insulin supplies: Bottle of insulin Sterile insulin syringe (needle attached) with wrapper removed Two alcohol wipes (or cotton balls and a bottle of rubbing alcohol) One container for used equipment (such as a hard plastic or metal container with a screw-on or tightly secured lid or a commercial "sharps" container) Wash hands with soap and warm water and dry them with a clean towel. Remove the plastic cap from the insulin bottle. Roll the bottle of insulin between your hands two to three times to mix the insulin. Do not shake the bottle, as air bubbles can form and affect the amount of insulin withdrawn. Wipe off the rubber part on the top of the insulin bottle with an alcohol pad or cotton ball dampened with alcohol. Set the insulin bottle nearby on a flat surface. Remove the cap from the needle. If you've been prescribed two types of insulin to be taken at once (mixed dose), skip to the instructions in the next section. Draw the required number of units of air into the syringe by pulling the plunger back. You need to draw the same amount of air into the syringe as insulin you need to inject. Always measure from the top of the plunger. Insert the needle into the rubber stopper of the insulin bottle. Push the plunger down to inject air into the bottle (this allows the insulin to be drawn more easily). Leave the needle in the bottle. Turn the bottle an 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 >>

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