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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 >>

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 >>

How To Draw Up Insulin

How To Draw Up Insulin

AMBULATORY CARE: Insulin should be drawn up correctly and safely. This will help prevent problems such as infection or low or high blood sugar levels. Use the correct size insulin syringe to make sure you get the right dose of insulin. For example, you must inject U100 insulin with U100 syringes. A different syringe is needed for U500 insulin. Your healthcare provider or pharmacist will help you find the right size syringe. The syringe will have measurements in mL and units. Contact your healthcare provider if: You have questions about how to draw up insulin. You cannot afford to buy your diabetes supplies. You have questions or concerns about your condition or care. How to draw up 1 type of insulin into a syringe: If you use only 1 type of insulin at a time, do the following: Remove insulin from the refrigerator 30 minutes before you will use it. Inject insulin that is room temperature. Wash your hands. This will help decrease your risk for an infection. Gather your insulin supplies. Get your insulin bottle, syringe, and alcohol pads. Check the insulin bottle to make sure it is the right type and strength of insulin. Also check the expiration date. Do not use expired 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. This can make the insulin clump together. You do not need to mix rapid or short-acting insulin. Prepare the insulin bottle. Clean the top of the insulin bottle with an alcohol pad or cotton swab dipped in alcohol. Pull air into the syringe. Remove the cap from the needle. Pull back on Continue reading >>

Types Of Insulin - Topic Overview

Types Of Insulin - Topic Overview

Insulin is used to treat people who have diabetes. Each type of insulin acts over a specific amount of time. The amount of time can be affected by exercise, diet, illness, some medicines, stress, the dose, how you take it, or where you inject it. Insulin strength is usually U-100 (or 100 units of insulin in one milliliter of fluid). Short-acting (regular) insulin is also available in U-500. This is five times more concentrated than U-100 regular insulin. Long-acting insulin (glargine) is also available in U-300. This is three times more concentrated than U-100 long-acting insulin. Be sure to check the concentration of your insulin so you take the right amount. Insulin is made by different companies. Make sure you use the same type of insulin consistently. Types of insulin Type Examples Appearance When it starts to work (onset) The time of greatest effect (peak) How long it lasts (duration) Rapid-acting Apidra (insulin glulisine) Clear 5-15 minutes 30-60 minutes 3-5 hours Humalog (insulin lispro) Clear 5-15 minutes 30-90 minutes 3-5 hours NovoLog (insulin aspart) Clear 5-15 minutes 40-50 minutes 3-5 hours Afrezza (insulin human, inhaled) Contained in a cartridge 10-15 minutes 30-90 minutes 2½-3 hours Short-acting Humulin R, Novolin R (insulin regular) Clear 30 minutes 1½-2 hours 6-8 hours Intermediate-acting Humulin N, Novolin N (insulin NPH) Cloudy 1-4 hours 4-12 hours 14-24 hours Long-acting Lantus (insulin glargine) Clear 1-2 hours Minimal peak Up to 24 hours Levemir (insulin detemir) Clear 2 hours Minimal peak Up to 24 hours Rapid-acting insulins work over a narrow, more predictable range of time. Because they work quickly, they are used most often at the start of a meal. Rapid-acting insulin acts most like insulin that is produced by the human pancreas. It quickly 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 >>

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 >>

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 >>

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 >>

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 >>

Insulin Injection: Two Bottle Injection Instructions

Insulin Injection: Two Bottle Injection Instructions

Wash your hands. Pick up the CLOUDY bottle and turn it upside down. Roll the bottle gently between your hands to mix the insulin. Wipe the top of both (clear and cloudy) bottles with alcohol. Remove the caps from the top and bottom of the syringe. Pull the plunger down to the correct unit mark for your CLOUDY insulin dose as ordered. Insert the needle into the CLOUDY bottle. Push the plunger down to inject air into the CLOUDY bottle. Withdraw the empty syringe from the bottle. Set the bottle aside. Pull the plunger down to the correct unit mark for the CLEAR insulin dose as ordered. Insert the needle into the CLEAR bottle. Push the plunger down to inject air into the CLEAR bottle. Leave the needle in the bottle. Turn the bottle upside down with the needle in it. Pull the plunger down to the correct unit mark for the CLEAR insulin dose. Look for air bubbles in the syringe. If you see air bubbles in the syringe, push the insulin back into the bottle, and repeat steps 17 and 18. Pull the bottle away from the needle, and set aside the CLEAR bottle. Pick up the CLOUDY bottle of insulin. Turn the CLOUDY bottle upside down and push the needle into the bottle. Be very careful not to move the plunger. Pull the plunger down and withdraw the correct number of units for the CLOUDY insulin. The plunger should now be on the unit mark showing the total units of both the CLEAR and CLOUDY types of insulin. For example, 6 units of CLEAR insulin are already in the syringe. Add 14 units of CLOUDY insulin for a total of 20 units in the syringe. Pull the bottle away from the needle. Set both bottles on the table. Look for air bubbles in the syringe. If you see air bubbles, discard the dose and begin again. Set the syringe down. Do not let the needle touch anything. Pinch or spread the skin a 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 >>

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 >>

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 >>

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 >>

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 >>

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