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 breakfast daily”
You’re giving a total of 22 units (10 Regular & 12 NPH)
As the nurse, it is important to know the peak times of the insulin you are giving because this is the most likely time the patient could experience HYPOGLYCEMIA.
- Regular insulin has an onset of 30 minutes, peak 2 hours, and duration of 8 hours
- NPH insulin has an onset of 2 hours, peak 8 hours, and duration of 16 hours
Learn these insulin mnemonics to remember the onset, peak, and duration times.
2. Wash your hands and don gloves!
3. Roll the “cloudy” insulin vial in between the palms of the hands to mix the ingredients because if you don’t mix the contents it can alter how much cloudy insulin you are actually drawing up. DON’T SHAKE the vial because this will cause air bubbles!
4. Clean off tops of vials with alcohol prep for 5 to 10 seconds.
5. Remove cap from syringe.
6. Inject 12 units of air into the Humulin-N vial & then remove syringe from vial.
7. Inject 10 units of air into the Humulin-R vial & turn bottle upside down (while syringe still inserted into the bottle) and then withdraw 10 units of clear insulin…REMOVE SYRINGE.
8. Insert syringe into Humulin-N and turn bottle upside down and remove TOTAL UNITS NEEDED by pulling the plunger to 22 units (this will equal removing 12 units of Humulin-N)
9. Recap the needle using the one-hand scoop technique…if not using immediately.
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Your doctor or diabetes educator may ask you to mix 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. 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. Diabetes Center
This video is intended as a tool to help you to better understand the procedure that you are scheduled to have or are considering. It is not intended to replace any discussion, decision making or advice of your physician.
Premixing short- and intermediate-acting insulins in one syringe, with refrigerated storage before injection, is practised by some centres in the treatment of older patients with non-insulin-dependent diabetes. Because other studies have reported the loss of the short-acting insulin component after mixing with intermediate-acting insulins, we examined the clinical effect of mixing soluble insulin with lente or isophane insulins in subjects with non-insulin-dependent diabetes. When soluble and lente insulins were mixed in the same syringe and injected immediately, the peak level of insulin was very similar to the peak level after separate injections but occurred at five hours instead of three hours after the injection. As a result, the plasma free-insulin profile over three hours was lower with premixed insulin than after separate injections of the two insulins (incremental insulin area, 88 +/- 20 mU.L-1.h, and 129 +/- 37 mU.L-1.h, respectively; P less than 0.05). This delay in the absorption of soluble insulin caused a greater rise in plasma glucose levels such that the incremental glucose area over eight hours was 25.5 +/- 4.4 mmol.L-1.h for premixed insulin compared with 10.4 +/- 6.2 mmol.L-1.h for separate injections (P less than 0.05). Soluble and isophane insulins had similar absorption profiles whether injected separately or premixed (incremental insulin area, 0 to 3 h, 176 +/- 44 mU.L-1.h and 156 +/- 29 mU.L-1.h, respectively). Our results indicate that the absorption of soluble insulin is delayed when it is mixed with lente insulin but not with isophane insulin. Even in subjects with endogenous insulin secretion, this effect may have clinical importance and should be taken into account when insulin therapy is adjusted for patients with non-insulin-dependent diabetes.
Insulin is a hormone that people use to treat diabetes. Mixing types of insulin can give certain people better control of their blood sugar levels.
The pancreas produces insulin to help fat, liver, and muscle cells absorb glucose from the bloodstream. However, if a person does not have or cannot use enough insulin, they can become hyperglycemic.
Hyperglycemia is when a person has high levels of blood sugar. Without treatment, hyperglycemia can be life threatening.
A person who has diabetes has an issue with how their body uses insulin. This means that a person with diabetes may need to have shots of insulin to maintain normal blood sugar levels.
Mixing insulin can help control blood sugar in certain people who have diabetes.
Read on to learn more about mixing insulin, including how to do it and different types.
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Self-mixing insulin allows a person to adjust the levels of different types of insulin that they receive. This can allow a person to have greater control over their blood sugar levels.
A person may find that mixing insulin is beneficial to them if they:
- have regular mealtimes
- want to be able to adjust the levels of the different insulins they receive as required
- prefer only to take two injections per day
Self-mixing insulin requires a person to inject themselves with two types of insulin in one injection.
The types of insulin people can use are intermediate-acting insulin and short- or rapid-acting insulin. These insulins take different lengths of time to work, helping a person’s blood sugar levels to remain steady throughout the day.
A person can mix the two insulins in the following way:
- Draw the short- or rapid-acting insulin into the syringe first. This insulin is clear.
- Before drawing the cloudy intermediate insulin into the syringe, roll it gently between the palms 10–20 times. This helps to mix the insulin suspension gently.
- Once the cloudy insulin is mixed, draw it into the syringe with the clear insulin.
- Inject the insulin mixture immediately.
A person can follow these instructions to inject insulin:
Learn more about the best insulin injection sites here.
Premixed insulin is a pre-prepared mixture of different insulins. Premixed insulin generally contains 70–75% intermediate-acting insulin and 25–30% short- or rapid-acting insulin.
A person may prefer to use premixed insulin if they:
- find it difficult to measure and draw up the insulin themselves
- prefer the convenience of a premade solution
- have variable eating and exercise patterns
However, a person is unable to adjust premixed insulin. This means that if a person increases their pre-dinner dose of premixed insulin to offset high blood sugar levels before going to bed, they are at risk of overnight hypoglycemia. Hypoglycemia is when a person’s blood sugar levels drop too low.
A person should store their insulin in a refrigerator. They may want to let their insulin warm up at room temperature before injecting it. People should avoid storing insulin in the freezer as this can damage the insulin.
Once opened, a vial of insulin can last for around 28 days at room temperature.
Different types of insulin may require different storage instructions. A person should discuss storage instructions with a healthcare professional.
A person should not use insulin that has passed its expiry date.
There are several different types of insulin, including:
- Rapid-acting insulin: This form of insulin starts to work around 15 minutes after injection. Rapid-acting insulin peaks after about 2 hours and can last between 2–4 hours.
- Short-acting or regular insulin: Short-acting insulin takes around 30 minutes to work. It peaks 2–3 hours after injection and lasts 3–6 hours.
- Intermediate-acting insulin: This insulin takes around 2–4 hours to work. It peaks after 4–12 hours and can be effective for around 12–18 hours.
- Long-acting insulin: This form of insulin reaches the bloodstream after several hours. Long-acting insulin can work for up to 24 hours after injection.
- Ultra-long-acting insulin: This insulin reaches the bloodstream in 6 hours and does not peak. It can last up to 36 hours after injection.
Information from the American Diabetes Association suggests that, on average, a person with diabetes spends $9,601 per year in medical expenses related to diabetes.
Regular insulin can cost between $25–100 per vial. Human insulin analogs can cost between $174–300 per vial. A human insulin analog can be faster acting and more predictable than regular insulin.
A person who does not have insurance, or is struggling to pay for diabetes treatment, may find the following resources useful:
- getinsulin.org
- insulinhelp.org
- jdrf.org
Mixing insulin can be an effective way for a person to control their blood sugar levels. However, if a person does not have regular mealtimes, mixed insulin may not be right for them.
A person should speak with a doctor before using mixed insulin. A person should also speak with a doctor about what dose of each insulin to use.
If a person is having trouble affording treatment for their diabetes, several resources can help them.