I have a question for everyone

  1. If you were out of 50/50 insulin and had a patient with the order, what would you do? If you had no 50/50 but plenty of N and R available, would you just draw it up yourself?


    2 weeks ago one of the LPNs was out of 50/50. I am the nursing supervisor in our LTC. She needed 20 units. I told her to use 10 of N and 10 of R.

    Now there is some, um..shall we say...drama at our facility because 2 other LPNs are telling all the other nurses that the nurse I told to do that is going to lose her license because she "mixed" insulin.

    I calmed her today and even called the pharmacist at the hospital so he could tell her what she did was correct.


    I feel like beating my head against the nearest brick wall .
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  2. 12 Comments

  3. by   traumaRUs
    Okay, I'll bite - what is 50/50 insulin? I am familiar with 70/30 but not 50/50...is this new? Thanks for the information.
  4. by   southern_rn_brat
    50/50 is 50% N and 50% R
  5. by   rehab nurse
    sounds like some of the ill-informed nurses that work in my facility.

    last weekend, a CNA gave a groshong cath to a agency nurse working the ltc part of my building. nurse didn't do anything about it, and neither did the 7 nurses on the following shifts. apparently, it sat on the desk for all that time as well. eeek!

    please don't flame me....i work with some awesome ltc nurses. but i also work with some that could use a little educational updates:stone things change from decade to decade. i cringe when people don't know the difference between lortab es and vicodin es, hence giving way over 4gm of tylenol a day...and tyring to explain the difference to some nurses. or trying to explain to a nurse that aldactone is NOT an antibiotic. where's the brick wall at? i'll join you!
    Last edit by rehab nurse on Nov 20, '05
  6. by   southern_rn_brat
    dang I'm so glad somebody understood me

    I have been in LTC for 14 years and it is my heart and soul. I work and have worked with some awesome nurses!

    but sometimes...sometimes I understand why people think nursing home nurses are idiots. and believe me, I will be the first person to jump if someone at the hospital treats me or one of my nurses like we are idiots, which happens. But when we do crap like this it makes me want to scream!

    Recently I had a nurse that didnt know that oxycodone was percocet.

    But this insulin thing is really making me mad. What is infuriating me is that some of the nurses are believing this stuff, that they can't "mix" insulin. I keep asking them.."can you tell me the difference in that and giving a patient some N insulin and some R sliding scale coverage at the same time in the same syringe?" and they STILL argue that you shouldnt "mix" insulins .

    I would like to find some documentation on the net that talks about this but when I googled, all I found was about the insulin itself.

    If any educator has any info I could use, I would be very appreciative.
  7. by   Bird2
    Have you checked with your pharmacy to see if they can do some education in your facility? I would also request that the pharmacy give you a cheat sheet for each nurses station that list each insulin, compatabilities, peak times, and when they should be given. We have a similar form in front of each med book. Im sure all pharmacies have something similar available and they are usually required to give so many inservices per year.
  8. by   aquiniangrad92
    Quote from southern_rn_brat
    dang I'm so glad somebody understood me

    I have been in LTC for 14 years and it is my heart and soul. I work and have worked with some awesome nurses!

    but sometimes...sometimes I understand why people think nursing home nurses are idiots. and believe me, I will be the first person to jump if someone at the hospital treats me or one of my nurses like we are idiots, which happens. But when we do crap like this it makes me want to scream!

    Recently I had a nurse that didnt know that oxycodone was percocet.

    But this insulin thing is really making me mad. What is infuriating me is that some of the nurses are believing this stuff, that they can't "mix" insulin. I keep asking them.."can you tell me the difference in that and giving a patient some N insulin and some R sliding scale coverage at the same time in the same syringe?" and they STILL argue that you shouldnt "mix" insulins .

    I would like to find some documentation on the net that talks about this but when I googled, all I found was about the insulin itself.

    If any educator has any info I could use, I would be very appreciative.

    HELLO...in my experience....i think lantus is one of those insulin that you cant mixed with other insulin. Hope that helps..
  9. by   Audreyfay
    When regular insulin is mixed with NPH insulin and sits for awhile, the regular insulin usually becomes blunted a little. For that reason, if people are drawing up their insulin before hand and are keeping it in the refrigerator, I always tell them that they should get the insulin drawn up again before they use the last dose. The dose they are using should have sat for at least 24 hours.

    If a person who is usually using pre-drawn insulin, uses it freshly drawn up, it could peak sooner and cause insulin reactions.

    However, I would have done exactly the same thing that you did in a pinch.

    Audrey RN, CDE
  10. by   cindyRN 2006
    In small hospitals this is a common practice. You have to mix your own insulin.
  11. by   DusktilDawn
    Quote from southern_rn_brat
    dang I'm so glad somebody understood me

    I have been in LTC for 14 years and it is my heart and soul. I work and have worked with some awesome nurses!

    but sometimes...sometimes I understand why people think nursing home nurses are idiots. and believe me, I will be the first person to jump if someone at the hospital treats me or one of my nurses like we are idiots, which happens. But when we do crap like this it makes me want to scream!

    Recently I had a nurse that didnt know that oxycodone was percocet.

    But this insulin thing is really making me mad. What is infuriating me is that some of the nurses are believing this stuff, that they can't "mix" insulin. I keep asking them.."can you tell me the difference in that and giving a patient some N insulin and some R sliding scale coverage at the same time in the same syringe?" and they STILL argue that you shouldnt "mix" insulins .

    I would like to find some documentation on the net that talks about this but when I googled, all I found was about the insulin itself.

    If any educator has any info I could use, I would be very appreciative.
    Is it possible to obtain a chart in regards to insulin combinations or have some reference available for staff. Lantus (insulin glargine) cannot be mixed. Regular insulin is compatible with all other insulins. Lente and ultralente is compatible with regular and semilente. Semilente is compatible with regular and lente. Isophane (Humulin N, NPH, Novolin N) is compatible with regular only. Aspart can only be mixed with NPH insulin. Lispro is compatible Humulin N, Humulin L, Humulin U (provided the injection is administered immediately). Insulin lispro may be mixed in the same syringe with these insulins, provided that the injection is administered immediately.14 Combinations (70/30, 50/50) you would not mix also. Human insulins should not be mixed with beef or pork insulins, insulins of the same species should not be mixed.
    When regular insulin is mixed with NPH insulin and sits for awhile, the regular insulin usually becomes blunted a little. For that reason, if people are drawing up their insulin before hand and are keeping it in the refrigerator, I always tell them that they should get the insulin drawn up again before they use the last dose. The dose they are using should have sat for at least 24 hours.

    If a person who is usually using pre-drawn insulin, uses it freshly drawn up, it could peak sooner and cause insulin reactions.
    Audreyfay also brings up another good point when mixing insulins.
    Now there is some, um..shall we say...drama at our facility because 2 other LPNs are telling all the other nurses that the nurse I told to do that is going to lose her license because she "mixed" insulin.

    I calmed her today and even called the pharmacist at the hospital so he could tell her what she did was correct.
    I'm not sure why others are creating drama over this. Perhaps they need a little education in regards to insulin. Why not ask the pharmacist if he could provide written info or a chart that you can keep near where your insulins are stored and/or drawn up.

    Hate to be picky, but Percocet is a combination of oxycodone and acetaminophen. Oxycodone alone is not Percocet. Sorry pet peeve.
  12. by   AuntieRN
    From what I remember from Nsg 101 and then this semester (3rd) is that you can mix insulin from clear to cloudy I believe it is...EXCEPT Lantus can NOT be mixed with anything else. You have to change the needle before you insert it into the other vial is all. I do believe it is in my Abrahms textbook which I do not have at my finger tips this moment but when I do I will look it up again.
  13. by   Mulan
    Quote from rehab nurse
    sounds like some of the ill-informed nurses that work in my facility.

    last weekend, a CNA gave a groshong cath to a agency nurse working the ltc part of my building. nurse didn't do anything about it, and neither did the 7 nurses on the following shifts. apparently, it sat on the desk for all that time as well. eeek!
    What are you referring to? A central line that fell out?
  14. by   suebird3
    i have used 70/30, but never heard of 50/50. as for mixing "n" and "r"....do that all the time. the ones who say we can't "mix"? maybe they need a refresher course. i believe it is lantus we cannot mix with anything else....

    suebird

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