Do you mix your insulins?

luvmy2angels · Jul 30, 2006

I mix also, clear to cloudy. I always double and sometime triple check to make sure that I am giving the right amount. I don't want to have to give my patients more injections than necessary.

all4schwa · Jul 30, 2006

i would like to add that the rational for clear to cloudy is that you don't want any part of longer acting insulin to mix with the rapid, so the rapid acting remains rapid.

but i'm wondering, why exactly don't we mix lantus?

caroladybelle, BSN, RN · Jul 30, 2006

i would like to add that the rational for clear to cloudy is that you don't want any part of longer acting insulin to mix with the rapid, so the rapid acting remains rapid.
but i'm wondering, why exactly don't we mix lantus?

We do not mix lantus as it has not been approved for that use.

When drawing insulins, the clear is drawn first, because the cloudy has product in it to make it long acting, but that can also contaminate the vial of clear. If you put the needle into the cloudy and then the clear, you will contaminate the clear.

As the clear regular may be used IV, it needs to stayed uncontaminated by product that cannot go IV (NPH/cloudy cannot go IV)

mom and nurse · Jul 30, 2006

i didn't mix at first because I was not confident enough as a new RN. Now after two years :) , yes I mix my insulins to keep from giving multiple injections. I know not to mix Lantus..... I guess I've become more confident from doing the same procedure (insulin injections) over and over again.......

lisamc1RN, LPN · Jul 30, 2006

Thank you all for your input. It does make me nervous to mix the insulins but I understand that I am subjecting my patient to more discomfort.I don't want to do that at all. At my facility, insulins are not required to be checked off with another nurse before being given but I think that I will ask for one of them to observe me for the first few that I mix up until I become confident.

lisamc1RN, LPN · Jul 30, 2006

OK, OK, my head is hanging at the thought of causing unnecessary discomfort to ANY pt. I just worry that when things are really nuts (busy med/surg floor) any step in eliminating potential med error is safer than not.??

Nieuport, I totally understand how you feel. As a new nurse, I feel very overwhelmed and haven't felt like taking any chances at all. I don't want to subject the patient to two shots, but I've been so worried that I might kill them that I've asked them to let me do it that way! :)

NrsJena · Jul 30, 2006

So you subject the pt to twice as many injections? Imagine what that will do after a couple of years.
I was taught at school, clear first then cloudy. Another RN told me recently that she was taught cloudy to clear so that if she accidentally put some cloudy into the clear she would notice and would not see if it happened the other way around.

I was actually taught that by getting the "clear" mixed into the cloudy vial- wouldn't damage the insulin- but to have the "cloudy" mix-it would due to the change in the duration of action.

CritterLover, BSN, RN · Jul 30, 2006

as the clear regular may be used iv, it needs to stayed uncontaminated by product that cannot go iv (nph/cloudy cannot go iv)

i was taught that the above is the reason for mixing clear to cloudy, and nph given iv can cause an embolus (learned this from pharmacy thanks to a co-worker's unfortunate mistake)

though i rarely give any nph/70-30 insulin where i work, our facility policy is to mix regular insulin with nph.

Home Health Columnist / Guide · Jul 30, 2006

if clear and cloudy insulins are to be mixed, the clear insulin should be drawn into the syringe first.

guidelines for the pre-filling of insulin syringes october 2001

easy visual for kids/adults: mixing insulins

is it ok to mix insulins together in the same syringe ahead of time?

follow your doctor's instructions on whether to mix your insulins ahead of time or just before giving your injection. activity of the insulin mixture and storage requirements depend on the types of insulins mixed. some insulins should not be mixed together in the same syringe.

mixing insulins, a guide.

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how to mix insulins

insulin facts - onset, peak time, duration, kinds, strength ...

gemcitygirl · Jul 30, 2006

per our pharmacist, we don't mix 70/30 ,50/50 or 80/20 insulins with R when it is ordered for extra sliding scale coverage, because the pre-mixed insulins may have a stabilizer that may cause a change in the peak times of the R. Although I've always mixed NPH and R insulins, in 8 years of insanely busy shifts I've always had a second nurse check the order and my math, and actually watch me draw it up, clear before cloudy. The policy in our hospital is to have insulins countersigned by 2 nurses as well. Lantus is never to be mixed. The other insulins like Lente, etc should not be mixed unless ordered, and there are still a few people out there on animal insulin. Lispro can given in same syringe with longer acting insulins but absorption may be delayed, and Novolog (Aspart) can be mixed with NPH, but must be given immediately. This is from the Prentice Hall nurses drug guide 2005, but it sound to me like it's better to poke a patient twice if in doubt than risk a bad reaction . Good luck in your career!

purplemania, BSN, RN · Jul 30, 2006

Be careful. Read up on your drugs. The only thing that mixes with NPH is Regular. The rapid acting drugs (Apidra, Novalog and Humalog) can mix with NPH if injected immediately, but only on the advice of MD (per drug insert). Lantus & Levimir do not mix with anything.

You did not ask but I will tell you also to be aware there are two non-insulin injectables currently on the market, with more to follow. They are NOT INSULIN and do not mix with insulin and do not substitute for insulin (Byetta and Symlin). Byetta comes pre-mixed in a pen, so hard to mess that up. Symlin comes in a vial like insulin and is dosed in MICROGRAMS, not units, but you administer in a insulin syringe. A 15 mcg. dose of Symlin, if actually dosed as 15 units, would come to 90 mcg. !!!!! There is a conversion chart online at http://www.symlin.com.

As a diabetic instructor, nurse and diabetic myself, I am glad to read you are being cautious about drug administration.

lisamc1RN, LPN · Jul 31, 2006

thank you! i'm going to make print some of this out to take with me when i go back to work! :)

if clear and cloudy insulins are to be mixed, the clear insulin should be drawn into the syringe first.
guidelines for the pre-filling of insulin syringes october 2001
easy visual for kids/adults: mixing insulins
is it ok to mix insulins together in the same syringe ahead of time?
follow your doctor's instructions on whether to mix your insulins ahead of time or just before giving your injection. activity of the insulin mixture and storage requirements depend on the types of insulins mixed. some insulins should not be mixed together in the same syringe.
mixing insulins, a guide.
how to mix insulins
insulin facts - onset, peak time, duration, kinds, strength ...