Proper insulin combining?

[danursern]

I also need this I need a how to paper on proper insulin combining and what insulins cannot be mixed with each other?

I've witness nurses incorrectly drawing cloudy before clear, and mixing Regular with lantus. I know you pull up the clear before cloudy as to not contaminate the Regular with long acting, but oters do not. I need to get this info out to the staff, because if I witness two I know there is more doing it. We use lots of agency and I do not know what they are doing. Not to knock agency or anything, this was our own facility nurses I witness doing it incorrectly.

Darcy

[oldnurse newnurse]

How about contacting your facilitiy pharmacy and ask them to send some postable info about insulin administration and proper procedure for mixing. This may help a little and at the same time may not offend anyone.

Well, Goodluck.

[oldnurse newnurse]

Besides Lantus being amazing what else do you want to know????? Yes it does provide 24 hr. coverage. I feel sooooooo much better on lantus,it does burn sometimes on injection, but almost everytime my husband gives me an injection of my reg, he manages to burn me with that pretty good, IT ISN'T JUST LANTUS.. But lantus has brought my numbers down. They are now lower even if I miss a dose. I can tell by my numbers and the way I feel if I miss my lantus.

I am a brittle diabetic of 23 years do you think Lantus will help me? I've had one doctor say no and the other says yes, Were you uncontrolled?

[Hairstylingnurse]

The chemical make up of lantus when mixed with another insulin changes and when injected produces a rather hard and sometimes painful marble like area in the tissue....it also negates the effect of both insulins, and the only way to soften the area so the body will absorb it is to inject more short acting insulin.....it isn't fun either way.......

:kiss Thank you, that is very intresting. It has been driving me bonkers...

[Hairstylingnurse]

Maybe it is the alcohol burning in the site. if you use alcohol and do not let it dry or wipe it off after cleaning the site it can travel into the site upon injection and burn. If this isn't the case it must be the insulin and if it is, is it supposed to burn.

Yes I definantly let it dry. I learned that while still in the hospital almost 2 yrs ago. I don't know why it burns. It burns sometimes when I self inject and not at other times.

[Hairstylingnurse]

I am a brittle diabetic of 23 years do you think Lantus will help me? I've had one doctor say no and the other says yes, Were you uncontrolled?

YES YES YES. It is really good stuff and what have ya got to lose. Everyones body is different but I believe most people on it are satisfied. I love it. Yes my sugars were majorly out of control. I still have alot of issues with my diabetes, but I'm much, much better.

[ogrern2002]

Yes I definantly let it dry. I learned that while still in the hospital almost 2 yrs ago. I don't know why it burns. It burns sometimes when I self inject and not at other times.

Do you happen to store your insulin in the fridge? A cold injection burns...I found that out the hard way myself...and it is safe to store the bottle you are using out of the fridge for up to 4 weeks. My suggestion is to draw and let it sit for 5 to 10 minutes to warm then inject. At least that is how I have done it for years and how I taught kids to do it.

[Hairstylingnurse]

I only store new insulin in the fridge, and then I take it out a few days before I'm going to start using it. I go thru insulin pretty quick with 5 injections a day.

[VickyRN, MSN, DNP, RN]

Great resource on mixing insulins

http://www.bddiabetes.com/us/demos/injecting.asp

[danursern]

I only store new insulin in the fridge, and then I take it out a few days before I'm going to start using it. I go thru insulin pretty quick with 5 injections a day.

Hello Again

Every since I posted this post on insulin I've been tearing into the PP at work. I found a lot of problems at this job. Do you know I found nurses using filter needles to give IM Tobamycin. I think it was a 18 g 1 1/2 but it was not for hypodermic use. I ask the one nurse what needle are you using she said a 25 5/8. Oh boy, two nurses one using filter needles and the other using sub Q for a IM. I have been copying PP, on lot sof issues I have here. Our PP tells how to give IM's etc. but does not give adequate needle size and gauge. At the hospital I used 22-23 g 1 1/2-2 L and 2-3cc being the limit to one site. I've passed this on to the DON. I think the policy needs to specify proper needle size, and gauge?

Anyway, I did find our policy on combining two insulins and passed it on to be inserviced.

I found our policy on DC'd orders but was wondering if it is up to date. Anyone want to share how a DC'd order is written. I am in a LTC facility and it is different from Hospitals, okay.

I think it should be written as stated verbatim on a doctors order sheet, but people are just writing a short hand version i.e. DC'D Antivert? This is inadequate to me, anyone else?

I want to soon step out of my role as floor nurse and into management like duties am I on the right track?

Thanks

[breezy5]

I was tought clear to cloudy!! Lantus is never to be mixed and cafeful what is mixed not all insulins can be.

PS does lantus have to be in the fridge after it is opened?

[candykane]

Hello Again

Every since I posted this post on insulin I've been tearing into the PP at work. I found a lot of problems at this job. Do you know I found nurses using filter needles to give IM Tobamycin. I think it was a 18 g 1 1/2 but it was not for hypodermic use. I ask the one nurse what needle are you using she said a 25 5/8. Oh boy, two nurses one using filter needles and the other using sub Q for a IM. I have been copying PP, on lot sof issues I have here. Our PP tells how to give IM's etc. but does not give adequate needle size and gauge. At the hospital I used 22-23 g 1 1/2-2 L and 2-3cc being the limit to one site. I've passed this on to the DON. I think the policy needs to specify proper needle size, and gauge?

Anyway, I did find our policy on combining two insulins and passed it on to be inserviced.

I found our policy on DC'd orders but was wondering if it is up to date. Anyone want to share how a DC'd order is written. I am in a LTC facility and it is different from Hospitals, okay.

I think it should be written as stated verbatim on a doctors order sheet, but people are just writing a short hand version i.e. DC'D Antivert? This is inadequate to me, anyone else?

I want to soon step out of my role as floor nurse and into management like duties am I on the right track?

Thanks

In my experience at LTC an order must be written to d/c any med, tx or change in plan of care. I have also been trained to aspirate Regular then NPH. Are the PP not enforced and updated at your facility? Sounds like there is a need for a Staff Development Nurse.

[auntmimi57]

In my experience at LTC an order must be written to d/c any med, tx or change in plan of care. I have also been trained to aspirate Regular then NPH. Are the PP not enforced and updated at your facility? Sounds like there is a need for a Staff Development Nurse.

And yes thinking is a good thing lol

BUT I'm now scratching my head now thinking after all of this reading..and after all the insulin injections I have administered in my Nursing days to others, I've never injected air first into an NPH (or cloudy) then I just inject in clear.

I've always done what all the others do as well and it is what I have learned, simply put Clear (Reg.) to Cloudy injecting the air into the clear first then go onto NPH (or cloudy)...with no air.

I would think after seeing the posts and even peeking at the BD demonstration link, that by injection air into the NPH (or cloudy) insulin first then air into clear regular - although the cloudy is not being "mixed" the needle is still in the bottle and may have a tad bit of NPH on the needle to put back into clear.

I think I AM thinking way too much now over a basic procedure.. but like input.

Have a super weekend everyone,

Mimi