Why is insulin drawn clear to cloudy?

[Cell-Nurse]

I have a question for my fellow nurses, one I have had since nursing school. A question I have asked fellow nurses throughout my nursing career with no answer to my question.

A simple question of why, when drawing up two different insulin's is the clear(regular) drawn up before the cloudy (nph, lantus, etc.)?

Is there any evidence based reasoning to this practice?

From what I can understand, it is done so that the regular insulin is not contaminated by the cloudy insulin.

IMO however, cloudy should be drawn up first. If I contaminate the clear insulin I will actually be able to visually tell because the bottle of clear insulin will turn cloudy. Yes, this means the bottle is now contaminated & must be disposed of but I much rather dispose of a bottle of insulin than give my patient the wrong dosage of medicine or NPH that was contaminated by regular insulin that I am unable to tell since I could pump a whole syringe full of regular into NPH & no-one would ever be able to tell.

Also, regular is rapid onset & hits the body much harder & faster than the longer acting NPH. If a patient was to get a few extra units of NPH, likely the patient would be no worse for wear. At best, I might have to babysit them for a shift & monitor their levels. However, depending on a patients insulin sensitivity. 1-3 units of regular can drop a patient by 50-150.

Maybe another nurse can help me out, because the best answer I have gotten is "its just the way it is done" I would really like to know the reasoning behind it. Thank's

[TheCommuter, BSN, RN]

We draw up the clear insulin first due to the following rationale:

1. Clear insulin will not significantly impact the action of cloudy insulin if we draw it up before drawing the cloudy insulin.

2. On the other hand, even minute amounts of cloudy insulin will slow down the action of clear insulin if we draw the cloudy insulin first.

3. The overarching point of drawing up 'clear before cloudy' is to prevent altering of the action of both insulins so they act as intended in our patients' bodies.

[Cell-Nurse]

Sorry, can you clarify this?

They are going to mix in the syringe. How does drawing one up before the other impact the other at all when they are simply going to mix anyways?

[RNcali22]

I would think it's so that if you get any in the vial that will be used again you have less concerns when going clear to cloudy

[NurseKatie08, MSN]

I have a question for my fellow nurses, one I have had since nursing school. A question I have asked fellow nurses throughout my nursing career with no answer to my question.

A simple question of why, when drawing up two different insulin's is the clear(regular) drawn up before the cloudy (nph, lantus, etc.)?

Is there any evidence based reasoning to this practice?

From what I can understand, it is done so that the regular insulin is not contaminated by the cloudy insulin.

IMO however, cloudy should be drawn up first. If I contaminate the clear insulin I will actually be able to visually tell because the bottle of clear insulin will turn cloudy. Yes, this means the bottle is now contaminated & must be disposed of but I much rather dispose of a bottle of insulin than give my patient the wrong dosage of medicine or NPH that was contaminated by regular insulin that I am unable to tell since I could pump a whole syringe full of regular into NPH & no-one would ever be able to tell.

Also, regular is rapid onset & hits the body much harder & faster than the longer acting NPH. If a patient was to get a few extra units of NPH, likely the patient would be no worse for wear. At best, I might have to babysit them for a shift & monitor their levels. However, depending on a patients insulin sensitivity. 1-3 units of regular can drop a patient by 50-150.

Maybe another nurse can help me out, because the best answer I have gotten is "its just the way it is done" I would really like to know the reasoning behind it. Thank's

Others have answered your question well. Just wanted to point out that Lantus, as you mentioned, is NOT cloudy, and should never ever be mixed with other insulin in the same syringe!

[TheCommuter, BSN, RN]

They are going to mix in the syringe. How does drawing one up before the other impact the other at all when they are simply going to mix anyways?

Sometimes the clear insulin will be administered unmixed by itself, e.g. during sliding scale meal coverage. Hence, it is important to not contaminate the clear insulin.

[loriangel14, RN]

The Commuter explained it perfectly. That is the way it was explained when I was in school.

[blondy2061h, MSN, RN]

I have mixed insulin exactly never in my career. Is this still a common practice elsewhere?

[TheCommuter, BSN, RN]

I have mixed insulin exactly never in my career. Is this still a common practice elsewhere?

It is allowed per the policies and procedures at my workplace. It is done mostly for the patient's comfort...to keep from sticking them twice to administer two injections (one of regular and one of NPH).

[heron, ASN, RN]

OP, think of it this way: it's not about what happens in the syringe. It's about what happens in the multiple dose vial from which you are drawing. It's considered safer to contaminate a longer acting insulin with trace amounts of shorter-acting than the other way around. Given that lantus is being used more widely and cannot be combined with any other insulin, drawing up more than one insulin in the same syringe is not as common as it used to be.

[amzyRN]

I don't mix them either. I give them separately. I was taught the clear before cloudy thing in nursing school, but I think it's better to just give them separately. Two small injections is not that bad.

[Cell-Nurse]

Does anyone have any peer reviewed publications that I could read regarding this topic?