Diabetes Outreach Network
QUICK REFERENCE GUIDE TO DIABETES FOR HEALTH CARE PROVIDERS
Chapter
9
Education
Concerns of Insulin
Mixing Insulin
- Glargine and detemir should not be mixed with other insulins
- Regular, Lispro, Aspart, Glulisine and NPH can be mixed - some premixed insulins are available for those unable to mix insulin for themselves.
- Glulisine mixed with NPH must be injected immediately after mixing
- Always draw up Regular or rapid-acting insulin first when mixing insulins.
Insulin mixed at home should generally be administered immediately after mixing.
Storage of Insulin
- In general, insulin vials in use can be stored at room temperature (59°-86°F) for 1 month. Back stock should be kept refrigerated but never frozen. — Some analogs recommend <77°F, check package insert
- See manufacturer guidelines for cartridges, pre-filled pens.
- Avoid freezing temperatures and temperatures above 86 degrees.
- Insulin should not be left in cars or checked in airline baggage.
Do not use Insulin if:
- Sediment is present.
- Clumping or frosting is apparent.
- Clear insulin is cloudy or discolored.
- It is beyond the expiration date.
- Stored improperly.
Injecting Insulin
- Sites to use in descending order of absorption: abdomen, upper arm, anteriolateral thigh, and buttocks.
- Give injections in different areas, abdomen may be used for most injections, but rotations around abdominal area must occur. Do not inject within a 2" radius of umbilicus.
- Inject into subcutaneous tissue.
- 90 degree injection angle works for most. Children and very thing adults may need to use a shorter syringe length or 45 degree angle.
- Massaging injection site is usually not recommended.
- Avoid injecting into an area that will soon be used in an activity or one that has just been used as absorption is increased.
- Avoid injecting immediately before using sauna, hot tub, or hot shower as temperature may increase absorption speed of insulin.
Insulin and Insulin Analogs
| Type
of Insulin (Trade Name) |
Appearance |
Onset (hours) |
Peak (hours) |
Duration (hours) |
When
to administer |
Rapid
Acting |
|||||
Lispro
(Humalog®) |
Clear |
0.25
- 0.5 |
0.5
- 4 |
4
– 6 |
0
-15 min before meals* |
Aspart
(Novolog®) |
Clear |
<
0.5 |
1
- 3 |
3
– 5 |
0
-15 min before meals* |
Glulisine
(Apidra™) |
Clear |
0.25 |
0.5
– 1.5 |
3
- 5 |
0
-15 min before meals* |
Short
Acting (Regular) |
|||||
Humulin®
R, Novolin® R |
Clear |
½
- 1 |
2
- 3 |
6
- 8 |
30-45 minutes before meals |
Intermediate
Acting |
|||||
NPH,
Humulin® N, Novolin® N |
Cloudy |
2
- 4 |
6
– 10 |
14
– 18 |
Before am & pm meals or before am meal & at HS |
Long
Acting |
|||||
Glargine
(Lantus®) |
Clear |
1 |
No
peak |
Up
to 24 |
am or HS Do NOT mix |
Detemir (Levemir®) |
Clear |
~1 |
No
peak |
Up
to 24 |
Once
or twice daily |
Combinations |
|||||
Humulin® 50/50 |
Cloudy |
½
- 1 |
2½
- 5 |
14
– 18 |
Before
breakfast & dinner |
Humulin®
70/30 |
Cloudy |
½
- 1 |
1½
- 16 |
14
– 18 |
Before
breakfast & dinner |
Novolin®
70/30 |
Cloudy |
½
|
2
– 12 |
Up
to 24 |
Before
breakfast & dinner |
Humalog®
Mix 75/25 |
Cloudy |
<
½ |
1
– 6½ |
~
22 |
Before
breakfast & dinner |
Novolog®
Mix 70/30 |
Cloudy |
<
½ |
1
– 4 |
Up
to 24 |
Before
breakfast & dinner |
The action time of any insulin may vary in different individuals or at different times in the same individual. Variables include size of dose, injection site, physical activity and body temperature.
References:
American Diabetes Association (2006). Clinical Practice Recommendations.
Diabetes Care, Vol 29 (1).
Core Curriculum for Diabetes Educators, Diabetes Management Therapies
5th Edition. AADE. 2003.
Product labeling information
| Independent
Study Modules |
