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INSULIN TIPS
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All insulin vials have a concentration of 100 units of
insulin in 1 ml and are therefore called U100 insulins. A more concentrated form of regular
insulin called U500 insulin (that is, 500 units of insulin in 1 ml) is available for use by
people who need extremely large amounts of insulin.
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You can keep the vials of insulin you are currently using
at room temperature. Do not “cook” them in a hot car or leave them in the sun, as this will
affect their efficacy.
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Any spare insulin vials, insulin cartridges, or disposable
insulin pens you have should be kept in the refrigerator (not the freezer) and are good until the
expiration date.
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Although insulins are very stable at room temperature, it
is best to open a new bottle monthly. Experience has shown that sometimes they go
bad.
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All insulins, with the exception of NPH, are clear liquids,
so you do not have to mix them. When you mix NPH insulin, it is best to roll the bottle in the
palm of your hand and not to shake it vigorously, because that will introduce bubbles and the
dosing will be inaccurate.
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You can mix NPH insulin with regular insulin or the
fast-acting insulin analogs in a syringe. However, mixing the long-acting insulin analogs
(insulin glargine or detemir) with the fast-acting insulin analogs is not recommended. Most
people no longer mix insulin: they give separate injections of the long-acting and fast-acting
insulin analogs. If you mix regular or fast-acting insulin analogs and NPH insulin, just remember
to draw the clear insulin before the cloudy insulin. You can ask a diabetes educator or your
pharmacist to explain the mixing procedure to you.
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In the
following sidebar you’ll find all the premixed insulins that are currently available. They are often
used by people with type 2 diabetes who take two injections a day: once before breakfast and once
before dinner. They are available as
various proportions of long-acting insulin with either regular or fast-acting insulin analog.
Generally speaking, NPH and regular insulin mixtures (70/30 and 50/50 insulin) are being
prescribed less and less. They have been replaced with long-acting insulin preparations and
fast-acting insulin analog mixtures such as Humalog Mix 75/25 and Novolog Mix 70/30. These are
popular because they can be injected immediately before a meal and they are much better at
controlling the postmeal blood glucose rise.
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Before the introduction of insulin analogs in 1996, when regular insulin was a clear
liquid and the long-acting insulin (NPH, Ultralente, and Lente) was cloudy, people had no problem
remembering to take the clear insulin before meals and cloudy insulin before bedtime. Now, with both
fast-acting and long-acting insulins being clear, it is easy to make a mistake and take the wrong
insulin, increasing the risk for hypoglycemia. So, it is imperative that you read the labels on your
vials of insulin. If you make a mistake and take a large amount of fast-acting insulin analog at
bedtime, do not panic. Just check your blood glucose levels frequently and take additional
carbohydrates for the next four to six hours until all the insulin has gone from your system. If you
are having problems keeping your glucose level up, then go to the emergency
room.
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