Mixing Insulins for Injection- If insulin is to be mixed in a syringe , the tops of both bottles are cleansed, and air equal to the insulin to be removed is injected into each of the bottles. Once the air is placed into the
short-acting insulin bottle (e.g., Regular), the desired amount of insulin is withdrawn. The needle is removed from that bottle and carefully placed into the other bottle. The insulin is very carefully withdrawn until the total amount of dosage is obtained in the syringe (for example, 10 units of Regular plus 20 units of NPH drawn up, in total, to the 30-unit mark on the syringe).
This insulin should be administered within 5 minutes from the time it was initially mixed. If the insulin is premixed in separate syringes or in a mixing bottle, it is necessary to wait 15 minutes before administering that insulin dosage from the syringe or bottle. Premixed insulin should not be kept in a syringe for longer than 2 weeks. Premixing of Lente with Regular insulin is not recommended unless it is administered immediately. Lente insulins cannot be premixed with NPH. Premixed NPH and Regular are usable up to the date (shelf life) on the box.
The least amount of discomfort is experienced during the injection when the insulin is at room or body temperature and is given without any “drag” on the needle (that is, the needle must either pierce tight skin or be rapidly placed through the skin layer). Insulin in use can be kept at room temperature for up to three months. However, if kept at a temperature greater than 90 degrees or below 32 degrees F, the insulin may be damaged.
To prevent infection, the skin should be as clean as possible. To be sure of this, give the injection after a bath or shower, or wash the injection area with soap and water or with a cleansing wipe. The skin should be made tight by pinching a large fold of skin or, in the case of loose skin (such as might be found on the abdomen), pinching and stretching the skin so that the injection will be given in the stretched area, not the pinched area.
Mixing Insulins for Injection, Steps for Preparing a Mixed Dose of Insulin, Instructions for Insulin Injection and Giving an insulin injection
The injection is given at an angle of 45 to 90 degrees, unless atrophy is to be treated, in which case a 20-degree angle is recommended. The angle depends on the thickness of the skin. In other words, a younger child or elderly person would most likely need a 45-degree angle injection, while a young or middle-aged adult would probably need a 90-degree angle. Once the insulin has been administered at an even rate of speed, the needle should be quickly with-drawn at the same angle at which it was inserted. Mild pressure on the injection site for a period of a minute or less will aid in keeping the insulin from leaking out onto the skin surface. (Some people use what is called Z-tracking: The needle is placed through the skin, the tip is moved to an angle, and the insulin is pushed in. On removal, the tip is moved back to its original location and is then pulled from the body. Such a technique is not usually necessary but can be helpful for those who experience a lot of “leaking.”)
Mixing Insulins for Injection- B-D Plastipak and Monojet are syringes that have developed shorter and smoother needles. They are available in 1 cc, 1/2 cc, and 1/3 cc. Sure-dose TM is a new syringe manufactured by Terum Medical Corporation. These syringes are available in 28 gauge, 1 cc, and 1/2 cc sizes and Sure-dose Plus TM in 29 gauge, 1 cc, and 1/2 cc sizes.