Insulin-Mixing Technique

Use only insulin syringes when mixing insulin.

Do not dilute or mix with noninsulin medications.

1. Clean each vial seal with an alcohol swab.
2. Aspirate enough air into insulin syringe that is equal to volume of NPH to be withdrawn.
3. Maintain NPH vial in an upright position. Pressurize NPH vial, being careful not to contact solution. Remove syringe and set NPH vial aside.
4. Aspirate enough air into insulin syringe that is equal to volume of regular insulin to be withdrawn. Inject air into regular insulin vial, then withdraw exact amount of desired volume of regular insulin. Remove syringe and expel any air bubbles.
5. Insert syringe back into NPH vial (already pressurized), and withdraw exact amount of desired volume of NPH.

Avoid pushing plunger and injecting regular insulin into NPH vial.

Insulin—Types

Insulin Type	Onset	Peak	Duration
Rapid-Acting Insulin
Insulin lispro (Humalog).	5 min.	60–90 min.	4–6 hr.
Insulin aspart (Novolog).	10–20 min.	1–3 hr.	3–5 hr.
Short-Acting Insulin
Regular insulin (Humulin R). Only insulin that can be given IV.	Sub-Q route: 30–60 min. IV route: 10–30 min.	Sub-Q route: 2–4 hr. IV route: 15–30 min.	Sub-Q route: 5–7 hr. IV route: 30–60 min.
Concentrated insulin (Insulin U-500). Do not give by IV route.	30–60 min.	2–3 hr.	5–7 hr.
Intermediate-Acting Insulin
NPH (Humulin N, Novolin R).	1–2 hr.	8–12 hr.	18–24 hr.
Long-Acting Insulin
Insulin glargine (Lantus). Cannot be mixed with other insulins.	3–4 hr.	None.	24 hr.
Insulin detemir (Levemir).	3–4 hr.	3–14 hr.	24 hr.
Premixed Insulin
NPH/regular (Humulin 50/50, Humulin 70/30; Novolin 70/30).	30 min.	4–8 hr.	24 hr.
Aspart protamine/aspart (NovoLog Mix 70/30).	15 min.	1–4 hr.	24 hr.
Lispro protamine/lispro (Humalog Mix 75/25).	15–30 min.	2–8 hr.	24 hr.