Can you mix glargine with other insulins

Your doctor or diabetes educator will instruct you in determining your insulin dose based on your blood sugar reading and anticipated meals and exercise. Always check the bottle before drawing up the insulin. If the solution is cloudy, discard the bottle. This insulin does not act as quickly as Humalog or Novolog. Regular insulin is a clear, colorless liquid that begins to work 30 minutes after injection and peaks at hours after injection. It lasts hours in the body.

Regular insulin is usually given 30 minutes before a meal. It can also be mixed in the same syringe with longer-acting NPH insulin or given separately immediately after each other. Regular insulin is the most stable of all the different types of insulin. Unopened regular insulin is best refrigerated.

If you are mixing Regular with a longer-acting insulin, always draw up the Regular insulin first to maintain the purity and clarity of the Regular solution. Intermediate-acting insulins are cloudy suspensions of crystalline insulin that need to be gently rotated between the hands before being used.

They begin to work 1 hour after injection and peak at hours after injection. As the individual insulin units detach from the cluster, the insulin analog can be absorbed into the blood stream.

The slow break-up of the insulin cluster gives insulin glargine its long action. After insulin detemir is absorbed into the blood stream, it becomes attached to a blood protein, albumin.

It slowly detaches from the albumin over the next hours. Self assessment quizzes are available for topics covered in this website. To find out how much you have learned about Treatment of Type 1 Diabetes , take our self assessment quiz when you have completed this section.

The quiz is multiple choice. However, no formal glucose clamp studies have been performed to determine whether mixing with glargine has an adverse effect on the early pharmacodynamic action of rapid-acting insulin in humans. To examine this question, euglycemic glucose clamps were performed twice, in random order, in 11 youth with type 1 diabetes age Mixing the two insulins shifted the time action curve to the right, with significantly lower glucose infusion rate GIR values after the mixed injections between 60 and min and significantly higher values between and min, lowered the GIR max separate 7.

The GIR area under the curve was significantly lower after the mixed injections. Mixing had similar effects on plasma insulin pharmacokinetics. These data demonstrate that mixing lispro with glargine markedly flattens the early pharmacodynamic peak of lispro and causes a shift to the right in the GIR curve changes that might lead to difficulties in controlling meal-related glucose excursions. Insulin glargine revolutionized the diabetes therapy by being the first soluble long-acting insulin analog without a pronounced peak and with a more prolonged time-action curve than NPH insulin 1 — 4.

Basal-bolus therapy with glargine and rapid-acting insulin analogs provided patients with greater accuracy and precision in insulin dosing than was possible with split-mix regimens using intermediate-acting insulin suspensions 5 , albeit at the expense of greater numbers of required daily insulin injections.

Poor compliance with the requirements of frequent injections is a major contributing cause of failure to achieve target plasma glucose and A1C levels in adolescents with type 1 diabetes using multiple daily injection regimes 6.

Consequently, some pediatric diabetes providers have opted to decrease the number of daily injections in youth using multiple daily injection therapy by mixing glargine with rapid-acting insulin analogs, despite company 7 and U. Food and Drug Administration warnings against doing so. Recommendations against mixing were based on preclinical glucose clamp studies in beagle dogs indicating that the maximal glucose-lowering effect of regular insulin was blunted and delayed by mixing with glargine 8.

On the other hand, three clinical studies that examined mixing of glargine with rapid-acting analogs in youth with type 1 diabetes did not demonstrate a change in 24 mean glucose concentrations or A1C levels 9 — However, glucose clamp studies have not been carried out to determine whether mixing of rapid-acting insulin analogs with glargine just before injection alters the early time-action profile of this combination in patients with type 1 diabetes.

The present study was conducted to examine this question in adolescents with type 1 diabetes, since this is the population of patients with type 1 diabetes in whom mixing is most often considered.

Eleven subjects with type 1 diabetes six male and five female who attended the Yale Children's Type 1 Diabetes Clinic were studied. Subjects were excluded for any other medical disease aside from type 1 diabetes or treated hypothyroidism; use of medications that might affect glycemic control; pregnancy or breast-feeding; not consistently using barrier methods or abstinence as contraception; or any other condition that in the judgment of the investigators would interfere with the subject's or parent's ability to provide informed consent or the investigator's ability to perform the study.

At the initial enrollment visit, the risks and benefits of the study were explained; informed consent from the parents and informed assent from the subjects were obtained; history and physical examinations were performed and A1C was measured. Subjects were admitted to the Yale—New Haven Hospital Research Unit on the evening before the euglycemic clamp to monitor blood glucose levels.

A second intravenous catheter was placed on the contralateral arm for infusion of exogenous glucose the following morning, and subjects were randomized to receive 0. Subjects who received both insulins mixed in a syringe before the initial clamp were given separate injections before the second euglycemic clamp performed within 4 weeks of the first clamp and vice versa. Subjects were given insulin glargine from the left arm and insulin lispro from the right arm on the day that they were randomized to receive insulins separately.

The infusion of insulin via the insulin pump was suspended just before the administration of lispro and glargine. It will peak when each type of insulin typically peaks, and it will last as long as the longest-acting insulin. Examples include:. Author: Healthwise Staff.

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Skip Navigation. Top of the page. Topic Overview Insulin is used to treat people who have diabetes. Types of insulin Type Examples Appearance When it starts to work onset The time of greatest effect peak How long it lasts duration Rapid-acting insulins work over a narrow, more predictable range of time. Apidra glulisine , Humalog lispro , Novolog aspart Clear 5—30 minutes 30 minutes—3 hours 3—5 hours Rapid-acting insulin also comes in a form that can be inhaled through the mouth.

Humulin R, Novolin R insulin regular Clear 30 minutes 3 hours 4—12 hours U— , Up to 24 hours U— Intermediate-acting insulins contain added substances buffers that make them work over a long time and that may make them look cloudy.