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Insulin: How to Give a Mixed Dose

Many people with diabetes need to take insulin to keep their blood glucose in a good range. This can be scary for some people, especially for the first time. The truth is that insulin shots are not painful because the needles are short and thin and the insulin shots are placed into fatty tissue below the skin. This is called a subcutaneous (sub-kyu-TAY-nee-us) injection.

In some cases, the doctor prescribes a mixed dose of insulin. This means taking more than one type of insulin at the same time. A mixed dose allows you to have the benefits of both short-acting insulin along with a longer acting insulin — without having to give 2 separate shots.

Usually, one of the insulins will be cloudy and the other clear. Some insulins cannot be mixed in the same syringe. For instance, never mix Lantus or Levemir with any other solution. Be sure to check with your doctor, pharmacist, or diabetes educator before mixing.

These instructions explain how to mix two different types of insulin into one shot. If you are giving or getting just one type of insulin, refer to the patient education sheet Insulin: How to Give a Shot.

What You Will Need

  • Bottles of insulin
  • Alcohol swab, or cotton ball moistened with alcohol
  • Syringe with needle (You will need a prescription to buy syringes from a pharmacy. Check with your pharmacist to be sure the syringe size you are using is correct for your total dose of insulin.)
  • Hard plastic or metal container with a screw-on or tightly-secured lid

Parts of a Syringe and Needle

You will use a syringe and needle to give the shot. The parts are labeled below.

Drawing Up the Insulin into the Syringe

  1. Wash the work area (where you will set the insulin and syringe) well with soap
    and water.
  2. Wash your hands.
  3. Check the drug labels to be sure they are what your doctor prescribed. Check the expiration date on the vials. Do not use a drug that is past the expiration date.
  4. Look at the insulin.
      • Many insulins are clear (for instance, Humalog, Novolog, Regular, Lantus, Levemir) and should always appear clear. Do not use the insulin if the drug appears to have pieces in it or if it is discolored.
      • Other insulins are cloudy and white (for instance, NPH, 75/25, 70/30, and 50/50). This type of insulin should be gently mixed before use. To do this, roll the vial between your hands. You can also turn it gently form side to side a few times. Do not use it if you see any discoloration, clumping, frosting, or settling out of particles after gentle mixing. Call your pharmacist if this happens.
  5. Remove the lids from the top of the insulin vials. (After the lids are removed, they will not go back onto the vial. The rubber tops will provide a seal.) Wipe the rubber tops with an alcohol swab or a cotton ball moistened with alcohol.
  6. Remove the plastic needle cap by pulling it straight off. Do not touch the needle. If the needle touches any surface, the syringe will need to be replaced before you use the syringe.
  7. Pull back the plunger of the syringe to the number of units of insulin you must take from the cloudy insulin bottle ( (A) _____ units). This will pull air into the syringe.
  8. Place the vial of cloudy insulin on a flat surface, and push the needle through the rubber top. Push down on the plunger to push air into the vial. Do not pull insulin into the syringe at this time. Take the needle out of the bottle.
  9. Using the same syringe, pull back the plunger to the number of units of insulin you want from the clear insulin bottle ( (B) _____ units).This will pull air into the syringe.
  10. Place the vial of clear insulin on a flat surface, and push the needle through the rubber top. Push down on the plunger to push air into the vial. Leave the needle in the bottle.
  11. Turn the clear insulin vial and syringe upside down, holding the syringe and needle in place.
  12. Make sure the tip of the insulin needle is in the insulin solution. Then pull the plunger back by the flat knob. This will draw insulin into the syringe. Keep pulling on the knob until the insulin reaches the prescribed number of units of clear insulin. (B).
  13. Check for air bubbles in the syringe. This is important. Having air space instead of insulin may lead to an incorrect dose. To remove air bubbles from the syringe:
      • Hold the syringe with the needle pointing straight up (still in the vial).
      • Gently tap the barrel of the syringe so air bubbles float to the top.
      • Still holding the syringe upright, slowly push the plunger until you push all the air out of the syringe, back into the bottle.
      • Check the number of units of insulin in the syringe.
      • If you have too much or too little, adjust the plunger again until you have the right amount.
      • Remove the needle from the vial.
  14. Using the same syringe, carefully insert the needle into the cloudy bottle. Be sure not to push any of the insulin from the syringe into the bottle.
  15. Turn the cloudy insulin vial and syringe upside down, holding the syringe and
     needle in place.
  16. Make sure the tip of the insulin needle is in the insulin solution. Then pull the plunger back by the flat knob, being careful not to pull any air into the syringe.

    This will draw additional insulin into the syringe. Keep pulling on the knob until the insulin reaches the total number of clear and cloudy units prescribed ([A+B] _____units).

    It is important not to pull past the total number of units. Once the insulins are mixed in the syringe, you cannot push any of the insulin back into the second bottle. And you cannot get rid of the extra amount in any other way.

    If you draw too much insulin, throw away the syringe and start over with a
    new one. (Refer to the next section for proper disposal instructions.)
  17. Remove the needle from the vial.
  18. Replace the needle cap. Place the syringe on a clean, flat surface.

Giving the Shot

Decide where on your body you will give the shot. Be sure to give the shot in a different place each time. You can stay in the same general area. Try to stay at least 1 inch from the last shot, any scars, and your belly button. Keep a diary to remember where your last shot was given.

  1.  Wipe the area of skin with an alcohol swab or a cotton ball moistened with alcohol.
  2. Remove the needle cap. Hold the syringe in one hand.
  3. With the other hand, gently pinch up the skin around where you will give the shot (unless your doctor gives you different instructions) and hold firmly.
  4. Insert the needle at a 45- to 90-degree angle.
  5. Push down on the plunger until all of the insulin solution is gone from the syringe.
  6. Take the needle out of your skin.
  7. If you bleed when the needle comes out, place an alcohol swab over the skin right away. Press gently on the swab until bleeding has stopped. Do not rub the skin.
  8. Do not re-cap the needle.
  9. Throw away the syringe and needle in a hard plastic or metal container. Close the lid tightly.When the container is full, tape the lid down, and throw it away in the garbage (but not with recyclables). Note: Check your town’s guidelines on syringe disposal.

Questions?

Most people find that taking insulin is not as hard as expected. When blood glucose is in control, you feel healthy. This often happens when people with diabetes take insulin.

If you have any questions about these instructions, call your doctor or nurse.

                                                                                                                             Reviewed July 2013

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