Combining insulin doses can be intimidating, particularly for those new to injections. Mixing two different insulins in a single syringe can also be challenging if it's a new instruction for you.
However, with the correct procedures and some practice, combining insulin is safe, routine, and highly manageable.
This guide provides information on when to mix insulin and details which types are compatible. You'll discover a straightforward step-by-step process. Safety tips are included throughout by the team.
⚠️ Always adhere to your healthcare provider’s guidance. This guide is for educational purposes and does not substitute for professional medical advice.
Why Mix Certain Insulins?
Doctors might recommend mixing two insulins in one syringe to:
- Decrease the number of daily injections
- Combine short-acting and intermediate-acting insulin
- Enhance blood sugar management around meal times
Combining insulin in a single injection can address both immediate requirements and provide extended coverage.
Which Insulins Can Be Combined?
✅ Insulins Frequently Combined
- Rapid-acting insulin (Regular/short-acting)
- Intermediate-acting insulin (NPH)
A typical pairing is Regular insulin with NPH insulin.
❌ Insulins That Must NOT Be Combined
- Long-acting insulins (Lantus®, Levemir®, Tresiba®)
- Pre-mixed insulin products (already blended)
- Insulin pens (do not withdraw insulin from pens unless directed)
If uncertain, consult your pharmacist or diabetes educator before combining.
Necessary Supplies
- Two types of insulin vials
- Insulin syringe
- Alcohol swabs
- Clean, flat surface
- Sharps disposal container
💡 Verify expiration dates and check insulin for cloudiness or particles before use.
Step-by-Step: Mixing Two Insulins in a Single Syringe
This adheres to the standard “clear before cloudy” guideline.
Step 1: Wash Your Hands
Use soap and water, and dry them thoroughly.
Step 2: Roll the Cloudy Insulin
If you have a cloudy insulin (commonly NPH):
- Gently roll the vial between your palms 10 to 20 times
- Avoid shaking it
This ensures the insulin suspension is mixed uniformly.
Step 3: Sanitize the Vial Tops
Use alcohol to wipe the rubber stoppers on both vials and allow them to dry.
Step 4: Draw Air Into the Syringe
- Pull back the plunger to the required dose of cloudy insulin
- Inject air into the cloudy insulin vial (do not draw insulin yet)
- Withdraw the needle
Step 5: Inject Air Into the Clear Insulin
- Pull back to the required dose of clear insulin
- Inject air into the clear insulin vial
Step 6: Draw Up the Clear Insulin FIRST
- Invert the clear insulin vial
- Draw the accurate dose
- Inspect for air bubbles and eliminate them
Always clear before cloudy.
Step 7: Prepare the Cloudy Insulin
- Insert the needle into the vial containing cloudy insulin
- Invert the vial
- Gently draw the prescribed amount
The syringe now holds both types of insulin.
Step 8: Administer Immediately
- Select your injection site
- Administer as directed
- Dispose of the syringe in a designated sharps container
Do not store a syringe with mixed insulin for future use.
Common Errors to Avoid
- ❌ Drawing cloudy insulin first
- ❌ Shaking the insulin vials
- ❌ Mixing long-acting insulin
- ❌ Storing mixed insulin for later use
- ❌ Estimating doses instead of measuring accurately
If anything seems off, discard and begin again.
Insulin Storage Guidelines
The effectiveness of insulin is highly dependent on correct storage:
- Keep unopened insulin refrigerated
- Store in-use vials at room temperature if permitted
- Avoid exposure to heat, freezing, and direct sunlight
For everyday activities, travel, or extended work hours, numerous individuals rely on DISONCARE medical coolers. These devices ensure insulin remains at safe temperatures when not refrigerated.
Commonly Asked Questions
Is it possible to mix insulin ahead of time?
No, mixed insulin should be injected immediately.
Why is the sequence important?
Drawing clear insulin first avoids contaminating the clear vial with cloudy insulin.
What should I do if I draw the incorrect amount?
Dispose of the syringe and begin anew. Precision is crucial.
Can children or caregivers handle insulin mixing?
Yes, with adequate training and oversight from a healthcare professional.
Key Takeaway
Mixing insulin is a skill that becomes easier with practice. By adhering to the clear-before-cloudy guideline, employing sterile techniques, and verifying doses, you can safely mix insulin.
If you ever feel uncertain, contact your diabetes care team. Perfection isn't required from the start.
This article is intended solely for educational use and is not a substitute for professional medical guidance. Always adhere to your healthcare provider’s recommendations.