Pre-mixed insulins are usually prescribed for patients needing a simple insulin treatment plan, and sliding scale therapy.
You may be in this category if you:
- Are older, with regular meal and activity patterns
- Have diminished vision or trouble with dexterity
- Are just starting insulin therapy
NPH insulin may be mixed with both rapid-acting insulin analogs and fast-acting human Regular insulin. These mixtures include various combinations:
- In the United States, rapid-acting insulin, Lyspro (humalog) is mixed with NPH in a 50:50 (50% NPH and 50% insulin Lyspro) and 75:25 (75% NPH and 25% insulin Lyspro) ratio.
- Insulin/Aspart (Novolog) combinations also are available as 70:30 mixtures (70% NPH, 30% insulin aspart).
- The traditional NPH ratio of Regular pre-mixed insulin 70:30 (70% NPH, 30% Regular) is still available. These insulins are available as vials, and as insulin pens.
The benefit of pre-mixed insulin is that the fast- and long-acting insulin is combined. No mixing of the insulin is necessary, and there is only one injection.
The disadvantage is that NPH, which has a relatively unpredictable action, is the only long-acting insulin that can be used. Also, when the doses in a mixture is increased or decreased, the amount both of the short acting insulin and long-acting insulin changes, which increases the risk of both high and low blood sugars. Mixtures also don’t allow a separate correction to be made for high blood sugars.
(You may wonder why there are NO pre-mixed insulins using Lantus and detemir. This is because insulin glargine (Lantus®) and detemir (Levemir®) cannot be mixed in the same syringe with other insulins!)
Pre-mixed insulins are usually prescribed for patients needing a simple insulin treatment plan, and sliding scale therapy.
You may be in this category if you:
- Are older, with regular meal and activity patterns
- Have diminished vision or trouble with dexterity
- Are just starting insulin therapy
Self-assessment Quiz
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