Question

Mrs. Garcia has returned from surgery. She needs blood glucose checks with sliding scale insulin ordered every 6 hours. Based on the order, you will administer 4 units of Humulin R U-100 insulin sub q for a blood glucose level of 196 mg/dL. She also has 30 units of Lantus U-100 insulin sub q ordered.

What are the steps to draw up the two insulins?

Answer 1

1. Remove insulin from the refrigerator 30 minutes before you will use it. Inject insulin that is room temperature.

2. Wash your hands-
This will help decrease your risk for an infection.

3. Gather your insulin supplies-
Get your insulin bottle, syringe, and alcohol pads. Check the insulin bottle to make sure it is the right type and strength of insulin. Also check the expiration date. Do not use expired insulin. Rapid and short-acting insulin should be clear with no particles. Do not use the insulin if there are clumps or particles in it.

4. Determine the total amount of insulin you need-
Add the number of units of each type of insulin together. For example you need 30 units of long acting insulin (Lantus) and 4 units of short-acting insulin (Humalin R).

5. Gently mix long-acting insulin (Lantus)-
These must be mixed before they are given. Turn the bottle on its side and roll it between the palms of your hands. Do not shake the bottle. This can make the insulin clump together. You do not need to mix the rapid or short-acting insulin.

6. Prepare the insulin bottles-
Clean the top of both insulin bottles with an alcohol pad.

7. Prepare the syringe-
Remove the cap from the needle.

8. Inject air into the long-acting insulin bottle (Lantus)-
This insulin should be cloudy. Pull back the plunger on the syringe to draw in an amount of air that is equal to your long-acting insulin dose. Place the bottle on a hard surface. Push the needle through the top of the long-acting insulin bottle and inject air into the bottle. Do not draw the insulin into the syringe. Remove the empty syringe and needle from the bottle.

9. Inject air into the short-acting insulin bottle (Humalin R)-
This insulin should be clear. Pull the plunger back to draw in enough air to equal your short-acting insulin dose. Push the needle in through the top of the short-acting insulin bottle. Inject air into the short-acting insulin bottle. Leave the needle in the bottle.

10. Draw up the short-acting insulin first-
Turn the bottle and syringe upside down. Pull the plunger to fill the syringe with just a little more than the insulin dose you need.

11. Check the syringe for air bubbles-
If you see any bubbles, hold the bottle and syringe with 1 hand. Tap the syringe with 1 finger on your other hand. This will make the air bubbles rise to the top of the syringe. Slowly push on the plunger to move out air and extra insulin.

12. Remove the needle from the bottle-
Recheck your dose.

13. Draw up the intermediate or long-acting insulin-
Insert the needle into the bottle of long-acting insulin. Turn the bottle and syringe upside down. Slowly pull on the plunger to draw insulin into the syringe. Because the short-acting insulin dose is already in the syringe, pull the plunger to the total number of units you need.

14. Check for bubbles-
Hold the bottle and syringe with 1 hand. Gently tap the syringe with 1 finger on your other hand. This will make them rise to the top. Do not push air into the bottle. This may cause you to push the mixed insulin into the bottle.

15. Remove the needle from the bottle-
Do not let the end of the needle touch anything. Inject the insulin as directed. If you need to recap the needle, place the cap on a table or hard surface. Slowly slide the needle into the cap.