How are insulins mixed with NPH?

Updated: Oct 04, 2017
  • Author: Mini A Mathew, DO, PharmD; Chief Editor: George T Griffing, MD  more...
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In order to properly resuspend the insulin, vials should be carefully rolled between the palms of your hands several times. Prefilled pens should be rolled between the palms 10 times and inverted 180° ten times. Properly resuspended insulin NPH should look uniformly cloudy or milky; do not use if any white insulin substance remains at the bottom of the container, if any clumps are present, or if white particles are stuck to the bottom or wall of the container. Cold injections should be avoided.

When mixing insulin NPH with other preparations of insulin (eg, insulin aspart, insulin glulisine, insulin lispro, insulin regular), insulin NPH should be drawn into the syringe after the other insulin preparations. After mixing NPH with regular insulin, the formulation should be used immediately.

Rapid-acting insulin can be mixed with NPH. When this is done, the mixture should be injected within 15 minutes prior to a meal.

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