How to mix short-acting (clear) insulin and intermediate-acting (cloudy) insulin

Step 1: Roll and clean

Wash and dry your hands. Roll the cloudy (intermediate-acting) bottle of insulin between your palms 10 times gently. Do not shake vigorously. Clean the top of vial with an alcohol swab.

Step 2: Add air to cloudy (intermediate-acting) insulin

Draw the required amount of air (equal to the dosage of cloudy insulin) into the insulin syringe. Inject air into the cloudy insulin vial. Do not draw out any insulin, and remove the syringe and needle.

Step 3: Add air to clear (short-acting) insulin

Using the same syringe and needle, draw the required amount of air (equal to the dosage for clear insulin) into the insulin syringe. Inject air into the clear insulin vial.

Step 4: Withdraw clear (short-acting) insulin first, then cloudy (intermediate-acting) insulin

With the insulin syringe and needle attached, turn the clear insulin bottle upside down, with the needle bevel within the insulin, withdraw the required amount of clear insulin into the syringe.

Then do the same with the cloudy insulin. Always withdraw clear insulin first before withdrawing cloudy insulin. Ensure the total dose of clear and cloudy insulin is correct. If overdrawn, discard and repeat.

"Not all types of insulin are suitable to be mixed. If in doubt, please check with your pharmacist or diabetes nurse educator," say nurses from the Department of Specialty Nursing, Singapore General Hospital (SGH), a member of the SingHealth group.

Reminders:

  • Look out for the expiry date on the bottle
  • Write down the date and time of opening on the bottle
  • Discard vial 4 weeks from date of opening
    Refer to manufacturer’s/pharmacist's recommendation
  • Do not use the insulin if it is discoloured, has lumps or flakes, is frozen or heated

See previous page to learn how to draw up insulin into a syringe.

See next page to find out how to administer insulin with a syringe.

Ref: O17