How to give an insulin injection using mixed insulin

A subcutaneous injection is a shot of medicine that is injected into the layer of fat and tissue between skin and muscle. People with type 1 diabetes must take insulin because their bodies do not make it. People with type 2 diabetes may need to take insulin.

There are many different types of insulin. The type of insulin that you take may determine how many injections you give yourself and when you need to give the injections.

You may be instructed to combine two types of insulin for your injection. When mixing insulin in the same syringe:

• The CLEAR insulin is rapid-acting or regular insulin.
• The CLOUDY insulin is intermediate or long-acting insulin. It may also be called NPH insulin.

Supplies needed:

• Soap and water to wash hands.
• A new, unused insulin syringe.
• Your insulin medication bottles (vials).
• Alcohol wipes.
• A disposal container that is meant for sharp items (sharps container), such as an empty plastic bottle with a cover.

How to choose a site for injection

The body absorbs insulin differently, depending on where the insulin is injected (injection site). It is best to inject insulin into the same body area each time (for example, always in the abdomen), but you should use a different spot in that area for each injection. Do not inject the insulin in the same spot each time. There are five main areas that can be used for injecting. These areas include:

• Abdomen. This is the preferred area.
• Front of thigh.
• Upper, outer side of thigh.
• Upper, outer side of arm.
• Upper, outer part of buttock.

How to give an insulin injection using mixed insulin

First, follow the steps for Get ready, then continue with the steps for Push air into the vials, then follow the steps for Combine clear insulin and cloudy insulin, and finish with the steps for Inject the insulin mixture.

Get ready

1. Wash your hands with soap and water. If soap and water are not available, use hand sanitizer.
2. Before you give yourself an insulin injection, be sure to test your blood sugar level (blood glucose level) and write down that number. Follow any instructions from your health care provider about what to do if your blood glucose level is higher or lower than your normal range.
3. Use a new, unused insulin syringe each time you need to inject insulin.
4. Check to make sure you have the correct type of insulin syringe for the concentration of insulin that you are using.
5. Check the expiration dates and the types of insulin that you are using.
6. Check the CLEAR insulin. It should be clear and free of clumps.
7. Do not shake the CLOUDY insulin vial to get it ready. Instead, get it ready in one of these ways:
   1. Gently roll that insulin vial between your palms several times.
   1. Tip that vial up and down several times.
8. Remove the plastic pop-top covering from the vial of CLEAR insulin and the vial of CLOUDY insulin. This type of covering is present on a vial when it is new.
9. Use an alcohol wipe to clean the rubber top of each vial.
10. Remove the plastic cover from the syringe needle. Do not let the needle touch anything.

Push air into the vials

1. To bring (draw up) air into the syringe, slowly pull back on the syringe plunger. Stop pulling the plunger when the dose indicator gets to the number of units that you will be using for CLOUDY insulin.
2. While you keep the vial of CLOUDY insulin right-side-up, poke the needle through the rubber top of the vial. Do not turn the vial upside down to do this.
3. Push the plunger all the way into the syringe. Doing that will push air into the vial of CLOUDY insulin.
4. Remove the needle from the vial of CLOUDY insulin. Do not turn the vial upside down to do this.
5. Slowly pull back on the plunger to repeat the step for drawing up air into the syringe. Stop pulling the plunger when the dose indicator gets to the number of units that you will be using for CLEAR insulin.
6. While you keep the vial of CLEAR insulin right-side-up, poke the needle through the rubber top of the vial. Do not turn the vial upside down to do this.
7. Push the plunger all the way into the syringe. Doing that will push air into the vial of CLEAR insulin.
8. Do not take the needle out of the vial of CLEAR insulin yet.

Combine clear insulin and cloudy insulin

1. While the needle is still in the vial of CLEAR insulin, turn that vial upside down and hold it at eye level.
2. Slowly pull back on the plunger to draw up the desired number of CLEAR insulin units into the syringe.
3. If you see air bubbles in the syringe, slowly move the plunger up and down 2 or 3 times to make them go away.
4. Remove the needle from the vial of CLEAR insulin.
5. Poke the needle of the partly filled syringe into the vial of CLOUDY insulin, turn the vial upside down, then hold the vial at eye level. Do not inject any of the CLEAR insulin (which is already in the syringe) into the vial of CLOUDY insulin.
6. Slowly pull back on the plunger until it gets to the number of units that is equal to the total number of units desired (CLEAR insulin units plus CLOUDY insulin units).
7. Remove the needle from the vial of CLOUDY insulin.
8. Do not let the needle touch anything.

Inject the insulin mixture

1. Use an alcohol wipe to clean the site where you will be injecting the needle. Let the site air-dry.
2. Hold the syringe in your writing hand like a pencil.
3. Use your other hand to pinch and hold about an inch (2.5 cm) of skin. Do not directly touch the cleaned part of the skin.
4. Gently but quickly, put the needle straight into the skin. The needle should be at a 90-degree angle (perpendicular) to the skin.
5. Push the needle in as far as it will go (to the hub).
6. When the needle is completely inserted into the skin, use your thumb or index finger of your writing hand to push the plunger all the way into the syringe to inject the insulin.
7. Let go of the skin that you are pinching. Continue to hold the syringe in place with your writing hand.
8. Wait 10 seconds, then pull the needle straight out of the skin. This will allow all of the insulin to go from the syringe and needle into your body.
9. Press and hold the alcohol wipe over the injection site until any bleeding stops. Do not rub the area.
10. Do not put the plastic cover back on the needle.
11. Discard the syringe and needle directly into a sharps container, such as an empty plastic bottle with a cover.

How to throw away supplies

• Discard all used needles in a puncture-proof sharps disposal container. You can ask your local pharmacy about where you can get this kind of disposal container, or you can use an empty plastic liquid laundry detergent bottle that has a cover.
• Follow the disposal regulations for the area where you live. Do not use any syringe or needle more than one time.
• Throw away empty vials in the regular trash.

Questions to ask your health care provider

• How often should I be taking insulin?
• How often should I check my blood glucose?
• What amount of CLEAR insulin do I need for each injection?
• What amount of CLOUDY insulin do I need for each injection?
• What are the side effects?
• What should I do if my blood glucose is too high?
• What should I do if my blood glucose is too low?
• What should I do if I forget to take my insulin?
• What number should I call if I have questions?

Where to find more information

• American Diabetes Association (ADA): www.diabetes.org  
• American Association of Diabetes Educators (AADE) Patient Resources: https://www.diabeteseducator.org  

Summary

• A subcutaneous injection is a shot of medicine that is injected into the layer of fat and tissue between skin and muscle.
• Before you give yourself an insulin injection, be sure to test your blood sugar level (blood glucose level) and write down that number.
• The type of insulin that you take may determine how many injections you give yourself and when you need to give the injections.
• Check the expiration dates and the types of insulin that you are using.
• It is best to inject insulin into the same body area each time (for example, always in the abdomen), but you should use a different spot in that area for each injection.