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Different Types of Insulin Preparations
and Their Actions

Injecting insulin:

1. Use a new needle/syringe each time.
2. Gently roll the cloudy insulin (NPH or a mix insulin).
3. If you are going to mix two types of insulin in the syringe, draw up the clear insulin first. DO NOT mix Lanuts or Levemir insulin with any other type of insulin in a syringe or injection site.
4. To draw insulin into the syringe, inject air (the same amount as the amount of insulin you plan to draw out). This helps equalize pressure and makes it easier to get the insulin out.
5. Injection sites include the abdomen, arms, thighs and buttocks. It is very important to rotate injection sites. Using the same site repeatedly can mean that you don’t absorb insulin very well.

Other helpful information:

• Alcohol swabs are not necessary.
• A larger gauge number for a needle size means that the needle is actually thinner.
• When testing your blood glucose: wash your hands with warm soapy water. Draw blood on the side of your finger, at the tip. It is important to rotate fingers when you test.
  

When to start insulin:

• If A1C >7 but <8.5 and on oral medication.
• Continue metformin and sulfonylurea (if on one) when starting insulin.
• Start with 0.2 mg/kg/day or 10 units/day of bedtime or morning Lantus or Levemir or bedtime NPH.
• Check fasting glucose daily and increase dose by 2 units every 3 days until fasting blood glucose is consistently between 90 and 130 mg/dL. If fasting levels are >180 mg/dL, then increase by 4 units every 3 days. If hypoglycemia occurs or fasting levels are <70 mg/dL, decrease bedtime dose by 4 units or 10%, whichever is greater.
• Check A1C every 3 months.
• If A1C >7% after 2-3 months, go to intensive insulin therapy algorithm OR can start on mix insulin: Start with 0.6 units/kg/day—2/3 of the dose 15 minutes before breakfast and 1/3 of the dose 15 minutes before dinner.
• MAJOR SIDE EFFECT IS HYPOGLYCEMIA: Ensure any patient on insulin knows about hypoglycemia. Click here for more information on hypoglycemia.

Click here for Intensive Insulin Algorithm