Question

Question 2 (Mandatory) (10 points) Directions: There are two answers for this question, separate them with a comma. Order: Novolin Regular U-100 10 units subcut and Novolin NPH U-100 18 units subcut stat Available: m U-100 NDC 0169-1833-11 10 ml 100 units/mL Novoline Exp. Date/Control: Regular, Human Insulin Injection (recombinant DNA origin) USP 09 100 101833 111 Novo Nordisk • Important: see insert • Keep in a cold place • Avoid freezing Novo Nordisk Inc. Princeton, NJ 08540 1-800-727-6500 Manufactured by DK-2880 Bagsvaerd Denmark Novo Nordisk AS u U-100 NDC 0169-1834-11 10 ml 100 units/mL Novoline Exp. Date/Control: NPH, Human Insulin Isophane Suspension (recombinant DNA origin) Novo Nordisk • Important: see insert • To mix, shake carefully • Keep in a cold place • Avoid freezing Novo Nordisk Inc. Princeton, NJ 08540 1-800-727-6500 Manufactured by Novo Nordisk AS DK-2880 Bagsvaerd Denmark a. What will you administer? b. Which insulin will be the first to be drawn up into the sryinge?

Answer 1

Novolin R can be mixed with NPH insulin right before use. When you are mixing Novolin R insulin with NPH insulin, always draw the Novolin R (clear) insulin into the syringe first. ... Add together the doses (total number of units) of NPH and Novolin R that you need to inject.

take Novolin regular U-100 10units in the syringe first and then add NovolinNPH U-100 18 units then administer to the patient

1. Insulin used in the United States is human-sourced synthesized in the laboratory using recombinant DNA technology (with E. coli or yeast) or genetically engineered (insulin analogs). Insulin extracted from beef pancreas is no longer available in the United States. a. Human insulin using recombinant DNA from E. coli is dispensed by Lilly as Humulin regular (Humulin® R) and Humulin NPH (Humulin® N). Human insulin using the recombinant DNA technique with yeast is dispensed by Novo Nordisk as Novolin

Regular (Novolin® R) and Novolin NPH (Novolin® N). Novo Nordisk also dispenses regular insulin that contains a phosphate buffer (Velosulin® BR) for use in insulin pumps. b. The insulin analogs are insulin lispro (Humalog®) dispensed by Lilly, insulin aspart (NovoLog®) dispensed by Novo Nordisk, and glulisine (Apidra®) and glargine (Lantus®) dispensed by Aventis.

2. Insulin lispro (Humalog), insulin glulisine (Apidra), and insulin aspart (NovoLog) are rapid acting. Regular insulin is short acting (Humulin R, Novolin R, Velosulin); NPH (Humulin N, Novolin N) is intermediate acting; and glargine (Lantus) and insulin detemir (Levemir) are long acting.

3. Combination insulin is a mixture of a rapid- or short-acting insulin and intermediate-acting insulin. The insulin is premixed and supplied in one vial. Examples are a. Humulin® 50/50 (50% NPH and 50% regular) b. Humulin® 70/30 (70% NPH and 30% regular) c. Novolin® 70/30 (70% NPH and 30% regular) d. NovoLog® Mix 70/30 (70% insulin aspart protamine suspension and 30% insulin aspart)

4. An insulin syringe is used to administer insulin via the subcutaneous route. Insulin syringes are calibrated in units with 100 units/mL. Insulin syringes usually have an orange plunger or needle cap. Regular insulin (Humulin R, Novolin R) can also be administered via IV route using a volumetric pump.

5. A Lo-Dose is a type of insulin syringe. It is calibrated in units with 100 units/mL, but the total volume capacity is less than 1 mL. The most frequently used Lo-Dose syringe is calibrated to 50 units with a volume capacity of 0.5 mL. Each calibration on a Lo-Dose syringe measures 1 unit while each calibration on a 1 mL insulin syringe measures 2 units. The Lo-Dose syringe allows for more precise measurement of low doses of insulin and should be used when 50 units or less are to be administered.

6. Regular insulin (clear in vial) can be mixed with NPH. Insulin lispro (Humalog) and insulin aspart (NovoLog), also clear in the vial, can also be mixed with NPH (Humulin N, Novolin N). Insulin glargine (Lantus) and insulin detemir (Levemir) must not be mixed with any other insulin or solution. Likewise, Velosuline BR should not be mixed with any   other insulin since the buffering agent in Velosuline BR may interact with the other insulin and result in a change of activity.

7. When mixing two insulins in the same syringe, the rapid- or short-acting drug (regular, lispro, aspart, glulisine) is drawn into the syringe first, followed by the cloudy insulin, to minimize contamination of the rapid- or short-acting drug with any zinc or isophane suspension in the intermediate- or long-acting agents. Such contamination would alter the action of the rapid- or short-acting insulin. The rapid- and short-acting insulins appear clear in the drug vial. Suggest to learners that, when mixing insulins in the same syringe, they always use the “clear to cloudy” order.

8. The abbreviation U for unit is no longer used as it has been misinterpreted as zero, four, or cc (cubic centimeter). The Joint Commission recommends that the word “unit” be written out.