In practice, yes. But AACE recommends against the use of regular human insulin ("R") and the use of NPH insulin ("N") due to th fact that these insulin preparations do not have a sufficiently predictable time courss that adequately mimics the normal physiologic profile.

Lispro (Humalog)

Aspart (Novolog)

Glulisine (Apidra)

they are injected when the person sits down to eat, or up to 15 minutes prior to eating. They are designed to last for a meal, but can last up to 5 hours.

Dosed for the amount of carbohydrates in a meal

They are clear and can be mixed with other insuilns (NOT glargine or determir), but they are usually given by themselves with meals

They are! They are in the pre-mixed formulations (such as Novolog 70/30, 75/25, 50/50).

They come in pre-filled injection syringes and in 10 ml vials, and are used in insulin pumps and for sliding scales in hospitals (as is regular insulin)

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Humulin R

Novolin R

as a mixture with the longer - acting NPH (or N) insulin in the mixture NPH/R 70/30.

Regular takes ~30 minutes to start to work, which is why the insulin is injected 30 minutes prior to the meal

No. No injection required at lunchtime, because there may be some regular left mid-day, and the NPH will be in effect.

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Regular is drawn up first (the clear insulin) and the NPH (cloudy) is drawn up second

A note:

Currently more people are either using a baseline insulin with oral agents for day-time control, or may be using a "type 1" regimen for tight control: a baseline insulin (such as glargine) with injections of a rapid - acting insulin at meal - times.

Regular insulin comes in mixtures (such as Humulin or Novolin 70/30, 50/50). They come in pre-filled injections and in 10 ml vials.

Regular insulin (by itself) is usually drawn from a 10 ml vial, or used in insulin pumps and for sliding scales in hospitals (as are the rapid - acting insulins)

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Humulin N

Novolin N

Glargine (lantus, lantus solostar)

Determir (levemir)

At bedtime to ensure no mixing occurs with other insulins (which are usually given at mealtimes)

All insulin pens use 3 ml insulin vials and are easier to use, and cause less dosing errors, if used correctly. They are easier to use for patients with dexterity problems (arthritis)

Hypoglycemia, weight gain, and local skin reactions (to avoid, rotate injection site)

Glargine (Lantus) may sting a little when injecting

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Sliding Scale

Not entirely.

Keep unused vials or cartridges in the refrigerator.

Vials or pens in current use are good for 30 days at room temperature

No. Do not shake the insulin vial or cartridge; gently roll in the palms to mix the suspension

Draw the short - acting (clear insulin) 1^st, then draw up the NPH

The abdomen. Alternating injection sites around the abdomen should be done regularly to prevent inflammation and atrophy

Preprandial blood glucose < 95 mg/dL

A1C should be < 6%

Mask the symptoms of shakiness and anxiety but NOT sweating or hunger

Most notable with the non-cardioselective agents

15 - 20 g of rapidly absorbed carbohydrates, which could be: 1/2 cup (4 oz) of any juice or non-diet soda, 1 cup (8 oz) milk, 1 tablespoon of sugar or honey, 5 - 6 pieces of hard candy, 3 or 4 glucose tabs, or 1 serving of glucose gel.

BG should be tested 15 minutes after treatment to see if it has reached a safe level.

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Glucagon 1 mg given by SC, IM, or IV injection, or glucose can be given as an injection

After administration, check blood glucose in 15 minutes to see if safe levels have been reached (> 70 mg/dL)

Depends. Some machines require calibration before the 1st uese, if a new package of strips is opened, machine is left in extreme conditions, machine is dropped, or if the level does not match how the patient is feeling

Yes. Close the lid of the strip container after every use, as air and moisture can destroy the strips and affect results