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View Full Version : yet another failed try at mixing Lantus and Novolog



wilf
03-04-2009, 02:09 AM
I keep reading that a variety of medical professionals are suggesting that you can mix Lantus and Novolog or Humalog in the same syringe.

At DD's request (we're always looking for ways to keep the number of injections down), I tried again tonight - gave a 2.5 unit Novolog bolus together with 8 units of Lantus. As has happened other times, the Novolog bolus seems badly delayed and DD shot up to 270 (now slowly coming down at 230)..

Is anyone out there mixing these insulins successfully, and if so how are you doing it?

mikesmom58
03-04-2009, 07:09 AM
I've always been under the impression that Lantus should never be mixed with anything else. Everytime I any read info on Lantus it says that.

etringali
03-04-2009, 07:26 AM
Same here. We were told to not mix in the same syringe, and to give lantus in separate area from the novolog as it can affect how the N would work.

Skyefire
03-04-2009, 07:59 AM
There has been studies showing that it is ok, we were told by our endo that we could try it, but then we switched to Diluted Humalog, which could not be mixed.

I can see how you would get your result Wilf, as Lantus crystallizes under the skin, for the long release...It makes since that other insulin's would get caught in the process. My worry would be, would it not only effect the Novolog but the lantus as well. I am all for less shots but if you are having this issue I would stop. I am sure it is one of those YDMV things :)

hawkeyegirl
03-04-2009, 09:50 AM
I suspect that the people who do it successfully don't know that it makes a difference. That is to say, I suspect that they do it from the beginning and just adjust the ratios and Lantus so that it "works" for them, not knowing that the Humalog and Lantus would work a lot differently if they were not mixed.

Jack HATED shots, but I could never bring myself to mix them.

danismom79
03-04-2009, 09:55 AM
I suspect that the people who do it successfully don't know that it makes a difference. That is to say, I suspect that they do it from the beginning and just adjust the ratios and Lantus so that it "works" for them, not knowing that the Humalog and Lantus would work a lot differently if they were not mixed.

Jack HATED shots, but I could never bring myself to mix them.

I was thinking along the same lines.

It's the same with Levemir. I mixed it once and it seemed to work, although it might have been a fluke. It never worked again. And I think I only noticed the difference because I didn't start off mixing them.

Adinsmom
03-04-2009, 09:55 AM
Our Endo told us to try griving Novolog and Lantus in the same syringe to cut down on shots. It didn't work for us. The Lantus wasn't as effective and the Novolog lasted even longer then his usual 5 hr dia.

Jordansmom
03-04-2009, 10:20 AM
I know someone who mixes them everyday, but I'm doubtful they'd be aware if it was working correcly or not. They aren't that conscientious.:(

samheis
03-04-2009, 10:27 AM
I don't know how it works, but that's the method we've been using since dx. He gets 2 mixed shots per day, at breakfast and dinner. I wish I could help you, but really this is the only way we know, so I wasn't even aware that it didn't work for some people!

iluvmhp
03-04-2009, 10:30 AM
Our endo said it was ok. We never tried it, because she used two pens. Hope you can get some solid answers.

AlisonKS
03-04-2009, 10:35 AM
we've mixed since diagnosis, TX childrens and OHSU have told us to do so.

candise
03-04-2009, 10:41 AM
We mix Humalog and Lantus in one syringe and have since diagnosis. We were given specific instructions to add air to Lantus then Humalog. Draw from Humalog first then Lantus. We pretty much always use the same site for injection (back love handle area). We have had good success but do not know any different.

danismom79
03-04-2009, 10:47 AM
For people who mix, do you notice how long the Novolog/Humalog stays active? What about postprandial spikes with mixing vs other times of the day with just Novolog/Humalog?

candise
03-04-2009, 10:53 AM
We have seen no spikes but Heaven is still honeymooning. She is around 100 before dinner eats 45 gram carb and takes Lantus6.5/humalog(sliding scale 4 usually) We test before bed around 3 hours later and she is back at 90-100. She wakes up around 100 in the morning.

candise
03-04-2009, 10:55 AM
Oops - forgot she eats a 15 carb snack after bedtime testing. We also mix NPH /Humalog in the am shot.

AlisonKS
03-04-2009, 11:54 AM
he needs way more novolog for breakfast vs the rest of his meals, that's the only thing that's different.

fossmommy
03-04-2009, 12:14 PM
Well, we have been mixing since DX and don't know any different, but we have only found one time of the day where there seems to be a jump after a meal and that's breakfast. Otherwise it seems to work really well for us. I hope you can find something that works for you!

Andrew's Mom
03-04-2009, 01:29 PM
we started mixing when we started using i-ports and its been fine, but i am only mixing 1.5 u lantus with 3 to 4 u of diluted humalog i don't know if the amount makes a difference.

Cathy

buggle
03-04-2009, 02:03 PM
We've never mixed. I like having the lantus site different than novolog site. We give lantus in the bum because we were told that it releases more uniformly from it. We give rapid in the arms or legs. Brendan gets two lantus shots a day, so he does get a lot of shots. So far, he hasn't complained so we haven't really had a reason to try mixing.

Wilf, have you worked out the chemistry of how the rapid would be affected by being mixed into the lantus matrix? I'd think that it would make rapid behave more like regular insulin by slowing down release. I really don't see a way to mix them and get the effect that you expect with rapid. You could play around with pre-bolusing to see if you can match the peak with food better. I can't really think of any other way of addressing it.

czardoust
03-04-2009, 02:06 PM
not mixing here, wouldnt try it.

C6H12O6
03-04-2009, 02:11 PM
Just so you know, if you are mixing humalog and lantus (for example) you draw up the humalog first and then draw up the lantus. So the lantus goes into the tissue first followed by the humalog.
With humalog and nph the common method was cloudy than clear. (If I remember correctly)

danismom79
03-04-2009, 02:13 PM
Just so you know, if you are mixing humalog and lantus (for example) you draw up the humalog first and then draw up the lantus. So the lantus goes into the tissue first followed by the humalog.
With humalog and nph the common method was cloudy than clear. (If I remember correctly)

Does it really do that - sit on top of the Humalog in the syringe? We draw Humalog/Regular then NPH, as instructed (always fastest to slowest), and since the NPH is cloudy, I can see it mixing with whatever else is in the syringe. I'd imagine Lantus would do the same thing, unless it's more viscous than Humalog.

buggle
03-04-2009, 02:20 PM
Isn't the pH of lantus different than all the others? Seems like it's acidic. So, it seems like mixing it with another insulin would affect the release of lantus too and make it release faster.

It's hard enough to figure out how it each insulin will behave on its own. I'd rather just do more separate shots. But... I don't have a child who has a huge issue with shots. If I did, I might feel differently about trying to make mixed shots work.

C6H12O6
03-04-2009, 02:41 PM
Does it really do that - sit on top of the Humalog in the syringe? We draw Humalog/Regular then NPH, as instructed (always fastest to slowest), and since the NPH is cloudy, I can see it mixing with whatever else is in the syringe. I'd imagine Lantus would do the same thing, unless it's more viscous than Humalog.


If you look at page 862 of this nursing text (google book) it says draw up nph then regular. The book is obviously dated but the current edition of the text says the same thing http://books.google.com/books?id=4DRbi3sUHMcC&printsec=frontcover&dq=fundamentals+of+nursing+potter+perry&lr=#PRA1-PA862,M1

danismom79
03-04-2009, 02:46 PM
If you look at page 862 of this nursing text (google book) it says draw up nph then regular. The book is obviously dated but the current edition of the text says the same thing http://books.google.com/books?id=4DRbi3sUHMcC&printsec=frontcover&dq=fundamentals+of+nursing+potter+perry&lr=#PRA1-PA862,M1

That actually says the opposite - air in NPH, air in Regular, draw up Regular, draw up NPH.

Either way, it all gets mixed together, so one insulin isn't going into the body first. I think the order has more to do with contamination of the vials. In general, it isn't advised to mix the long-acting (NPH is intermediate) insulin with anything else. Maybe the amounts of each insulin is a factor.

C6H12O6
03-04-2009, 02:55 PM
That actually says the opposite - air in NPH, air in Regular, draw up Regular, draw up NPH.

Either way, it all gets mixed together, so one insulin isn't going into the body first. I think the order has more to do with contamination of the vials. In general, it isn't advised to mix the long-acting (NPH is intermediate) insulin with anything else. Maybe the amounts of each insulin is a factor.

Oh sorry you?re right, clear and then cloudy makes more sense also. Either way since NPH is regular insulin with added components the chance of those components mixing with the humalog, regular etc and modifying its activity is still there but less so than in the case of the nph being pushed in after the regular, humalog etc.

annaluvspink
03-04-2009, 03:24 PM
We were taught not to mix Lantus and Novolog. Never asked why. Just never seemed like it was a remote possibility.

Michelle
dd Annabelle 6.5 dxd 3/29/07

wilf
03-05-2009, 01:57 AM
Thanks for your comments folks.

It was the latest in a series of experiments (it seems I feel compelled to try this every 6 months or so). Each time has been a fiasco.

My guess is that the mixing might work for kids who are still honeymooning - it sure doesn't work here. Didn't mix tonight (though DD got the same amount of each insulin), and everything is on track - with BG in the 90-140 range instead of 200+.. :cwds:

Mom2Deacon
03-05-2009, 09:03 AM
Whenever I mixed the two insulins, I noticed that Deacon's numbers were always higher. The Lantus seems to slow down the absorption rate of the Novolog.

--Sara

shirley83006
03-05-2009, 09:27 AM
We were always told from the beginning that you were not to mix the both. and to give the injections far from each other.