ADMINISTRATION (Part 1 of 2) Preparation Brand Route Administration Mixing Comments RAPID-ACTING insulin Afrezza ℞ oral At the beginning — Loss of drug effect if inhaler is inh of a meal mishandled. See full labeling. Fiasp ℞ SC, Individualize. Do not dilute/mix with other Should look clear, colorless. CSII, SC: at start of meal insulins SC: use with intermediate or IV* or within 20mins long-acting insulin. after starting meal NovoLog ℞ SC, Within 5–10mins SC: May mix with NPH insulin. CSII: Change inj site at least CSII, before a meal Draw NovoLog into syringe every 3 days and reservoir at IV* first. Inject immedi­ ately­ after least every 6 days. mixing. May dilute with Insulin Diluting Medium for NovoLog to 1:10 (U-10) or 1:2 (U-50) concentrations. CSII: Do not dilute/mix with other insulins IV: Do not mix with other insulins insulin Apidra ℞ SC, Individualize. SC: May mix with NPH insulin. SC: use with intermediate or glulisine CSII, SC: 15mins before Draw Apidra into syringe first. long-acting insulin. IV* meal or within Inject immediately after mixing. CSII: Change inj site at least 20mins after CSII: Do not dilute/mix with every 48hrs and reservoir at least starting meal other insulins­ every 2 days. IV: Do not mix with other insulins Admelog ℞ SC, Within 15mins Do not dilute/mix with other CSII: Change inj site at least IV*, before or insulins every 3 days and reservoir at CSII immediately after least every 7 days. a meal Humalog ℞ SC, Within 15mins SC: May mix Humalog U-100 CSII: Change inj site at least IV*†, before or with NPH insulin. Draw Humalog every 3 days and reservoir at CSII† immediately after into syringe first. Inject imme­ least every 7 days. a meal diately after mixing. May dilute with STERILE DILUENT for Humalog to 1:10 (U-10) or 1:2 (U-50) concentrations. CSII: Do not dilute/mix with other insulins insulin lispro- Lyumjev ℞ SC, At the start of a Do not dilute/mix with other SC: use with intermediate aabc IV* meal or within insulins or long-acting insulin. 20mins after IV: for Lyumjev U-100 only. Do not starting a meal give U-200 intravenously. SHORT-ACTING insulin Humulin OTC SC, Individualize. SC: May mix with NPH insulin only. Use syringes marked with U-100. injection R U-100 IV* SC: ~30mins Draw Humulin R (clear) into syringe regular (R) before a meal first then NPH. Inject immediately. Humulin ℞ SC Individualize. Do not dilute/mix with other Caution with dosage. Should R U-500 ~30mins before insulins look clear, colorless. Use with a meal U-500 insulin syringes. Novolin R OTC SC, Individualize. SC: May mix with NPH insulin Use syringes marked with U-100. IV* SC: ~30mins before only. Draw Novolin R (clear) into a meal syringe first then NPH. Inject immediately. (continued) INSULIN ADMINISTRATION (Part 2 of 2) Preparation Brand Route Administration Mixing Insulins Comments INTERMEDIATE-ACTING insulin Humulin OTC SC Individualize May mix with Humalog or Rotate vial or pen until uniformly isophane N Humulin R. Draw clear insulin white and cloudy. Use syringes suspension into syringe first then Humulin marked with U-100. (NPH) N. Inject immediately. Novolin OTC SC Individualize May mix with only. Roll vial in horizontal position N Draw regular insulin (clear) into 10 times or move pen up and syringe first then Novolin N. Inject down 20 times until uniformly immediately. white and cloudy. Inject immediately. SHORT- AND INTERMEDIATE-ACTING MIXTURES insulin aspart NovoLog ℞ SC Twice daily within Do not mix with other insulins Roll vial, prefilled syringe protamine/ Mix 70/30 15mins before a 10 times until uniformly cloudy. insulin aspart meal insulin Humulin OTC SC Individualize. Do not mix with other insulins Rotate vial or pen until uniformly isophane 70/30 ~30–45mins white and cloudy. Use syringes suspension before a meal marked with U-100. (NPH)/regular Novolin OTC SC Individualize. Twice Do not mix with other insulins Roll vial in horizontal position 10 insulin (R) 70/30 daily ~30mins times or move pen up and down before a meal 20 times until uniformly white and cloudy. Inject immediately. insulin lispro Humalog ℞ SC Within 15mins Do not mix with any other Rotate vial or pen 10 times until protamine/ Mix 50/50 before a meal insulins uniformly white and cloudy. insulin lispro Humalog Mix 75/25 LONG-ACTING insulin Tresiba ℞ SC Once daily at any Do not dilute/mix with other Should look clear, colorless. degludec time of day insulins insulin Levemir ℞ SC Once daily with Do not dilute/mix with other Should look clear, colorless. detemir PM meal or at insulins bedtime or twice daily (AM and PM) insulin Basaglar ℞ SC Once daily at the Do not dilute/mix with other Should look clear, colorless. glargine Lantus same time every insulins day Semglee Toujeo LONG-ACTING MIXTURES insulin Xultophy ℞ SC Once daily at same Do not dilute/mix with other Should look clear, colorless. degludec/ 100/3.6 time each day, insulins with or without food insulin Soliqua ℞ SC Once daily within Do not dilute/mix with other Should look clear, colorless to glargine/ 100/33 the hour prior to insulins or solutions almost colorless. first meal NOTES Key: CSII = continuous subcutaneous insulin infusion; *IV to be used in a clinical setting under proper medical supervision. †IV and CSII administration for Humalog U-100 only. Rate of insulin absorption, onset and duration of action may be affected by the injection site, blood supply, temperature, exercise, and other variables. Caution with changes in strength, manufacturer, preparation, species of insulin source. Not an inclusive list of medications and/or dosing instructions. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling. (Rev. 12/2020)