How to Mix Insulin

“Clear to cloudy.”

This is a common phrase that you might hear when it comes to mixing insulin.

But what does it mean, and why is it important?

Insulin is a hormone the pancreas produces that helps regulate blood sugar levels. It’s a vital medication for individuals with diabetes who may need to take multiple types of insulin throughout the day.

Correctly mixing and administering insulin ensures effective blood glucose control and reduces the risk of complications. In this guide, we’ll explore how to mix insulin and the reasons behind it.

We’ll also explain the correct order to follow using the “clear before cloudy” insulin method.

Purpose of Mixing Insulin

The two types of insulin most commonly mixed are regular insulin (clear) and neutral protamine Hagedorn (NPH) insulin (cloudy).

Regular insulin acts quickly to lower blood sugar, while NPH insulin has a slower onset and longer duration. Combining these allows better control of blood glucose levels throughout the day.

By mixing the two, nurses can administer them in a single injection, simplifying the process for them and the client.

The Clear to Cloudy Concept: Do You Draw Up NPH or Regular Insulin First?

Always follow the “clear to cloudy” rule when drawing up insulin.

Draw regular insulin (clear) before NPH insulin (cloudy). This prevents contamination of the fast-acting insulin with the slower-acting NPH, ensuring each type maintains its unique properties.

Here’s an easy way to remember the process: think of the mnemonic RN (Regular insulin to NPH).

Step-by-Step Guide on How to Mix Insulin

Mixing insulin involves precision and attention to detail.

Below is a simple guide on how to properly mix and administer insulin.

Step 1: Check the health care provider’s order.

The health care provider specifies the type and dose of insulin the nurse needs to administer.

Ensure that the order matches the insulin vials you have on hand. For example, if the order is for 10 units of regular insulin and 20 units of NPH insulin, make sure the vials contain these amounts.

Step 2: Wash your hands and gather supplies.

Before handling insulin, always wash your hands with soap and warm water.

Gather all necessary supplies:

• Insulin syringes
• Regular (clear) insulin vial
• NPH (cloudy) insulin vial
• Alcohol swabs
• The client’s injection site plan

Make sure to check the expiration date on both vials and inspect them for any unusual changes in appearance. Remember the peak times of each insulin type to plan for the injection timing.

Injection Timing

Source: National Institutes of Health

Step 3: Roll the NPH insulin vial.

Gently roll the NPH insulin vial between your hands to mix it.

NPH insulin naturally separates, so this step ensures the nurse combines it well. Never shake the vial, as this can cause air bubbles, which may affect the dosage.

Step 4: Draw the Insulin.

• Clean the tops of both vials with alcohol swabs.

• Remove the caps from both vials. Don’t touch the needle.

• Draw air into the syringe equal to the dose of NPH insulin. Inject it into the NPH vial (cloudy) without drawing any insulin.

• Remove the syringe and set it aside.

• Next, draw air into the syringe equal to the dose of regular insulin and inject it into the regular vial (clear) without drawing any insulin.

• Turn the vial upside down with the needle tip still inserted in it.

• Slowly pull back on the plunger until you have drawn up the dosage.

Step 5: Check for air bubbles.

Hold the syringe upright and tap it gently with your finger to dislodge any air bubbles. Push out any excess insulin if necessary.

Step 6: Insert the needle back into the NPH vial.

Insert the needle back into the NPH vial and draw out your prescribed dosage.

Step 7: Check for air bubbles again.

Hold the syringe upright and tap it gently with your finger to dislodge any air bubbles. Push out any excess insulin if necessary.

• You should have two doses in one syringe — regular and NPH insulin.
• If you notice that there are still air bubbles, repeat this step until they’re gone.

By following these steps, you ensure proper mixing of insulin while maintaining the integrity of both medications. Mixing insulin correctly is essential for effective blood sugar management in clients living with diabetes.

“Clear to cloudy” ensures the nurse draws up regular insulin (clear) first, avoiding contamination and preserving the efficacy of the treatment.

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