It is possible to mix insulins in the same syringe?

González Sevilla, M.; de Lorenzo Pinto, A.; García Sánchez, R.; Ortega Navarro, C.

doi:10.1016/j.rceng.2018.12.009

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"apellidos" => "Ortega Navarro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Farmacia, Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Es posible mezclar insulinas en una misma jeringa?" ] ] "textoCompleto" => "A widespread practice for hospitalized patients is mixing a slow or intermediate insulin and a rapid insulin in a single syringe with the aim of reducing the number of injections administered to the patient.<a class="elsevierStyleCrossRefs" href="#bib0050">1,2</a> The nursing staff perform this single administration for insulins marketed in vials because, in the case of pens and other devices, the insulin cannot be extracted.<a class="elsevierStyleCrossRef" href="#bib0060">3</a>However, if we review the information included in the datasheets of insulins marketed in vial form, the only compatible mixture is the one with neutral soluble insulin (Regular®, Actrapid®) and insulin isophane (NPH®, Insulatard®). The other possible combinations (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) should not be mixed. The reason is clear: there is a risk of physiochemical changes in the mixture that can cause an abnormal physiological response.<a class="elsevierStyleCrossRef" href="#bib0065">4</a><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The reason for the neutral soluble insulin and insulin isophane combination could be related to the old insulin therapy regimen that consists of combining the two insulins and jointly administering them at breakfast and dinner.<a class="elsevierStyleCrossRefs" href="#bib0070">5,6</a> However, the most recommended regimen in the hospital setting is currently the basal–bolus–correction regimen because it is the one that most resembles the physiological secretion of insulin.<a class="elsevierStyleCrossRefs" href="#bib0065">4,7</a> This regimen generally consists of administering 50% of the total daily insulin in the form of slow insulin (basal) and the remaining 50% in the form of rapid or ultrarapid insulin throughout the day (bolus), adding the necessary corrections based on capillary blood glucose.<a class="elsevierStyleCrossRef" href="#bib0080">7</a>In this regimen, a slow insulin is employed rather than administering insulin isophane. The only slow insulin marketed in vial format is insulin glargine (Lantus®), which cannot be mixed due to the low pH of its solvent and the possibility of changing its pharmacokinetic profile.<a class="elsevierStyleCrossRefs" href="#bib0060">3,8,9</a>Therefore, we want to alert all health professionals that the practice of mixing insulins in a single syringe is not recommended because it can affect the safety and efficacy of the insulins." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: González Sevilla M, de Lorenzo Pinto A, García Sánchez R, Ortega Navarro C. ¿Es posible mezclar insulinas en una misma jeringa? Rev Clin Esp. 2019;219:226–227." ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Intermediaries</th><th class="td" title="table-head " align="left" valign="top" scope="col">Slow \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Humulin NPH® (insulin isophane) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Insulatard® (insulin isophane) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lantus® (insulin glargine) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Ultrarapid</td><td class="td" title="table-entry " align="left" valign="top">NovoRapid® (insulin aspart) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">✓ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Humalog® (insulin lispro) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Apidra® (insulin glulisine) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">✓ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Rapid</td><td class="td" title="table-entry " align="left" valign="top">Humulin Regular® (neutral soluble insulin) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">✓ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Actrapid® (neutral soluble insulin) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">✓ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2017995.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Possible combinations of insulin in a single syringe." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Aplicar una inyección de insulina: MedlinePlus enciclopedia médica. 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Revista Clínica Española (English Edition)

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Impact factor 2023

2.3

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0.7

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Vol. 219. Issue 4.

Pages 226-227 (May 2019)

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