Insulin Admin and Counseling

What is the standard concentration of most insulin products?

U-100 = 100 units/mL

What is considered a concentrated insulin?

Insulin containing >100 units/mL

What size are most insulin vials?

10 mL

What vial sizes are available for Humulin R U-500?

20 mL vial; a few products also come in 3 mL vials

How much insulin do most insulin pens contain? and what is the exception?

3 mL; Toujeo which can be 1.5 mL or 3 mL

Are insulin pens single-dose or multidose devices?

Multidose

What must be dispensed with insulin pens?

Pen needles

What are the 2 general types of insulin pens?

Disposable pens and pens with replaceable cartridges

Why can large doses of U-100 insulin be difficult to administer?

They require a larger injection volume and may require more than one syringe if >100 units

What is the primary advantage of concentrated insulin? what about the primary disadvantage?

Provides large insulin doses in a smaller injection volume; Dosing errors can be fatal

How are most concentrated insulin pens dosed?

Dial the prescribed number of units directly on the pen

Which concentrated insulin is available in BOTH a pen and a vial?

Regular insulin U-500 (Humulin R U-500)

Why does regular insulin U-500 have a higher risk for dosing errors than most concentrated insulins?

It is available in both a pen and a vial

Which rapid-acting insulins are available as U-200?

Humalog KwikPen and Lyumjev KwikPen (lispro)

Which short-acting insulin is available as U-500?

Humulin R U-500 KwikPen and vial

Which ultra-long-acting insulin is available as U-200?

Tresiba FlexTouch (degludec)

What is the concentration of Tresiba FlexTouch pen?

200 units/mL

Which long-acting insulin is available as U-300?

Toujeo SoloStar and Toujeo Max SoloStar (glargine)

What is the concentration of Toujeo?

300 units/mL

When using a concentrated insulin pen, should the prescribed units be converted before dialing the pen?

No; dial the prescribed number of units directly

If 80 units of Tresiba are prescribed, what dose is dialed on either the U-100 or U-200 pen?

80 units

What differs when giving the same number of units with Tresiba U-100 versus U-200?

The injection volume

What is the general formula for converting insulin units to mL?

Volume (mL) = prescribed units ÷ concentration (units/mL)

For what insulin requirement is Humulin R U-500 useful?

patients who require >200 units/day

What is the maximum amount of Humulin R U-500 that the KwikPen can deliver in one injection?

300 units

What are the 3 basic steps for calculating how many insulin pens to dispense?

Calculate total units needed → calculate units per pen → divide total units needed by units per pen and round up

How do you calculate the total units of insulin needed for a prescription?

Units/day × days' supply

How do you calculate the number of units contained in an insulin pen?

Concentration (units/mL) × pen volume (mL)

How should the number of insulin pens to dispense be rounded?

Round up to the next whole pen

Why must the number of insulin pens dispensed be rounded up?

Insulin pens cannot be broken

Do insulin pens require priming before each dose?

Yes; usually with 2 units

Is insulin pen priming routinely included when calculating days' supply?

Some pharmacists account for it, but it is not standard practice

How should unused insulin vials, pens, and cartridges be stored?

In the refrigerator

What expiration date applies to insulin continuously stored unopened in the refrigerator?

The manufacturer's expiration date on the label

How may insulin generally be stored once it is in use?

At room temperature for a product-specific number of days

What is the typical room-temperature stability of most insulin products?

About 28 days

Which insulin products are stable at room temperature for 10 days?

Humalog Mix 50/50 pens

Humalog Mix 75/25 pens

Humulin 70/30 pens

How long are Humulin N pen and Novolog Mix 70/30 pen stable at room temperature?

14 days

Which insulins are stable at room temperature for 14 days?

Humulin N pen

Novolog Mix 70/30 pen

Which rapid-acting insulins are stable at room temperature for 28 days?

All of them!

How long is a Humalog Mix 75/25 vial stable at room temperature?

28 days

How long is a Novolog Mix 70/30 vial stable at room temperature?

28 days

How long are Novolin R U-100, Novolin N, and Novolin 70/30 pens stable at room temperature?

28 days

How long is a Humulin R U-500 pen stable at room temperature?

28 days

How long are Lantus, Basaglar, and Semglee vials and pens stable at room temperature?

28 days

Which insulins are stable for 31 days at room temperature?

Humulin R U-100, Humulin N, and Humulin 70/30 vials

Which insulins are stable at room temperature for 40 days?

Humulin R U-500 vial

Which insulins are stable at room temp for 42 days?

Novolin R U-100, Novolin N, and Novolin 70/30 vials

Which insulin pens are stable at room temperature for 56 days?

Tresiba and Toujeo pens

How long are Tresiba and Toujeo pens stable at room temperature?

56 days

What size syringe should be used for the following doses of insulin?

1. < 30 u

2. 30-50 u

3. 51-100 u

1. 0.3 mL syringe

2. 0.5 mL

3. 1 mL

How can U-500 insulin vials and syringes be visually identified?

Dark green vial cap and dark green syringe needle cover

How can U-100 insulin syringes be visually identified?

Orange caps

How many units can a U-500 insulin syringe hold?

Up to 250 units

How many units can a 1-mL U-100 insulin syringe hold?

Up to 100 units

What 2 characteristics are used to select an insulin pen needle?

Length and gauge

How does needle gauge relate to needle thickness?

Higher gauge = thinner needle

What is the gauge range of insulin pen needles?

28G (thickest) to 32G (thinnest)

Approximately how wide is a 32G pen needle?

~2 human hairs

Which pen needles generally cause less pain?

Shorter, higher-gauge needles

What are the shortest insulin pen needle lengths?

4 mm and 5 mm

Which pen needle lengths are preferred for most patients and why?

4 mm and 5 mm; because they do not require pinching and are the least painful

For which patients are 4-mm and 5-mm pen needles particularly useful?

Thinner patients and children

What technique should be used with an 8-mm and 12.7-mm (1/2-inch) insulin pen needle?

Pinch up the skin before injecting

When might a 12.7-mm (1/2-inch) insulin needle be needed?

Obese patients

What are common brands of insulin pen needles and syringes?

BD, Comfort EZ, and Easy Touch

What should insulin be inspected for before injection?

Discoloration and particles

What should be done if unexpected discoloration or particles are present in insulin?

Discard the insulin

How should NPH or protamine-containing insulin be resuspended before injection?

Gently resuspend; via rolling or inverting 4-5 times; do not shake

How is an insulin pen generally primed before each injection?

Dial 2 units, point the needle away, and press the injection button

How can a patient confirm that an insulin pen has been properly primed?

A drop or stream of insulin should appear at the needle tip

What should be done after priming an insulin pen?

Dial the prescribed number of units and inject

What should be injected into an insulin vial before withdrawing the insulin and why?

An equal volume of air; To replace the volume of insulin being removed and facilitate withdrawal

When withdrawing insulin from a vial, what should be done with air bubbles in the syringe?

Limit/remove air bubbles to improve dosing accuracy

When mixing NPH with regular or rapid-acting insulin, which insulin is drawn up first?

Clear regular or rapid-acting insulin before cloudy NPH

When mixing NPH with clear insulin, in what order should air be injected into the vials?

Inject air into cloudy NPH first, then inject air into clear insulin

What is the full sequence for mixing NPH with regular or rapid-acting insulin?

Air into cloudy → air into clear → draw up clear → draw up cloudy

Why is the abdomen the preferred insulin injection site?

Insulin is best absorbed there

What are alternative sites for insulin injection?

Back of upper arm, upper buttock, and lateral thigh

How much skin should be pinched when using an insulin needle >5 mm?

About a 2-inch portion between the thumb and first finger

How long should the needle remain in place after injecting insulin?

5–10 seconds