How to prepare a mixed dose of insulin

You will mix insulin from two bottles (vials). The order in which you mix the cloudy (long-acting) and clear (short or rapid-acting) insulin is important. Follow the order of the steps below.

Roll the cloudy insulin bottle gently between your hands.

slide 1 of 9 slide 1 of 9, Roll the cloudy insulin bottle gently between your hands.,

Roll the cloudy insulin bottle until all the white powder has dissolved.

Rolling the bottle warms the insulin if you have been keeping the bottle in the refrigerator.

Do not shake an insulin bottle.

Clean the lids of the bottles.

slide 2 of 9 slide 2 of 9, Clean the lids of the bottles.,

If you are using a bottle for the first time, remove the protective cover from the rubber lid.

If the rubber lid of the insulin bottle is dirty, clean it with an alcohol wipe or a cotton ball dipped in alcohol. Let the alcohol dry.

Draw air into the syringe for the cloudy insulin dose.

slide 3 of 9 slide 3 of 9, Draw air into the syringe for the cloudy insulin dose.,

Remove the plastic cap that covers the needle on your insulin syringe. Important: Do not touch the needle.
Pull the plunger back on your insulin syringe and draw air into the syringe equal to the number of units of cloudy insulin to be given.

Force air into the cloudy insulin bottle.

slide 4 of 9 slide 4 of 9, Force air into the cloudy insulin bottle.,

Push the needle of the syringe into the rubber lid of the cloudy insulin bottle.
Push the plunger of the syringe to force the air into the bottle. This equalizes the pressure in the bottle when you later remove the dose of insulin.
Remove the needle from the bottle.

Draw air into the syringe for the clear insulin dose.

slide 5 of 9 slide 5 of 9, Draw air into the syringe for the clear insulin dose.,

Pull the plunger of the syringe back and draw air into the syringe equal to the number of units of clear insulin to be given.

Force air into the clear insulin bottle.

slide 6 of 9 slide 6 of 9, Force air into the clear insulin bottle.,

Push the needle of the syringe into the rubber lid of the clear insulin bottle. Note: You will draw the clear insulin into the syringe first, then the cloudy insulin (Step 8). It is important to follow this order.
Push the plunger to force the air into the bottle. Leave the needle in place.

Draw clear insulin into the syringe.

slide 7 of 9 slide 7 of 9, Draw clear insulin into the syringe.,

Turn the bottle and syringe upside down. Position the tip of the needle so that it is below the surface of insulin in the bottle.
Pull back the plunger to fill the syringe with slightly more than the correct number of units of clear insulin to be given.
Tap the barrel of the syringe so that trapped air bubbles move into the needle area. Push the air bubbles back into the bottle. Important: Make sure that you have the correct number of units of insulin in your syringe.
Remove the needle from the clear insulin bottle.

Insert the needle into the cloudy insulin bottle.

slide 8 of 9 slide 8 of 9, Insert the needle into the cloudy insulin bottle.,

Insert the needle into the rubber lid of the cloudy insulin bottle.

Important: Do not push the plunger because this would force clear insulin into your cloudy insulin bottle. If clear insulin is mixed in the bottle of cloudy, it will alter the action of your other doses from that bottle.

Draw cloudy insulin into the syringe.

slide 9 of 9 slide 9 of 9, Draw cloudy insulin into the syringe.,

Turn the bottle and syringe upside down. Position the tip of the needle so that it is below the surface of insulin in the bottle.
Slowly pull back the plunger of the syringe to fill the syringe with the correct number of units of cloudy insulin to be given. This will prevent air bubbles entering the syringe.
Remove the needle from the bottle. You should now have the total number of units for the clear and cloudy insulin in your syringe. For example, if you need 10 units of clear and 15 units of cloudy, you should have 25 units in your syringe. Now you are ready to give the shot.

Current as of: October 2, 2023

Author: Healthwise Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

Current as of: October 2, 2023

Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content.

To learn more about Healthwise, visit Healthwise.org.

NOTICE: This health information was not created by Columbia University Irving Medical Center and may not necessarily reflect specific CUIMC practices. For medical advice to your personal condition, please consult your doctor. Medical advice disclaimer.