Mixing Insulin
Karmen Rutter, RPNS
Time to complete skill: 10 minutes
Student Learning Objectives:
1) Identify proper syringe for mixing insulin and difference compared to other syringes.
2) Understanding peak times in relation to insulin medications.
3) Correct order for mixing insulin.
Procedural Steps
Needs Improvement
1. Assesses patient and provides blood glucose test.
Assessing to make sure patient is not hypoglycemic before
preparing a medication that needs to be used within a specific time
frame.
2. Reviews Doctor’s Order and MAR.
Confirm how much insulin is needed from each insulin medication.
3. Calculates insulin doses together correctly.
Calculate both insulin doses together to know how many units total
will be drawn up between the two insulin
4. Retrieves supplies needed.
Explains supplies needed.
States proper insulin syringe and why.
5. Performs hand hygiene.
6. Retrieves correct medication.
Check for right medications.
Read each vial to confirm regular and NPH insulins.
Humulin R is clear, Humulin N is cloudy.
7. Researches medications peak time.
Understands the peak times and when to assess for risk of
hypoglycemia.
8. Performs hand hygiene (moment two) and applies gloves to
hands.
9. Gently mixes insulin medication by rolling between palms of
hands.
Identifies proper insulin to mix and states rationale for why that
insulin is mixed.
10. Removes caps from insulin vials.
Expiry label of 28 days can be placed on vial or expiry date as per
workplace policy.
If no caps on vials move on to next step.
11. Cleans top of vials with alcohol pads.
Allows vials to sit and dry for 15 seconds. Decreases risk of
microbes.
12. Remove syringe from packaging carefully.
13. Confirms NPH and Regular Insulin and doses with MAR before
beginning to mix medication.
Remember: CLOUDY (inject air), CLEAR (inject air)  CLEAR
(draw medication), CLOUDY (draw medication) when mixing
insulin solutions.
14. Removes cap from needle carefully ensuring needle safety.
Being careful not to bend tip of needle.
Competent
15. Draws back correct amount of air in units starting with NPH
(cloudy) insulin.
16. Places needle tip in NPH vial and injects air into vial.
Removes needle from vial safely.
17. Draws back correct amount of air in units for Regular (clear)
insulin.
Ensure this process is done AFTER injecting air into NPH.
DO NOT remove needle from vial.
18. Flips vial upside down with syringe still inside and begins to
draw up correct dose of Regular (clear) insulin.
Ensures dose is correct in syringe with Instructor.
19. Removes bubbles from syringe if any present.
20. Flips vial back over and removes needle from vial.
21. Takes NPH (cloudy) vial and inserts syringe into vial carefully.
Ensures not to depress on the syringe when inserting needle into
cloudy vial.
22. Flips vial upside down with syringe inside and carefully begins
to draw up correct dose of NPH (cloudy) insulin.
This process ensures carefully drawing up insulin, so no bubbles
become present in drawing up insulin.  This ensures no mixing of
insulins inside the vial.
Knowing the dose was calculated correctly by the correct total units
that were calculated.
23. Flips vial back over and remove syringe.
24. Replaces needle cap to needle.
Ensures the needle tip stays sterile before administering to patient.
 Ensures needle safety.
25. Remove gloves and provide hand hygiene (final moment).
26. Create med label as per MAR and doctor order.
Medication label should state the patient’s name, the date, and the
types of insulins and their doses.
****Highlighted tasks must be completed in order to meet passing requirements***
P/NP:______________________________
References
How to Mix Insulin NPH and Regular Insulin Nursing | Mixing Insulin Clear to Cloudy (2016) YouTube. RN
Sarah. Available at: https://www.youtube.com/watch?v=O_kXOnrYYRA (Accessed: March 28, 2023).