# Mixing novo rapid and insulatard



## AaronJane (Feb 26, 2013)

Have been mixing novo rapid and insulatard for six years and have recently found out that this is now not advised by my doctors (NHS) and they say they have not been advising this method for three years now.  Any advice on why they stopped using this method and why wasn't I ever informed.

I have tried to find out weather or not mixing these insulins is appropriate or not as I have had lots of conflicting answers and many different ideas on what the long lasting effects could be    

Advice appreciated


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## Copepod (Feb 26, 2013)

Welcome to the forum, AaronJane.

Most people find that having long and short acting insulins at separate times gives the best scope for adjusting doses according to food intake, activity, stress, infections etc. Most people take long acting once or twice a day, plus short acting with each meal. Plus, there's scope for confusing doses. 

What doses / times are you injecting at present? What doses / ratios / times did your doctor recommend?


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## everydayupsanddowns (Feb 26, 2013)

Hi Aaronjane

Welcome to the forum

Not sure what you mean by 'mixing'. Do you mean drawing up in the same syringe? 

I've used both of the insulins you mention, but only as separate 'basal:bolus' style insulins. Could you use them that way?


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## AaronJane (Feb 26, 2013)

Always in the same syringe and that's the way I was shown six years ago and I always go to my check up


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## AaronJane (Feb 26, 2013)

Same syringe just the way I was shown


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## MeganN (Feb 27, 2013)

I used to be on the premixed version. Maybe they just mean that they would prefer you to use this? They might think it would reduce the chances of dosage mistakes. 

I'm now on the same insulins just split up


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## DeusXM (Feb 27, 2013)

Insulatard and Novorapid can be mixed in the same syringe - after all, Novo Nordisk make a range of pre-mixed insulins that are exactly that.

However I'm slightly astonished that you were diagnosed 6 years ago and put on syringes. These haven't been frontline treatment for over a decade -they were considered old fashioned when I was diagnosed over 14 years ago. The usual route is to use insulin pens with prefilled cartridges, either containing a pre-mixed insulin administered in fixed doses, or two separate pens, one with slow, long-acting insulin (basal insulin) and one with a rapid, quick-acting insulin (bolus insulin). 

Insulatard used to be used as a basal but was largely superseded a decade ago by Lantus and Levemir, which are much more predictable insulins. This, the easy availability of prefilled cartridges, and near total abandonment of syringes for pens, are all reasons why using a syringe to mix insulin from vials is no longer recommended. As for why your care team didn't inform you....well, you'll have to take that up with them and ask them why they stopped bothering to learn about diabetes in 1990.

Having said all that....if your insulin regime is working for you and getting A1Cs below 6.5% with few hypos, there is no reason for you to change.


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## Pumper_Sue (Feb 27, 2013)

There is no reason not to mix in the same syringe. Cuts down on the amount of injections you need per day.
This info should be in the patient leaflet. If you do have any concerns then email the manufactures.
Ps welcome to the forum.

Deus.
        has it ever acured to you that some people do not like using pens and would prefer to use a syringe?


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## DeusXM (Feb 27, 2013)

> has it ever acured to you that some people do not like using pens and would prefer to use a syringe?



Yes, absolutely. It's just that there's nothing in here to suggest the OP was even shown insulin pens, particularly as in my experience most diabetes patients aren't even made aware that syringes are an option.


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## Abi (Feb 27, 2013)

Certainly unusual to be self mixing and using syringes nowadays
However, I think there is a place for it in those for whom MDI is not an option/ not wanted but who want to better tailor their insulin to their own needs than with a premix
I was reading the messages on a diabetologists forum a while ago- it seems that a comparison of diabetes control in youngsters in different counties revealed far better control in those countries where self mixed twice daily insulin was the norm rather than a premix ( ( assume in scenarios where MDI deemed innapropriate/ not wanted - and with some means of carbohydrate assessment)
In 1986 when I was diagnosed I self mixed. The standard 30/70 of soluble or rapid to intermediate would have resulted in massive post breakfast and post dinner highs, with hypos across the rest of the day and overnight- despite uniform carbohydrate content of 3 main meals with snacks in between- I needed far less intermediate and more rapid and in fact even now basal requirements are less than 40% total dose. I'm sure that others are similar
Also would have thought convenience of e pen less important if only injecting twice daily
I wonder how many people's health and quality of life has been compromised due to this dumbing down approach of pre mixes rather than self mixing- especially as MDI has only relatively recently become the norm


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## Pumper_Sue (Feb 27, 2013)

I used syringes every day for 40 plus years mainly because I prefered the syringe rather than the pen and used the same method for MDI. This way I only needed 3 injections a day instead of 4.  If for any reason I need to inject due to a pump problem out comes the trusty syringe.


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## Monica (Feb 28, 2013)

DeusXM said:


> However I'm slightly astonished that you were diagnosed 6 years ago and put on syringes.



Well DeusXM - Carol was diagnosed 12 March 2007, so 6 years ago. We were taught how to inject Mixtard30 with syringes and not told about pens. Only due to us researching Diabetes did we find out about the pens. So a month later we asked to go on pens, but they said NO. After 3 months we insisted that we wanted the pen, so we got told we need to change the insulin to Novomix30 too. A few months down the line we found out about the pump, but when we asked about that it was categorically NO too. And if Carol's bloods behaved themselved I don't think we'd ever got off the mix either. Luckily 3 years down the line things changed dramatically at our clinic  and she does have the pump.
It seems to me consultants just let you do the work and if you don't research you stay stuck in the "dark ages"


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## DeusXM (Feb 28, 2013)

Wow - that's a real shock. It's completely different from my experience of diagnosis in 1998.

I was taken to hospital and given a syringe injection by the nurse - no idea what insulin it was but I suspect in hindsight it was probably Actrapid. I then did one injection with a syringe myself but it was made abundantly clear that this was a temporary fix and I would be using pens - I think after my two syringe injections, I was put straight on pens, one of Mixtard 30, one of Mixtard 50. I was also given an 'emergency' pen of Actrapid that I was told to give myself 2u of whenever I went over 12.

After a year, I was then moved onto MDI - not even at request, I was just told this would give me better control. I think this might be because I was already highlighting to my care team that if I was eating a bigger meal, I would need to inject more insulin to get control so I was sorta doing DAFNE with a mix insulin but with no real understanding of carbs. Even on MDI I wasn't actually taught about carbs (I was given fixed doses) but frankly I haven't had a medical professional set my dose for me since 2000, I just noticed I'd need to adjust things myself.

I accept I'm projecting my experience as 'normal' as I don't really have much to compare it to - I just know that pens are far more common in the UK (although not the US) and that from what I've been through, syringes weren't ever seriously considered as a treatment method. That's not to say people shouldn't have the option or they have no place in modern diabetes treatment, far from it. It's just I'm stunned that an NHS system that has been paying for pen needles for over a decade is telling people they shouldn't have pens. I wouldn't have necessarily though my original PCT was dramatically more forward thinking than any others and it is a bit concerning that there seems to be such a huge discrepancy between PCTs and how they tackle diabetes.


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## Monica (Feb 28, 2013)

I wish we'd had your experience DeusMX, although being on the mix did make life easier while Carol wouldn't inject herself. This meant I wouldn't have to go to school to do it myself or get school to do it. I have a feeling if she'd been on MDI, I'd have had to go to school every day and do it myself.
I didn't know about carb counting until about 2 1/2 years later, when the mix wasn't working and we started using rapid at evening meal and levemir at bedtime.

And you know what!! It's shocking me even now. We DID have Actrapid too, but were never told how/when to use it apart from when she's poorly. I even got told off for ringing the DSN on her mobile when Carol was 30, because she'd been to a Birthday party. Carol told me afterwards that she thought she'd drunk some full sugar drink by accident. We didn't use the Actrapid then either  Actually, we NEVER used it at all!


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## trophywench (Mar 1, 2013)

This is bats.  I changed to pens and MDI in 1995 and they'd been out a while at that stage.  I know the year; and it was either late May or early June, cos it was just after I had my hysterectomy!

I really never imagined there would ever be anyone using syringes after then - except by choice - I mean I do quite happily as a back-up to my pump but no way would I want to on MDI or otherwise. 

12mm needles?  No way, Pedro!


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