IS EXTRACTED. If the bottle is shaken, air bubbles may be introduced into the product
and the measured dose may be inaccurate (i.e., air bubbles are measured instead of
insulin). To properly mix the insulin, the patient should roll the bottle slowly between the
palms of the hands. Insulin bottles should be discarded when they contain lumps or
visible grains of insulin or if the contents of the vial are discolored.
10-13. STORAGE OF INSULIN PREPARATIONS
Insulin preparations should be refrigerated, but they should not be frozen.
Specifically, insulin preparations should be stored between two and 8oC (36o to 46o F).
Expiration dates should be examined to insure the product is in date when it is
dispensed and used.
10-14. INSULIN SYRINGES
The patient should use only one brand or type of syringe to either mix or
administer the insulin. Differences in brands or types of syringes (even those made by
the same manufacturer) can mean the patient is receiving too little or too much insulin.
This occurs because of the unmeasured volume of fluid between the bottom calibration
on the syringe and the tip of the needle.
10-15. MIXING OF INSULIN TYPES
Depending on patient needs, some types of insulin may be mixed. Such mixing
would, of course, be directed by the physician who deals with the patient. References
(like the United States Pharmacopeia Dispensing Information) should be consulted to
determine if such mixing is possible.
10-16. TYPES OF INSULIN
The various types of insulin you will encounter in your pharmacy are listed and
a. Insulin Injection (Regular Insulin, Crystalline Zinc Insulin). Insulin
injections may be given subcutaneously in the treatment of diabetic hyperglycemia and
intravenously in the treatment of diabetic ketoacidosis. This product is available in the
40 and 100 unit strengths in a mixture of beef and pork insulin. The 100 unit strength is
available as either beef or pork source. The onset of action of this product is from 30
minutes to one hour. The time required to reach the peak effect is from two to four
hours. The duration of action of this product ranges from five to seven hours.
b. Protamine Zinc Insulin Suspension (PZI Insulin). This product is
administered subcutaneously only. It is typically administered once a day, from 30 to 60
minutes before breakfast. The onset of action of this product is from four to six hours.
The peak effect of PZI insulin is reached within four to six hours after administration.
The duration of action of the preparation is approximately 36 hours.