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mkachar

Can you Mix Levimir with Humalog in one syringe ?

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According to Gary Scheiner " Think Like a Pancreas " (2004 edition) Detimir ( Levemir ) can be mixed with a fast acting insulin. However most other sources state that you can not mix them. Has anyone tried mixing Levemir and Humalog with success ?

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You can't mix them in the same syringe. What Scheiner means is you can take them at the same time - you just do two injections in different parts of your body.

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I'd defer to the manufacturers with this, who state explicitly not to mix. AFAIK mixing won't make the world explode but studies suggest it may change the profile of one or both, an x factor you could do without.

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The exact quote from Scheiners book is

" Lantus must be given in it's own syring (it can not be mixed with other insulins, meaning that a lot of injections will be necessary. Detemir may be mixed with fast acting insulin."

 

I'm pretty sure that means that Scheiner is saying mixing in the same syringe. ( Not 2 injections in different parts of body)

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From the Levemir pharmaceutical notes: (http://www.novo-pi.com/levemir.pdf)

 

Mixing of Insulins

If LEVEMIR® is mixed with other insulin preparations, the profile of action of one or

both individual components may change. Mixing LEVEMIR® with insulin aspart, a

rapid acting insulin analog, resulted in about 40% reduction in AUC(0-2h) and Cmax

for insulin aspart compared to separate injections when the ratio of insulin aspart to

LEVEMIR® was less than 50%.

 

Assuming your quote is correct, I don't know why Gary Scheiner recommends this. Potentially mucking around with the onset of insulin is just bad news.

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The quote form Schiener's book is from 2004. Maybe at the time mixing Levemir was considered OK , but further research showed that it can not be mixed ?

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The quote form Schiener's book is from 2004. Maybe at the time mixing Levemir was considered OK , but further research showed that it can not be mixed ?

 

I don't think it is a matter of more research - these are specifications for use by the manufacturer.

Tread across that line, and it is your ballgame. Keep behind that line - you can count on support from the manufacturer.

 

If you are trying to save on use of syringes - that is another story. I also want to save on use of syringes, so I load a syringe with humalog (I use apidra currently) and then take the number of units I need and put the syringe away until later when I need more insulin. I usually load one syringe up for the day for all the meals and corrections that I anticipate. It usually works out okay, but some days I need to load up the next day's syringe with a little extra so I can have enough insulin to finish out the current day's needs.

 

There are other ways to save syringes than messing with the manufacturer's rigorous testing and certification. But, if you want to have an insulin vial contaminated with two different types of insulin - it is your syringe and your body. You might be surprised, but then again you might find us to be fuddy-duddy in saying you are best to follow the manufacturer's guidelines. I'm one to challenge all things - but on this one, I stick to the manufacturer - I don't need any more surprises in this insulin junkie game than I already experience.

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If you are trying to save on use of syringes - that is another story.

 

The expense of syringes is nor an issue for me. I'm just trying to minimize the discomfort for my 8 year old daughter associated with the injections. She has to suffer the rest of her life with these **** injections and fingersticks ( Just like all of you guys). So if I can reduce the number of injections by mixing it would make it a little more tolerable.

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The best way to minimize discomfort of shots is to use the smallest gauge needle possible. I take a minimum of 10 shots a day and don't even notice it.

 

I'm sure you're hurting for your little one, but if mixing insulins in one syringe means she's got to take more insulin to get the same effect, the trade-off for one or two fewer shots a day may not be worth it in the long run. How long has she been diabetic? A raw deal for sure, but it's really just her new normal now. The shots and fingerstick tests may be harder on you than on her ;).

 

Jen

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I was able to get clarification on mixing Levemir from Gary Schiener himself. He stated as follows:

 

Detemir should not be mixed with any rapid insulins. When I was putting together the book, Novo's representatives told me that they believed it could be mixed, but since then it was learned that the pH of the two insulins is not compatible.

 

I'll have a new edition out later this year with the correct information.

 

Gary Scheiner MS, CDE

Owner & Clinical Director

Integrated Diabetes Services

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