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NPH Insulin: Be Sure to Mix It Before Injecting

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Here’s your friendly reminder to pay attention to insulin preparation instructions. If you take NPH (“N”) intermediate-acting insulin, you need to resuspend it before injecting, by rolling the vial gently in your hands and by tipping the pen. In a study, 11 adults with type 1 diabetes either tipped a pen containing NPH insulin 20 times or kept it steady, facing up or down, prior to injecting. Compared with the resuspension, the unsuspended insulin acted more slowly when the pen was facing up (and the injection was mostly the clear liquid) and more quickly when facing down (injecting more of the insulin crystals). Researchers say they would expect similar results with NPH vials and in those with type 2 diabetes. In contrast, the long-acting analog insulins glargine (Lantus) and detemir (Levemir) don’t require resuspension. 
Source: Diabetes Care, published online Sept. 10, 2015