Page 1455 - Saunders Comprehensive Review For NCLEX-RN

insulin is reserved for clients with
severe insulin resistance who require
large doses of insulin. A special
syringe calibrated for use with U-500
insulin is required.
c. Prefilled syringes (pens) are commonly
used; a new needle needs to be
attached before each injection.
d. Most insulin syringes have a 27- to 29-
gauge needle that is about 0.5-inch
long (1.3 cm).

e. NPH insulin is an insulin

suspension; the appearance is cloudy.
All other insulin types are solutions;
the appearance of all other insulin
products is clear.
f. Before use, NPH insulins must be
rotated, or rolled, between the palms
to ensure that the insulin suspension is
mixed well; otherwise, an inaccurate
dose will be drawn; vigorously
shaking the bottle will cause bubbles to
form. It is not necessary to rotate or
roll clear insulins before using.
g. Inject air into the insulin bottle (a
vacuum makes it difficult to draw up
the insulin).
h. When mixing insulins, draw up the
shortest-acting insulin first.
i. Short-duration (i.e., regular, lispro,
aspart, and glulisine) insulin may be
mixed with NPH.
j. Administer a mixed dose of

insulin within 5 to 15 minutes of
preparation; after this time, the short-
acting insulin binds with the NPH
insulin and its action is reduced.
k. Aspiration after insertion of the needle
generally is not recommended with
self-injection of insulin.
l. Administer insulin at a 45- to 90-degree
angle in clients with normal
subcutaneous mass and at a 45- to 60-
degree angle in thin persons or those
with a decreased amount of

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