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Re: [IP] re: mixing insulins...another question

In a message dated 1/5/00 5:52:03 PM Eastern Standard Time, 
email @ redacted writes:

<<Please be more specific about this. Are you really using an H/V mix 
 that is a 5 to 1 ratio -- that would be 4 parts H and 1 part V or are 
 you using  5 parts H and 1 part V ??>>

We use 5 parts Humalog to 1 part V.
 <<From and engineering standpoint, to promote mixing you would draw the 
 smaller amount of fluid first -- this will allow the turbulence of 
 drawing the second larger amount to promote good mixing. A secondary 
 effect is that the resulting mix is closer to the characteristics of 
 the last fluid drawn. What you draw last will have a small amount of 
 "pure" stuff in the leur lock area. When this is infused, the 
 difference between the pure H and the H/V mix will be slight and any 
 change in effectiveness as it is used up will go unnoticed. If it 
 were the other way around, you conceivably could draw as much as 
 10-30 units of V -- which is regular -- before the mix began to enter 
 the system. Since the absorption time of the V is much different than 
 either H or the H/V mix, this could create a problem !!>>

I see what you mean Michael.  I hadn't thought of this!  What I have been 
doing to "mix" is this....I take of the needle from the reservoir and pull 
back an air bubble into the leur neck.  I then turn the reservoir upside down 
and roll it a bit so the bubble does the mixing.  It is a fairly large, 
single bubble that is just as easily expelled when I tip the leur neck back 
up.  It is easily pushed out just before I attach the tubing.  Now I know 
this is not the best way to mix and from now on I'll be using the method you 
mention, Michael.  It makes a lot more sense than what I've been doing thus 
far!  I still have one burning question though....do you compensate for the 
amount in the leur neck or not?  How do you know exactly how much is in the 
leur neck to begin with?  If I go strictly by the lines on the reservoir, 
will it be a "true" 5:1 mix?  As I said, the mix we've used so far has worked 
amazingly well....I guess I would feel better having a more "solid" assurance 
as to how to handle the leur neck leftover.

Thanks so much for your help!    
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