My background: type 1, age 56, diagnosed 43 years ago, current HbA1c less than 7%, considered to be in good control by my endocrinologist, generally healthy with no significant complications, current insulin dose: 27 units/day — 6 units Ultralente plus 3 units fast-acting pre-breakfast, 2 units fast-acting pre-lunch and 11 units Ultralente plus 5 units fast-acting pre-dinner. I started using Humalog a year ago with good results but find that if I take enough to cover a meal (e.g., 5 units before dinner), I can’t eat fast enough to avoid hypoglycemia. As a result, I’ve been taking a mix of Humalog and Regular and have had good results. Are there any problems with mixing Humalog with Regular either briefly in the syringe just before injection or for an extended period in a pre-drawn syringe? Are there any plans to sell Humalog-Regular mixes in vials or cartridges as is done now for Regular and NPH?

Although not officially approved by Eli Lilly, I have had no problems mixing Humalog and Regular in the same syringe and studies have been published combining these insulins. It has been my experience that in many patients Humalog alone works too quickly and doesn’t last long enough while Regular doesn’t work fast enough and may last too long. I have had patients combine the two insulins in the same syringe with no problem. Giving a mixture of Humalog and Regular before meals is somewhat similar to what is frequently done using an insulin pump — that is giving part of your premeal bolus as an immediate injection of Humalog and giving the rest of the premeal insulin as a ”square wave bolus” — Humalog given over 30 to 120 minutes.

Some of my patients premix these two insulins in a syringe and bring the filled syringe to school or work with them to facilitate giving their pre lunch insulin more conveniently. Several years ago I asked a physician at Eli Lilly if there were any plans to make a premixed preparation of Humalog and Regular and I was told no.

TGL