I didn't understand the comments you made in the answer to the 9 year old whose parents wanted to mix R and L. We also have the problem of high mid-morning sugars even though we have decreased breakfast and include now only 1.5 starch, .5 milk, and 1 fat for breakfast, and we give R a half an hour before eating. It seems logical to me to replace some of the morning R with L so that his breakfast is better covered without switching to complete L and losing the lunch coverage I know his morning R is giving him. Is this done? What would be wrong with mixing R and L in the same shot?
In answer to your question, you are correct that one disadvantage of substituting Lispro for Regular is that the Lispro may not work long enough to help cover lunchtime insulin needs. In many people the Regular continues to work into the afternoon and help prevent the blood sugar from increasing after lunch.
I have many patients who mix Regular and Humalog in the same syringe as you suggest. Although mixing these 2 insulins isn't yet officially approved by Eli Lilly, there have been some abstracts published describing this combination and I understand more studies are in progress. As far as I know, there is no known contraindication to mixing these 2 insulins together in the same syringe.
If you mix Lispro and Regular together in the same syringe, I would not worry about giving the Regular 30 minutes before eating as the Lispro will start to work quickly and you want the Regular to be working later than the Lispro.
Original posting 2 Apr 97
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