Mixed insulin regimen
In a mixed insulin regimen, a mixture of rapid- or short-acting and intermediate-acting insulin is usually given twice daily. A mixed insulin regimen may use free-mixing of insulin, which allows for variation of the ratio of rapid- or short-acting to intermediate-acting insulin, or fixed-dose combination (biphasic premixed) insulin (for insulin formulations, see Action profiles of insulin formulations). Parents, carers and older children and adolescents can be taught to prepare free-mixed insulin doses. The procedure for free-mixing insulin and other practical information is given in the parent’s manual Caring for diabetes in children and adolescents 1.
A mixed insulin regimen can be used instead of a multiple daily injection (basal–bolus) regimen, but should not be continued if it is ineffective and glycaemic targets are not met.
Fixed-dose combination (biphasic premixed) insulin used twice daily is also a ‘last resort’ option in young patients who have significant problems with adherence despite involvement of a multidisciplinary diabetes team.