Do You Shake or Roll Insulin?

By |2017-02-20T12:47:54+00:00March 16th, 2017|Pet Care, Pet Diabetes, Pet Newsletter|7 Comments

When I was in vet school many moons ago, they taught us that shaking insulin could inactivate the particles. We were taught to gently roll the bottle between our hands to suspend the particles. The story has changed a bit since. The package insert for Vetsulin now actually recommends shaking the bottle. This wording was new when Vetsulin came back on the market. Some insulin, such as Glargine, apparently doesn’t need mixing at all.

Mostly, I’d still recommend rolling most insulin bottles. If in doubt, roll it. Why does this matter?

A few years ago I met a pet owner who didn’t mix the insulin before giving her pet an injection. She was essentially giving the fluid that suspends the insulin, but the insulin particles sat at the bottom of the vial. It only makes sense that the stuff at the end of the vial would then be more concentrated than the fluid when the bottle is new if it isn’t properly mixed. Her pet had been diabetic for a few months when I met her, and she was frustrated. Talk about lack of diabetes control if you somehow didn’t know to suspend the particles of insulin. We throw so many facts at clients when we first diagnose a pet as diabetic. I can see how she missed this simple step. This is why I sometimes ask pet owners to come into the clinic to show us how they perform various diabetic-related tasks if we don’t achieve good diabetic control. Never be offended if your vet wants to witness your technique – whether that is giving an injection, pulling up the insulin, or even checking a blood glucose. We do this for a living and could possibly catch such an error.

NPH and lente and ultra lente insulins should be mixed before each administration. Vetsulin should be mixed well, particularly the first time it is mixed. The insert says “shake”. Somehow, I just can’t wrap my brain around shaking a bottle of insulin, but the manufacturers of Vetsulin thinks it is fine to do so. They know best. It’s their product after all. NPH should be gently rolled or inverted repeatedly until the particles are evenly distributed. Both Vetsulin and NPH look milky and homogeneous when properly mixed.

One possible downside of shaking an insulin could be incorporating air bubbles which would make the amount of insulin given to the pet less than desired if part of the volume was air. I read online the following advice regarding Vetsulin, “Don’t over shake it and don’t under shake it.” Gee, that’s helpful. I think I’d probably stick with the good old fashion techniques we’ve used for decades.

Ways to mix the insulin:

  • Roll it between your hands about 20 times until it is evenly suspended.
  • Invert it end over end about 20 times until it is evenly suspended.
  • Hold it in your hand and move your hand in a ‘figure 8’ sign about 20 times until it is evenly suspended.
  • If in doubt, mix it. Personally, I’d stick with a gentle roll or inversion over shaking to avoid air bubbles in the insulin.

    Have a question or comment? Post below or email me at joi.suttondvm@adwdiabetes.com. I always enjoy hearing from my readers!


    NOTE: Consult your veterinarian first to make sure my recommendations fit your pets special health needs.

No votes yet.
Please wait...

About the Author:

Dr. Joi Sutton is a 1993 graduate from Oregon State University. She has practiced both in emergency medicine and general practice. Dr. Sutton has done extensive international volunteer work though Veterinary Ventures, a nonprofit organization that takes teams of veterinarians to undeveloped countries for humane medical care. She also runs a small animal practice in South Florida.

7 Comments

  1. FRAN MUNSCHAUER March 16, 2018 at 1:36 pm - Reply

    I spoke several times with Vetsulin experts? that claim “You should vigorously shake it”..My concern was, could shaking it like shaking a can pf paint at Lowe’s, damage the crystalline portion making the longer lasting portion less effective. they simply said, “No”..I don’t trust this answer and am seeking more info on this “shaking”..may switch to Levemir. Suzie 5 kg charts NPH, Lantus, Vetsulin (vigorously shaken).

    • Dr . Joi Sutton March 18, 2018 at 10:24 pm - Reply

      Apparently Vetsulin is to be shaken. For years we were told not to shake insulin, but the company says to shake it… so shake it.
      I strongly prefer levemir over Vetsulin and NPH for dogs. Vetsulin and NPH don’t last as long as levemir. Know that the levemir dose will be less than the Vetsulin dose as dogs are very sensitive to levemir.
      🙂 Joi

  2. FRANCES MUNSCHAUER May 2, 2018 at 12:52 pm - Reply

    I appreciate your response..I do not have a DVM that is familiar with levemir but bought a vial recently but have no protocol or guidance to utilize it. I cannot find a DVM that supports it..even at MSU. I see no predictability with Vetsulin and do worry about the shaking-but we do it. I know that every dog is different but with no change in diet, exercise or dosage..to get 73 FBG before meal and 73 2 hours after vs 3-400 other times..no predictable nadir make..However, the warnings of levemir on 5 kg dog are worrisome. I am now researching everything: Some DVM’s believe that vigorous shaking an damage the particles? Does particle size differences via 30 gauge needle hinder delivery of either particle..since the crystalline portion is less predictable and also does not last past 8 hours. Merck is not helpful and offers the owners’ DVMs’ who learns from reading the Vetsulin insert. I guess more intensive research is not a priority yet. It would be great if DVM’s or dog owners would publish some information, their charts, curves of dogs that have been treated with detemir..like cat people do on the cat forum.

    • Dr . Joi Sutton May 21, 2018 at 11:43 am - Reply

      Merck now tells clients to mix Vetsulin well. Do what the manufacturer suggests. I don’t choose Vetsulin often. My go to insulin for dogs at my small animal general practice is levemir, but levemir is so potent in dogs it would be difficult to dose for a small dog. Dogs are very sensitive to levemir, about 4 times more sensitive to levemir than to Vetsulin or NPH. Levemir cannot be diluted. Even with a 3/10 cc syringe with half unit markings it can be difficult to measure such a tiny dose.

Leave A Comment