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Kos Diabetes Group: Insulin Injections: Sites, Techniques & Tips [1]
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Date: 2022-07-08
All Type 1 diabetics and about 17% of Type 2 diabetics use insulin daily to stabilize blood sugar levels. Insulin can’t be swallowed in a pill because it would be broken down through digestion like food. In most cases, it must be injected. You need to inject insulin into the fat beneath your skin, so it can make its way into your bloodstream. There, it can do its job to help control your blood glucose levels.
Many people are afraid to start taking insulin, but it is better to inject insulin and have in-range blood sugars than to be afraid to add insulin to your treatment program and have high blood sugars.
If you are new to insulin use, see if your doctor’s office has a nurse or certified diabetes educator who can go over insulin use details with you. They may have you give yourself an injection to observe your technique and provide support. If one of those is not available, ask for a referral to a local diabetes center where you can sit down and go over insulin use.
Insulin injection side effects are not common. However, some people may have allergies to certain types of insulin, the type of rubber in the insulin vial stopper, or to other preservatives and coatings involved when injecting insulin. If you notice redness and itching or related problems at your injection sites, contact your healthcare provider right away. You may need to switch to another type of insulin or alternate insulin injection technique. There is also a small risk of infection at an injection site, so take proper care to disinfect the injection site before your injection, and always use a new pen needle or syringe when injecting insulin.
Most people who use insulin inject it with a pen or syringe, although a growing number of people with Type 1, Type 2, and gestational diabetes are choosing to use insulin pumps. There are also a few needle-free options, including insulin that can be inhaled rather than injected and a jet injector which sprays the insulin under the skin.
To prepare for your insulin injection, wash your hands and gather your supplies, including your insulin vial or pen, a new pen needle or syringe, an alcohol swab, sharps container, and a magnifier if needed.
Insulin syringes
Learning how to inject insulin with a syringe is a common starting point for many people with diabetes. Some people choose to continue using disposable insulin syringes to give an insulin shot due to cost or other factors. Insulin syringes come in a variety of sizes and needle lengths. The syringe size you need will be based on how much insulin that you inject, while the needle length will depend on your body type.
If you have more body fat, you may need a longer needle. If you are very lean or injecting a child, you may need a shorter needle. If you inject a large amount of insulin at once, you will need a larger syringe so that you won’t need to take more than one injection in order to deliver your total insulin dose.
The markings on some insulin syringes can be challenging to see. If you have vision problems, you may want to consider purchasing a magnifier that snaps on to the syringe or using an insulin pen that measures your dose by dialing in a specific number.
Filling a syringe
Check the insulin bottle label. Make sure it is the right insulin. Make sure it is not expired.
The insulin should not have any clumps on the sides of the bottle. If it does, throw it out and get another bottle.
Use one alcohol swab to clean the injection site. Let the injection site thoroughly dry. If the insulin vial has a plastic cover, take it off. Wipe the top of the bottle with an alcohol wipe. Let it dry. Do not blow on it.
Know the dose of insulin you are going to use. Take the cap off the needle, being careful not to touch the needle to keep it sterile. Pull back the plunger of the syringe to put as much air in the syringe as the dose of medicine you want.
Put the needle into and through the rubber top of the insulin bottle. Push the plunger so the air goes into the bottle.
Keep the needle in the bottle and turn the bottle upside down.
With the tip of the needle in the liquid, pull back on the plunger to get the desired dose of insulin into the syringe.
Check the syringe for air bubbles. If there are bubbles, hold both the bottle and syringe in one hand, and tap the syringe with your other hand. The bubbles will float to the top. Push the bubbles back into the insulin bottle, then pull back to get the correct dose.
When there are no bubbles, remove the needle from the vial, and double check that you have the correct dose. If you need to set the syringe down momentarily, do so carefully so the needle does not touch anything.
How to inject insulin with a syringe:
Once the syringe has been filled, p inch the skin that you have cleaned and insert the needle into your skin at a 90-degree angle, straight in. Depress the plunger to deliver the insulin.
Count to five to make sure that all of the insulin has been delivered before removing the needle from your skin.
Discard the used syringe into a sharps container.
A note about mixing insulin: Some people mix two types of insulin in one syringe. Mixing insulin in a syringe requires specific steps, and you will want to meet with your healthcare provider or diabetes educator to ensure that that you are accurate in dosing your insulin.
Insulin pens
Many insulin pens come prefilled and are disposable, while some are considered “durable” and can be reused by inserting a new insulin cartridge. Insulin pens use pen needles for injection, which are available in different lengths to best accommodate your body type.
Insulin pens have a dial that allows you to easily set your insulin dose before injecting, and the numbers are easy to see. Insulin pens do not need to be refrigerated once opened and can be conveniently carried with you.
Pen needles are very thin and should only be used once. If you try to reuse your pen needle, you may experience pain and can risk the tip of the needle breaking off. Due to the risk of spreading infectious conditions to others, don’t share your insulin pen with anyone else — even if you change the needle. Small amounts of blood can be pulled into the pen, which could possibly be injected into the other person.
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How to inject insulin using an insulin pen:
Clean the injection site with an alcohol swab and let the alcohol dry.
Double check that you are using the correct insulin pen, as many people have a pen of rapid-acting mealtime insulin and one for long-acting insulin. Make sure that you have the correct pen and that it is not expired.
Remove the cap from the insulin pen. Attach a new pen needle and remove the protective cap.
Set the dial to the correct insulin dose.
Pinch the skin at the injection site and carefully press the needle into your skin at a 90-degree angle, straight in. The needle is thin. Do not push too hard.
Hold the barrel of the insulin pen loosely and press the plunger down with your thumb to deliver the insulin. Always count to ten before removing the needle from the skin to make sure that the entire dose has been delivered.
Lift the insulin pen away from the skin and place the clear cap back on to the pen needle. Twist the pen needle off and dispose properly in a sharp container. Store the insulin pen only with the pen cap on. Do not store the insulin pen with the needle attached.
Injection Sites
When learning how to take insulin, it’s important that you know which areas of the body are appropriate sites to give an insulin injection.
Abdomen
When planning on injecting into abdomen do not inject within approximately the width of two fingers (2 inches) around the belly button. The abdomen is the most common insulin injection site because it’s easy to reach.
Upper arms
Choose an area on the back of the arm that has the fattiest tissue. You may need someone to assist you if you are not able to reach the back of your arm to do an insulin injection in this site.
Thighs
When selecting an insulin injection site on the front and sides of the thighs, avoid getting too close to the bony area near the knee. The thigh is the second most common injection site.
Lower back/buttocks
Choose an area on your lower back, just above your hips. The upper portion of the buttocks can also be used, but this area may be a little more challenging to reach on your own. It is also typically the slowest to absorb insulin.
In general, it’s recommended to avoid insulin injection in areas where you have a mole, wound, or scar.
Depending on the type of insulin you use, the area of your body that you inject insulin may affect how quickly it’s absorbed. The American Diabetes Association (ADA) states that insulin is most quickly absorbed when injected in the abdomen, followed by the upper arms, and more slowly when injected into the legs or buttocks/lower back area.
Site rotation tips
It’s important to rotate the injection site so that you can reduce the occurrence of lipohypertrophy. Lipohypertrophy looks like lumps under the skin and is caused by an accumulation of extra fat at injection sites that have been used over and over. Insulin injection sites affected by lipohypertrophy do not absorb insulin well, resulting in lower insulin exposure and a higher blood sugar level after injection. Although you may have favorite areas where you like to inject your insulin or wear your insulin pump infusion set, you will need to rotate sites on a regular basis.
The ADA recommends injecting mealtime insulin in the same area of the body for each meal. For example: you could try using your abdomen for breakfast and your thigh for lunch, while alternating to a new spot within each of these sites, each day. Using a different spot within the same area of your body for each mealtime can help with consistency in your blood sugar patterns while preventing fat or scar tissue from accumulating in a specific spot.
If keeping track where you injected is difficult, there’s a new product called SiteSmart™ pen needles. Each box of pen needles includes four different colors of needles to remind users to inject into the area that corresponds to the needle color they are using, making site rotation easier. The product is currently available in Canada, but not yet available in the U.S.
Storage and disposal tips:
Ask your pharmacist about the storage guidelines for the type of insulin vial or pen you are prescribed. In general, unopened insulin pens can be stored in the refrigerator and once you open and use a pen, you can keep it at room temperature for two weeks to a month based on insulin type. Store unused insulin vials in the refrigerator. Insulin vials in use can be stored at room temperature for 28 days. Again, check with your pharmacist since storage guidelines vary based on type of insulin.
Make sure to dispose of used pen or syringe needles safely so that no one gets an unwanted stick. Pick up a sharps container at the pharmacy, or make your own with a sturdy detergent container or similar plastic jug. Once the container is ¾ full, tape the top back on securely and contact your town to see if they have a sharps program for proper disposal. Sharps disposal guidelines and programs vary depending on where you live. Check with your local trash removal services or health department (listed in the city or county government (blue) pages in your phone book) to see which of the following disposal methods are available in your area:
Drop Box or Supervised Collection Sites
You may be able to drop off your sharps disposal containers at appropriate chosen collection sites, such as doctors' offices, hospitals, pharmacies, health departments, medical waste facilities, and police or fire stations. Services may be free or have a nominal fee.
Household Hazardous Waste Collection Sites
You may be able to drop off your sharps disposal containers at local public household hazardous waste collection sites. These are sites that also commonly accept hazardous materials such as household cleaners, paints and motor oil.
Mail-Back Programs
You may be able to mail certain FDA-cleared sharps disposal containers to a collection site for proper disposal, usually for a fee. Fees vary, depending on the size of the container. Follow the container manufacturer's instructions because mail-back programs may have specific requirements on how to label sharps disposal containers.
Residential Special Waste Pick-Up Services
Your community may provide special waste pick-up services that send trained special waste handlers to collect sharps disposal containers from your home. These services are typically fee-based and many have special requirements for the types of containers they will collect. Some programs require customers to call and request pick-ups, while other offer regular pick-up schedules
Tracking insulin doses
Sometimes people forget whether they took their insulin or not, and/or how much they took at their last dose. Some people record the dose in a paper logbook along with their blood sugar readings. Keeping a record of your insulin doses can help prevent taking a second injection or missing one due to fear of double dosing.
You can use your phone to help you remember to take your insulin and track doses
New technology can make keeping track of insulin doses easier. There are a number of mobile apps available to help track insulin doses. Check the app store you use to purchase apps your phone.
Insulin is an amazing tool to control blood sugar, and nothing to fear. Your healthcare provider, diabetes educator, and pharmacist are helpful resources if you need information about storing insulin, taking an insulin shot, making dose adjustments, and more. Giving an insulin injection should not typically be painful, especially with today’s pen needles and syringes which offer more comfort. You can do this!
General Tip Recap
Keep the insulin you’re currently using at room temperature. The rest can be stored in the fridge – not the freezer.
Double-check expiration dates. Each type of insulin has its own expiration date and length of longevity after opening. Write the date you opened the insulin on the insulin vial or pen so you remember when it was opened. Patients sometimes want to continue to use insulin past its expiration date to save money. However, this is a bad idea because the product may not work effectively.
Inject in the fatty parts of your skin. With guidance from your diabetes care team, you can find pictorials online that show specific areas where you can inject. Generally speaking, the areas where you will want to inject are the fatty parts of your abdomen, thighs and arms.
Choose your injection site carefully. If you’re new to insulin use, you may think it’s easiest to continually inject in the same site on your body. However, each insulin injection area needs some time to heal. If you always inject in the same place, you’ll build up scar tissue there. Alternate where you inject and stay at least 1 1/2 inches away from the last area where you injected. You should also stay 1 1/2 to 2 inches away from your belly button and any scars. Do not put a shot in a spot that is bruised, swollen, or tender. Do not put a shot in a spot that is lumpy, firm, or numb (this is a very common cause of insulin not working the way it should).
Prime your insulin pen needle before you set the dose of insulin you need. Look for the drop on top of the needle before injecting.
Hold the needle in the skin for five to seven seconds. This is to make sure all of the insulin is injected into your body.
Don’t reuse a needle or syringe. If you do, it could cause an infection at the injection site. Change it every time.
Set a system to remind yourself of when to do your injections. With traditional medications, like a pill or tablet, you can use a pill box to remind you when to take the meds. That’s not the case with insulin but many people find that setting an alarm on their phone is a good way to remember their insulin dosing.
If you take insulin you should have some kind of medic alert ID on you
Wear a medic alert ID in case you have a hypoglycemic event and can’t speak for yourself.
Since insulin is a glucose-lowering medication, you should always be prepared in the event you need to treat a low blood sugar (hypoglycemia) by carrying a rapid acting source of glucose with you, like a juice box, glucose tabs, or hard candy.
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