Injecting Insulin

 


Outline for the videotape "Injecting Insulin", from The American Association of Diabetes Educators Patient Education Video Series, produced by Milner-Fenwick, Inc., copyright 2003.

 

**Funded through a grant from the Friends of the University of Michigan Hospitals. **

 


  1. Using a Syringe

A.     Parts of the syringe

1.      Barrel – holds the insulin

2.      Plunger – the tip of the plunger shows how much insulin has been drawn up

3.      Needle – is sterile, do not touch anything before the injection

B.     U-100 syringe is standard, 3 sizes: 1 cc (100 units), ½ cc (50 units), 3/10 cc (30 units)

C.     Select the syringe with the number closest to but higher than the dose you will be injecting

 

  1. Single dose vs. mixed dose

A.     Single dose injection – one type of insulin

B.     Mixed dose injection – two types of insulin mixed in one syringe

 

  1. Preparing for the injection – Single Dose

A.     Supplies: insulin bottle and syringe, alcohol swab, sharps container

B.     Wash and dry your hands.

C.     Clean cap with alcohol.

D.     If using clear insulin – do not need to mix.

If using cloudy insulin – mix by gently rolling the bottle between your hands and tip end to end 15-20 times.  Do not shake.

E.      Pull air into syringe to the number of units needed.

F.      Inject the air into the bottle.  Leave the needle in the bottle and turn the bottle upside down.  The needle should be covered by insulin to prevent drawing up air bubble.

G.     Draw insulin into syringe to correct number of units.

H.     Check syringe for air bubbles.  If air bubble is present, push insulin back into bottle and draw up again.

I.        Set syringe down – needle must not touch anything.  If needle is bent, discard it and start again.

 

  1. Preparing for the injection – Mixed Dose

A.     Some insulins come premixed in a single bottle (e.g. 70/30) or you may need to mix 2 separate insulins together into the same syringe.

B.     Add number of units of the longer acting insulin plus the shorter acting insulin – this is the total number of units you will need.

C.     Wash and dry your hands.

D.     Clean caps of both bottles with alcohol.

E.      Draw up air equal to the number of units of the longer acting insulin.  Inject into the longer acting insulin bottle.  Withdraw syringe from the bottle.

F.      Draw up air equal to the number of units of the short acting insulin.  Inject into the short acting insulin bottle.  Leave the needle in the bottle and turn the bottle upside down.  The needle should be covered by insulin to prevent drawing up air bubbles.

G.     Draw insulin into syringe to correct number of units for the short acting insulin.

H.     Check syringe for air bubbles.  If air bubble is present, push insulin back into bottle and draw up the number of units again.  Withdraw the syringe.

I.        Cloudy insulin – mix by gently rolling the bottle between your hands and tip end to end 15-20 times.  Do not shake.

J.       Insert needle into the bottle of longer acting insulin and turn the bottle upside down.  The needle should be covered by insulin to prevent drawing up air bubbles.  Withdraw insulin just to the total number of units needed.  If you draw up too much insulin or air bubble is present, do not push mixture back into bottle.  Discard the syringe and start again.

K.    If needle is bent, discard it and start again.

 

  1. Where to inject:

A.     Into the fatty tissue of the:

1.      Abdomen

2.      Backs of the arms

3.      Tops or sides of the thighs

4.      Buttocks

B.     Avoid: scar tissue, area around navel, bruises

C.     Where you inject changes how fast insulin begins to work:  abdomen works fastest, then arms, then thighs.  Buttocks are slowest.

D.     Use same area at the same time each day, e.g. abdomen in morning, thigh in evening.  Change injection sites each time within this area to keep the skin and tissue healthy.

E.      Do not inject into an area that will be exercising (e.g. thigh) due to insulin absorbs faster.  May need to change sites and eat a snack before exercise.

 

  1. Injecting the insulin

A.     Wipe skin with alcohol and allow to dry.

B.     Pinch the skin up into a fold.

C.     Dart needle straight into the skin at 90 degree angle.

D.     Inject the insulin.

E.      Pull out needle.  If bleeding occurs, gently press the site – do not rub.

F.      Drop used syringe into sharps container (heavy plastic bottle with tight fitting lid, clearly labeled as “Medical Waste”)

G.     Reusing syringes can increase risk for infection or be more painful to inject.

 

  1. Using an Insulin Pen

A.     Check pen or cartridge for correct type of insulin.

B.     Supplies: insulin pen, needle, alcohol swab, sharps container

C.     Wash and dry your hands.

D.     Remove cap from pen.  Clean rubber seal with alcohol.

E.      Pull paper tab off needle and screw tightly onto pen.  Remove outer needle cap.  Remove inner needle cap.

F.      Prime the pen before each injection to ensure proper dose. 

1.      Turn the dose knob until you see an arrow in the window. 

2.      Pull the dose knob out until you see a zero in the window.

3.      Turn the dose knob to 2 and hold the pen upright. 

4.      Push the injection button – should see insulin come out.

G.     Set the pen with your dose of insulin.

1.      Turn the dose knob until you see an arrow in the window. 

2.      Pull the dose knob out until you see a zero in the window.

3.      Turn the dose knob to the number of units for your insulin dose.

H.     If using cloudy insulin, mix by gently rolling the pen between your hands and tip end to end 15-20 times.

I.        Wipe the injection site with alcohol and let air dry.

J.       Push needle into skin at 90 degree angle.  Press down the injection button – may need to hold for 5 seconds or more.

K.    Pull the needle straight out.  Unscrew the needle and dispose of in sharps container.

L.      Recap the insulin pen.

 

  1. Insulin Pump

A.     Computerized device, size of pager

B.     Delivers constant low dose of insulin throughout the day (basal dose).

C.     At meals, need to calculate amount of insulin needed to cover for the rise in blood glucose after the meal (bolus dose).

D.     Requires frequent blood glucose monitoring and intensive management of blood glucose level.

 

  1. Care of insulin

A.     Do not use if:

1.      bottle is frosted

2.      clear insulin that is cloudy or discolored

3.      cloudy insulin that is yellowish or lumpy

4.      expiration date has already passed

B.     Keep a spare insulin bottle, pen or pen cartridge.

C.     Storage of Insulin:

1.      Store insulin not being used in refrigerator door to keep cool but prevent freezing.

2.      Open bottles are good for 28 days – can store at room temperature.

3.      Pen cartridges vary – check with pharmacist or diabetes educator re: how long can store at room temperature.

4.      To decrease pain, warm insulin in syringe to room temperature before injecting.

5.      Store only at temperatures between 40-90 degrees.  Discard insulin that was frozen or left in hot areas, e.g. hot car, windowsill.

D.     Keep plenty of syringes on hand.