Islets of Hope treatment options for persons with diabetes

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By Lahle Wolfe

Sources

How to inject insulin

Lilly answers questions about using prefilled pens

Insulin pens: are you using yours correctly?


This article is part of a series on insulin shot therapy and insulin pens

Part 1 (Pens)
Information about

Insulin Pens

What is an insulin pen?
Advantages of Pens
Disadvantages of Pens
Where to Buy Insulin Pens'
How to Use an Insulin Pen
Types of Pens Available

Part 2 (Pens)
Step-by-step Guide to
Using Insulin Pens

Choosing An Injection Site
Rotating Injection Sites
Giving the Injection
Sharps Disposal
Troubleshooting & Tips
Links

Part 3 (Shots & Pens)
How to Inject Insulin

Choosing An Injection Site
Rotating Injection Sites
Giving the Injection
Sharps Disposal
Troubleshooting & Tips
Links


Part 1 (Syringe)

What is insulin shot therapy?

About Insulin

About Syringes

Other Insulin Delivery Devices

Step-by-Step Guide to Preparing Insulin for Injection

- Shot Preparation
Check Your Insulin
- Preparing the Insulin

Preparing the Syringe &
Drawing upt he Insulin
(Single Insulin Injection)

Preparing a Mixed Insulin Injection


Also, see

Insulin Delivery Devices

Conventional vs. Intensive (Flexible) Therapy

Types of Insulin

Insulin Reactions

Glucose Monitoring Tips

Treatment Options for Type 1 Diabetes

Diabetes Care Tips


ada complete guide to diabetes  ADA Complete Guide to Diabetes:  Perhaps the most complete and authoritative resource on diabetes, American Diabetes Association Complete Guide to Diabetes covers everything from how to manage types 1 and 2 and gestational diabetes, to traveling with insulin, sick-day action plans, and recognizing hypoglycemia.

Other contents include information on symptoms, complications, exercise and nutrition, blood sugar control, sexual issues, drug therapies, insulin regimes, and much more. Plus, information for every parent about children, schools, and day care. This updated third edition features new information on medications, diabetes management and new therapies, and new treatments for diabetes complications.  


Links to Insulin Injection Tips

BD Diabetes

Tips for giving a child shots

How can I make my insulin injections easier and more comfortable?

BD answers questions about insulin injection during pregnancy

Injecting Insulin - DrugDigest.org


Comfort Links for Children with Diabetes

Teddy Bears Teach Tots - Diabetes Health on helping children deal with shots.

Children With Diabetes Question Forum on Insulin and Injections

Overcoming a Fear of Needles  

JDRF link to books about diabetes and children, including taking shots.

Live and Learn with Diabetes: Educational Toys and Products for Kids

Bearing with Type 1 Diabetes.  An article about Rufus and Ruby, teddy bears that bring comfort to children with diabetes.  The bears were even launched into orbit aboard the space shuttle Atlantis!

Teddy Bear with Diabetes Helps Children Through Diagnosis and Beyond

Helping Your Child Manage Type 1 Diabetes.  An article on children with diabetes by Brighmas and Women's Hospital.

 islets of hope diabetes medical library                                 main Treatment Options page
Diabetes Treatment Options                                                       animated demo of preparing & injecting insulin

Insulin Therapy
How to Inject Insulin with a Syringe or Insulin Pen


Want a visual aid?  Visit Lantus' online video guide for step-by-step instructions on how to inject insulin.

Mini site index
Choosing An Injection Site
Rotating Injection Sites
Giving the Injection
Sharps Disposal
Troubleshooting & Tips
Links

 

Choosing an Injection Site

There are many parts of the body that you can inject.  It is important to note how you react to various sites.  For example, sometimes, injecting in areas that are more muscular (i.e., thighs and buttocks) may be more sensitive to insulin than fattier areas like hips, tummy and the arms.  If you are going to be exercising, or using a particular muscle group, it is better to inject in another area like the tummy or hips.  This is because exercise increase temperature and blood circulation, especially to muscles, this in turn can increase the rate of insulin absorption and may lead to hypoglycemia.

It is important that you rotate your injection site, however, you should try to use the same body area for injections that are given at the same time each day.  If you prefer using your arms in the morning, always use your arms in the morning.  If you use your tummy in the evening, always use your tummy in the evening.  Because different areas respond to insulin in various ways, by using the same body area for these routine injections your response to insulin will be more predictable and consistent.

Do not inject:

  • near moles
  • near scars
  • areas that looked inflamed, infected, or have a rash
  • within 2 inches of the naval (all the way around)
  • the same spot (see "Rotating Your Injection Site," below)


Rotating your Injection Site

It is very important that you rotate injection sites.  Repeated injection into the same site can cause scarring, which will make the site less sensitive to insulin.  It also causes (definitions courtesy of Children With Diabetes):

  • Lipoatrophy - Small depressions in the subcutaneous tissues just under the skin that form when a person keeps injecting insulin into the same spot. Injecting around the depressed area can very slowly fill in the depression (over a period of many months).
     
  • Lipodystrophy  Lumps (lipohypertrophy) or depressions (lipoatrophy) below the surface of the skin that form when a person keeps injecting insulin into the same spot. Both forms of lipodystrophies are harmless. People can decrease this problem by changing (rotating) the places where they inject their insulin. Using purified insulins may also help.
     
  • Lipohypertrophy - Bulging of an area of the skin (due to fat accumulation) that forms when a person keeps injecting insulin into the same spot. Continued injection into these lumpy areas delays the absorption of insulin, and is not recommended even though injecting into the lumpy area is painless (as there are no nerve endings in the lump).


Giving the Injection

  1. Hands.  Wash hands with warm, soapy water using plenty of friction.
     
  2. Clean the site.  Make sure the injection site is clean and sterilized with soap and water or an alcohol pad.  The area should be dry before injecting because you need to make sure all the insulin gets under the skin.  If skin is wet you won't be able to tell.
     
  3. Numbing the area.  You can numb the area with ice, a bag of frozen vegetables (never put cold objects directly on the skin, wrap them in a hand towel or wash cloth).  This is usually not necessary but sometimes helps children feel better about a forthcoming shot.

    Numbing creams that contain lidocaine are expensive and have some side effects and are not recommended for multiple daily injections.

    Cold insulin right from the refrigerator can causes stinging when injected.  It is fine to let your pen, or syringe warm up for 5 minutes, or, even the bottle of insulin for 5-10 minutes.
     
  4. Pinch up a fold of skin surrounding the site you've selected. Hold it firmly with one hand  You can inject insulin into muscle, but it is more painful and it is better to inject into fat when possible.
     
  5. Inserting the needle.  Faster is better, inserting slowly will cause more pain.  Try inserting the needle almost like you would toss a dart.
     
  6. Needle angle.  For adults or those with good fatty tissue, insert at a 90° angle. Thin adults and children may need to inject at a 45° angle. Try to get the needle all the way into fatty tissue below the skin, but not so deep that it hits the muscle below.
     
  7. Injecting the insulin. Push the syringe plunger all the way in with a slow steady motion or firmly press the insulin pen injection button. The injection should take a couple of seconds, unless you take a very small dose. Let go of the skin.
     
  8. Remove the needle by pulling straight out. Twisting or shifting the needle's position will cause pain.  You may gently press on the injection site with your finger for a couple seconds. Do not rub or massage the skin where the insulin is injected; it can affect how fast the insulin is absorbed and acts within the body.


Sharps Disposal

It most states it is illegal to throw syringes into garbage cans where someone else could accidentally get poked.  You can purchase sharps containers at any drug store, on the Internet, and many local fire departments offer "trades" of used containers for empty ones.  Be sure to call your city officials to see what disposal restrictions apply in your area.

When you traveling you may not be able to find a sharps disposal container (sometimes they are featured in public restrooms).  Break the needle off the syringe and store the syringe part in an empty soda can.  You can also purchase needle clippers at most drug stores (don't use scissors).  Store needles and used lancets in an old film canister or empty test strip container.

You can reuse syringes, ask your doctor how to keep them sterile.  Reusing needles does dull them with each use also bends the tip.  This may not be visible to the naked eye, but you will feel it when you use it again for injection!  The thinner the needle, the faster it dulls; this will cause more pain upon injecting.


Trouble Shooting & Tips

Insulin Leaking Out of Injection Site

This can happen because either the dose was large and injected too quickly, or because the needle was removed too fast or not inserted deeply enough.  This may affect your blood glucose for a while so be sure to check more often (not getting enough insulin leads to hyperglycemia).  Next time try:

  • Syringe suggestion.  After injecting, wait 5 seconds before removing needle from site.
  • Insulin pens.  Count to 10 while injecting instead of 5.  
  • Apply pressure.  You can put light pressure directly on the injection site with your finger tip.  Your hands have already been washed and putting a finger on the injection site is very unlikely to cause an infection.

Bleeding

There are tiny blood vessels throughout the body including under the skin and interlaced in fat.  From time-to-time everyone giving injections will hit one and a few drops of blood may result.  This is nothing to be concerned about, however, if it happens a lot your technique may need improving.  Your physician or diabetes educator can show you ways to inject without bleeding and with little or no pain involved.

Preparing Insulin Ahead of Time

Insulin that is not mixed is generally fine to pre-fill syringes, however, once insulin is mixed it needs to be used (some mix better than others).  You can buy pre-mixed insulin or ask your doctor about the specific combination of insulin you use and if it is acceptable to prepare syringes ahead of time.

If you do prepare syringes ahead of time make sure that they are refrigerated.  You need to make sure the needle side is point up because otherwise crystals may form in the needle making it harder to inject and less effective.

If you do this, you will have to warm the insulin in the syringe between the palm of your hands (just like you do when mixing insulin).  This helps mix and warm the insulin.  You can take insulin shots straight from the refrigerator, however, cold insulins more upon injection than does insulin warmed in the hands a few seconds.

Your doctor can answer all your questions about insulin and shot therapy, don't be afraid to ask a question!

 

 

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Page Updated 08/12/2006