Islets of Hope treatment options for persons with diabetes

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Article disclaimer

Compiled by Lahle Wolfe

Sources
Web MD
BD Diabetes
Kids Health.org


Next Section

How to Inject Insulin

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


Also, see:

Insulin Delivery Devices
Conventional vs. Intensive (Flexible) Insulin Therapy
Types of Insulin
Shot Therapy
Insulin Reactions
Glucose Monitoring Tips
Treatment Options for Type 1 Diabetes


 
Diabetes Health:
 The essential resource for people living with diabetes, both newly diagnosed and experienced. DH provides balanced expert news and information on living healthfully with diabetes. Each issue includes cutting edge editorial coverage of new products, research, treatment options, and lifestyle issues.      IOH Rating 5/5 

 
Diabetes Self-Management:  Aimed at the diabetic population, containing articles of interest to all diabetics, in subjects such as health, medication and diet.  
 
  IOH Rating 5/5  


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.


 Gary Scheiner, CDE
Think Like a Pancreas:    IOH Rating 5/5    Many books offer advice on managing diabetes, but few focus specifically on the day-to-day issues facing those who use insulin.  Scheiner, a certified diabetes educator and himself an insulin user himself since 1985, gives you the tools to "think like a pancreas; "that is, to successfully master the art and science of matching insulin to the body’s ever-changing needs. Free of medical mumbo jumbo, comprehensive, and packed with useful information not readily available in other books, Think Like a Pancreas discusses: day-to-day blood glucose control and monitoring, designing an insulin program, measuring insulin to carbohydrate intake and physical activity ,  pluses and minuses of different insulin-delivery  methods, optimal management of diabetes using an insulin pump, hypoglycemia—the best ways to avoid it and treat it , the impact of emotions, stress, illness, and aging , making the best use of your health care team and community resources , plus dozens of other issues that everyone taking insulin needs to understand and master.   Read IOH Book Reviews


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


 John Walsh
Pumping Insulin:
 This is a must-read book for anyone on the pump or considering using one.  The information is exhaustive and straight- forward.  Even if you think you know it all about pumping, this book will teach you even more!

"As a young Internist, this book proved to be essential in my understanding of diabetes. Searching through my more commonly used references to include Internal Medicine and Endocrinology Textbooks I was unable to find a concise summary of the information and recommend- ations necessary to manage my patients with pumps. The 500 rule and the 1800 rule were just vague concepts found in obscure manage- ment articles and discussions with other providers. I did not have the benefit of a certified pump trainer or diabetic nurse educator. But with this reference as a guide I was able to develop a management plan. In 3 short months I dropped my patient from a HgBA1C of 9.4 to 6.3."   IOH Rating 5/5 

 Kaughfman/Halverson/Lorey
Putting Your Diabetes on the Pump:
Putting Your Diabetes on the Pump is 64 pages of essential information on using an insulin pump for better blood sugar control. It includes the pros and cons of using a pump, medical guidelines, insulin to carbohydrate ratios, and the skills and personality traits necessary for successful pump use. Plus, real-life advice from a person who has used an insulin pump for several years.

  Howard Wolpert
Smart Pumping
:  The insulin pump has opened a whole new world for people with diabetes­­more flexibility in what and when they eat and better blood sugar control, too.

Smart Pumping integrates this new successful technology with the physical and psychological aspects of diabetes care, and helps patients adopt the insulin pump into their self-care regime.

This book combines a comprehensive medical approach toward intensive diabetes management and pump therapy with a patient-centered appreciation of the real-life challenges and frustrations.

Howard Wolpert, M.D., is an instructor in medicine at the Harvard Medical School Joslin Diabetes Center and is also in charge of the pump clinic there. He has written extensively on the use of insulin pumps.  
  IOH Rating 5/5 

 

islets of hope diabetes medical library                               main Treatment Options page
Diabetes  treatment options

Conventional insulin shot therapy


Mini Site Index
What is insulin shot therapy?
About Insulin
About Syringes
Other Insulin Delivery Devices
Step-by-Step Guide to Preparing Insulin for Injection
--  
Basic Shot Preparation  
--  
Check Your Insulin Carefully
--  Preparing the Insulin
--  Preparing the Syringe & Drawing up the Insulin (Single Insulin Injection)
--  
Preparing a Mixed Insulin Injection

What is Insulin Shot Therapy?

Insulin shot therapy simply means that you administer insulin via a syringe or insulin pen.

Only your doctor can tell you what type of insulin is best-suited for your needs and lifestyle, how much to take, and when to take it. It's important to get and use the exact type of insulin your doctor prescribes because insulin can vary in strength and speed and how and when you take it depends on many factors.  


About Insulin

In the United States, insulin is made from pork or is synthesized to be identical to human insulin. Its strength is measured by its concentration. The most common strength is 100 units of insulin per milliliter; it is known as U-100 insulin. On occasion, people who need to take very large or tiny doses of insulin may be advised to use other strengths (such as U-500 or U-10).

Insulin comes in four different speeds:

  • rapid-acting (used in most insulin pumps)
  • short-acting
  • intermediate-acting
  • long-acting

The faster-acting insulins begin lowering blood glucose more quickly after injection than the slower-acting insulins, and they continue working for a shorter amount of time. Some insulins last for only two hours, while others can last for an entire day. Many people on shot therapy take more than one kind of insulin each day.

See "Types of Insulin" and for more detailed information about kinds of insulin and how each one works.


About Syringes

When choosing a syringe, there are four things to consider:

  • which insulin concentration it's designed for
  • its capacity
  • the needle gauge (or thickness)
  • the needle length

Your doctor can help you choose a syringe that's designed for the insulin strength that you use as well as the needle gauge (children often need smaller gauge needles for comfort). For example, if you use U-100 insulin, use U-100 syringes; otherwise, you will inject the wrong amount of insulin.

Common syringe capacities in cubic centimeters (cc) are:

  • 3/10 cc - designed for people who take less than 30 units of insulin per dose.
  • 1/2 cc - works best for doses of 25 to 50 units
  • 1 cc - holds doses up to 100 units of insulin

Choose the smallest syringe barrel that can hold the total insulin dose you need to take. This will make reading the unit increments on the syringe barrel easier.

Syringe and Insulin Pen Needle Gauges

Needle gauges range between 27 and 31. The higher the gauge, the thinner the needle. Pick a needle gauge that feels most comfortable for you. Needles also come in different lengths, such as 5/16 inch and 1/2 inch. Some insulin pen needles are as short as 1/3 inch. Insulin needles are short to help prevent insulin injections from going in too deeply. Ask your doctor which length needle he/she recommends for you.


Other Insulin Delivery Devices

See, "Insulin Delivery Devices" for more detailed information.

For people who don't want to use a syringe (or those who have trouble such as visually impaired individuals or persons with arthritis), there are a number of alternative insulin-injecting devices.  People who need to take insulin at work, school, or when traveling may want to use an insulin pen. Each pen is about the size of a Magic Marker, contains a small cartridge of insulin, and uses a disposable needle. Pens are available in different types and styles and are easy to carry in a purse or pocket.  Pens are simple enough that even young children, when properly trained and supervised, can use them with ease.

Another way to take insulin without a syringe is to use an insulin pump. About the size of a pager, a pump delivers a continuous supply of insulin through a small tube and a needle, which is usually inserted into a person's abdomen. Pumps work well for people who take multiple doses of insulin each day but they are not ideal for every person with diabetes.

Yet another option is a spray injector, which uses high pressure to "spray" insulin in a fine stream through a person's skin without a needle.


Step-by-Step Guide to Preparing Insulin for Injection

Although alternatives exist, injecting with a syringe is a fundamental skill in insulin management. Even people who use an insulin pump, insulin pens, or a spray injector may occasionally need to inject with a syringe. Knowing how to use a syringe carefully and consistently can prevent costly mistakes such as incorrect doses, damaged needles, and wasted insulin. Here's how it's done:

Basic Shot Preparation

It helps to have all your supplies ready to go in one place.  Wash your hand thoroughly to prevent contaminating needles and insulin.  Warm, soapy water is best.  Using friction (rubbing hands and fingers together vigorously) will kill more germs than rinsing or passive hand-washing.

Check Your Insulin Carefully

Bad insulin can lead to high blood glucose levels.  Insulin does not have to be kept refrigerated but it lasts longer when it is.  All insulin should be discarded after the expiration date or 30 days after it was opened and pierced with a syringe, whichever is sooner.  Insulin that has been frozen or exposed to any heat source should also be thrown out.

Insulin types that should look clear, like water:

  • The rapid-acting insulins should be clear and colorless like water. These are lispro (sold as Humalog) and aspart (sold as Novolog).  Short-acting insulin (Regular) insulin and insulin glargine (Lantus) a longer-acting insulin should also be clear, like water.
     
  • Long-acting insulin should have a cloudy or milk look.  These include NPH, Lente, and Ultralente.

Prepare Insulin

  1. Pop off the cap to the insulin bottle (you can throw the cap away after removal).  Be sure to mark the carton with a permanent pen with the date the bottle was opened and pierced.  You need to use the insulin within 30 days of opening it, or throw it away.
     
  2. Clean the latex stopper with an alcohol pad.  Do not use Q-Tips, cotton balls or packaged hand sanitizers.  You do not need to remove the metal band or the latex stopper (this keeps the insulin in and contaminants out).  If the stopper is broken or comes off, throw out the insulin.  (Note:  If you are allergic to latex, call your doctor.  As of February 2004 there was at least one company manufacturing latex-free stoppers on their insulin bottles.)
     
  3. If you are mixing insulin, prepare the longer-acting insulin first by gently rolling it between the palms of your hands 10 or more times.  This helps to warm the insulin (better mixing as well as less discomfort upon injection).

Never shake insulin as it will create air bubbles and you won't be able to fill your syringe right away.  If you drop the bottle, or it does get shaken violently, throw it away because this type of action can destroy insulin.  

Prepare Syringe & Draw up Insulin (Single Insulin Injection)

  1. Remove the cap from the needle tip with care.  If you touch it or it falls onto any surface, throw it away and get a fresh syringe.
     
  2. Pull back on the plunger and draw air into the syringe equivalent to how much insulin you plan to fill the syringe with (i.e. if you are planning to draw 3 units from the bottle of insulin, put 3 units of air into the syringe).
     
  3. With the bottle upright (with the bottom facing down, and stopper facing up -- do not tip it upside down yet) insert the syringe through the stopper and into the air space of the bottle of insulin.  
     
  4. Slowly inject air into the bottle.  (Note:  Putting air into the insulin will not hurt it but it may create bubbles that you will have to "tap" out later if they get into your syringe when you draw out the insulin.)
     
  5. Gently push the needle into the bottle to draw up the insulin into the syringe.
     
  6. Now, turn the bottle upside down (with the syringe still inserted) and holding it with one hand (most people manage to do this by holding the bottle in their palm and wrapping fingers around to hold it in place).
     
  7. Make sure the tip of the needle is submerged in insulin.  If the bottle does not have enough insulin left to get the tip submerged use a new bottle.
     
  8. Using your other hand, slowly (pulling too hard can cause the syringe plunger to come out) pull back on the plunger to draw the correct dose of insulin into the syringe.  It's okay if you draw up too much because you can reinject it back into the bottle as long as you have not yet removed the syringe or mixed it with another insulin.
     
  9. Do NOT remove syringe from bottle yet and keeping the bottle upside down, check for air bubbles inside the syringe.  
     
  10. If you see any air bubbles, tap the side of the barrel a few times with your finger to allow the bubbles to float to the top of the syringe. Gently push the plunger to inject the air bubbles back into the insulin bottle. Larger bubbles should easily inject back into the bottle, "champagne" (tiny) bubbles are harder to tap out.  
     
  11. Pull back slowly once again to redraw your full dose of insulin.
     
  12. Repeat this step SLOWLY as needed if you see more bubbles in the syringe.
     
  13. Turn bottle back right-side-up and remove needle from bottle.
     
  14. Always double-check to make sure you have filled the syringe with the right dose!
     
  15. Put the insulin bottle, marked with the date opened, back into the refrigerator.  

Preparing a Mixed (Insulin) Injection

Many people with diabetes take two types of insulin.  One to cover meals and another for background (basal) insulin.  Sometimes you have to take two separate shots because not all insulin (like glargine) can be mixed with others.  However, some insulins can be mixed together into one shot.

If you mix two different insulins in one syringe:

  1. fast-acting insulin is drawn into the syringe first
  2. slower/longer-acting insulin is added last (think "slow pokes come in LAST")

If the bottle of fast-acting insulin, such as Regular, were to get contaminated with slow-acting insulin, such as NPH, the insulin will not work as quickly as it usually does.  If you accidentally do the mixing backwards, call your doctor to see if you need to throw out the contaminated insulin bottle.

The first several steps for preparing a mixed injection are similar to those for preparing a single dose.  Organize your all your supplies, wash your hands in warm, soapy water, clean the tops of both insulin bottles with an alcohol swab, and prepare your syringe as outlined above.

Following the detailed guidelines above for injecting single insulin (for injecting air, drawing insulin, and removing air bubbles):

  1. Inject air into the slower/longer-acting insulin first - but do NOT draw up any insulin.
  2. Remove the (still empty) syringe from the slower-acting insulin bottle.
  3. Inject air into the faster-acting insulin, draw up insulin, remove bubbles, then remove the syringe.
  4. DOUBLE CHECK to make sure you have the correct amount of faster-acting insulin in the syringe!
  5. Since you already injected air into the slower/longer-acting insulin all you need to do is insert the syringe and draw up the required amount,
  6. Insert the needle into the slower/longer-acting insulin bottle. Turn the bottle and syringe upside down and gently jiggle or tap the bottle to force air bubbles in the insulin to rise to the top of the bottle. Doing this too hard can cause "champagne" (tiny) bubbles that are hard to deal with so be patient and work slowly.  
  7. Make sure the tip of the needle is submerged in the insulin.
  8. Pull back on the syringe plunger until the amount of insulin in the syringe is equal to the sum of the fast-acting + slower/long-acting insulin doses.
  9. Remove the needle from the bottle and double-check your dose.

         

        Your total dose in the syringe should now equal:

        faster-acting dose + slower/longer acting dose =  total dose in syringe

 

You did it!  Now the syringe is now loaded and ready to inject.   On to "How to Inject Insulin"

Note:  If you are using an insulin pen for injections, please see our section on "Insulin Pens" for information about the types of pens available and the advantages and disadvantages of insulin pen use.  You can also read "Step-By-Step Guide to Injecting with Insulin Pens."  

 

On to "How to Inject Insulin"

   

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Page Updated 03/12/2006