Diabetes: Giving Insulin Shots
To give yourself insulin shots you will need to learn:
- What kind or kinds of insulin you will be using
- What dosage of insulin you need
- When you should give yourself shots
- Where and how to inject the insulin
- How to store the insulin
If you use a prefilled pen, the insulin is not drawn from one container into another. The pen has a little plunger inside. When you set the dose on your pen, you are setting how far forward this plunger will move. This sets the amount of insulin that you get with each dose.
If you use a syringe, you also need to learn:
- What kind of syringe to use
- How to use the syringe
- What to do with used needles and syringes
Syringes come in different needle widths and lengths. Insulin syringes have thin, short needles that are easy to insert.
The amount of insulin a syringe can hold varies. Insulin is measured in units. Syringes have markings on the side that measure the units. Ask your pharmacist or healthcare provider if you have questions about needles, syringes, insulin, or dosage.
Your healthcare provider will tell you what kind of insulin to use, the dosage, and when you should give yourself a shot. Carry a written list of all medicine you take in your wallet, including the type and dose of insulin you use.
Is A Skin Lift Necessary
In adults, a skin lift is used in some situations, based on needle length and the amount of adipose tissue. A skin lift should be used when the needle is 8 mm or longer. In addition, in people whose arms and legs or abdomen have little fatty tissue, a skin fold might be justified when using a needle of 5 mm or 6 mm. A skinfold may not be necessary especially when using a 4 mm needle .
A skin lift, if required, must be done properly to ensure that the medication is not injected into the muscle or not deeply enough.
Step 3 Giving The Injection
- Clean the injection site. Use an alcohol wipe to clean the area where youre going to inject. Allow the area to air-dry. If the skin is wet with alcohol the injection will sting.
- Pinch an inch of skin. Pull up about 1 inch of skin. Pinch the skin gently. Dont squeeze it. This is to prevent injecting into muscle.
- Insert the needle. Insert the needle into the skin at the angle you were shown.
- Inject the insulin. Slowly push in the plunger until the syringe is empty.
Dont Inject The Insulin Too Deep
Insulin is supposed to be injected into the fat layer under the skin using a short needle. This is referred to as a subcutaneous injection.
If you inject the insulin too deep and it enters your muscle, your body may absorb it too quickly. The insulin might not last very long and the injection could be very painful.
Can I Reuse My Syringe
You may increase your risk for a bacterial infection when you reuse syringes. Ask your healthcare provider if it is safe for you to reuse a syringe. Do not reuse a syringe if you have an open wound, trouble seeing, or have an infection. The following are tips on how to safely reuse a syringe:
- Recap the needle as soon as you are done using it. Place the cap on a table or hard surface and slide the needle into the cap.
- Do not let the needle touch anything but clean skin or the top of the insulin bottle.
- Never share syringes with anyone.
- Do not clean your needle with alcohol. This will remove the coating that helps your needle slide easily into your skin.
- Throw out any syringe that bends or touches anything other than clean skin.
Rotate Your Injection Sites To Avoid Lumpy Skin
If you tend to inject in the same places you may find that your flesh becomes less flexible than usual. This is called lumpy skin and means the insulin wont be absorbed as well.
Avoid having a favourite part of that area to inject into as this greatly increases the risk of lumpy skin. If this is the case, try injecting into surrounding areas, picking a new spot each time.
Each of the main four areas should give a give a good area of flesh to inject into. Using different areas of the body to inject into is insulin injection site rotation
However, you may find you have a favourite part of that area to inject into. If this is the case, try injecting into surrounding areas, picking a new spot each time.
One way to pick a non-lumpy area is to feel or squeeze the skin before injecting insulin If it doesnt feel as supple as it could be, pick a different spot to inject into.
How To Inject Insulin
Before injecting insulin, be sure to check its quality. If it was refrigerated, allow your insulin to come to room temperature. If the insulin is cloudy, mix the contents by rolling the vial between your hands for a few seconds. Be careful not to shake the vial. Short-acting insulin that isnt mixed with other insulin shouldnt be cloudy. Dont use insulin that is grainy, thickened, or discolored.
Follow these steps for safe and proper injection:
Diabetes: Giving Insulin Shots: References
Giving an insulin injection. . National Institutes of Health U.S. National Library of Medicine. Retrieved 12/21/14 from http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000660.htm.
Chase, H. Peter. Understanding Diabetes, 11th Edition, Childrenâs Diabetes Foundation, 2006.
Chase, H. Peter. Understanding Insulin Pumps & Continuous Glucose Monitors. Childrenâs Diabetes Foundation, 2008.
Frid A. et al. New injection recommendations for patients with diabetes. Diabetes and Metabolism 2010; 36:S3-18.
Hirsch I. Insulin analogues. NEJM 2005; 352:174-83.
WebMD. Diabetes: Giving Yourself an Insulin Shot. July, 2011. Accessed 12/2013 from
Give The Insulin Dose
Figure 10. Holding the insulin pen
Monitoring Your Blood Glucose And Ketone Levels
If you have missed an injection, it is important that you monitor your blood glucose levels more regularly than usual over the next 24 hours to prevent blood glucose levels from going either too high or too low.
If you have type 1 diabetes , or have type 2 diabetes and produce very little of your own insulin, be prepared to test your blood or urine for ketones if your blood glucose levels rise above 15 mmol/l.
Tips For Choosing Insulin Injection Sites
|Change injection sites with every injection. Inject at least one finger-width away from your previous injection site. If you are having 2 or more injections a day, choose a different site for your morning and afternoon doses. When injecting 2 different insulins, inject them in different sites. Use a new needle for every injection.||Don’t inject deep into the muscle. Insulin should only be injected into the fatty layer under your skin. Don’t inject into fatty lumps. Don’t inject on damaged or scarred skin. Don’t move daily from one part of your body to another, such as from your tummy area to your thigh. Instead move within the area being used.|
Does Hypoglycemia Occur In Dogs
Hypoglycemia means low blood sugar. If the blood sugar falls below 40 mg/dl, it can be life threatening. Hypoglycemia generally occurs under two conditions:
“It is possible for the dog’s insulin requirements to suddenly change.”
Your veterinarian may have you offer an extra meal and recheck the glucose level within a short time after the dog eats.
What Is Different About Insulin Lispro
Insulin lispro is a new type of insulin. It starts working sooner than other insulin types. It also reaches peak activity faster and goes away sooner. Insulin lispro helps keep your blood sugar level from going too high after you eat. To keep your blood sugar level steady, your doctor will probably prescribe either a longer-acting insulin or another drug for you to take each day in addition to the insulin lispro.
If you need to mix insulin lispro with a longer-acting insulin, it’s best that you mix insulin lispro only with Humulin U or Humulin N, which are brand names for certain longer-acting insulins. Insulin lispro should always be drawn into the syringe first. This will keep the longer-acting insulin from getting into the insulin lispro bottle.
Types of insulin
Each type of insulin works at a different speed and lasts for a different length of time.
Quick-acting, such as insulin lispro , begins to work very quickly and lasts for 3 to 4 hours.
Short-acting, such as Regular insulin, starts working within 30 minutes and lasts about 5 to 8 hours.
Intermediate-acting, such as NPH or Lente insulin, starts working in 1 to 3 hours and lasts 16 to 24 hours.
Long-acting, such as Ultralente insulin, doesn’t start to work for 4 to 6 hours, but lasts 24 to 28 hours.
NPH and Regular insulin mixture, two types of insulin mixed together in 1 bottle, starts working in 30 minutes and lasts 16 to 24 hours.
Should I Sterilize The Skin With Alcohol Before Giving The Injection
No, do not swab the skin with alcohol to ‘sterilize’ it. There are four reasons:
- The smell of the alcohol can make your dog dislike the injections.
- Due to the nature of the thick hair coat and the type of bacteria that live near the skin of dogs, brief swabbing with alcohol or any other antiseptic is not effective.
- Because a small amount of alcohol can be carried through the skin by the needle, it may actually carry bacteria with it into the skin.
- If you have accidentally injected the insulin onto the surface of the skin, you will not know it. If you do not use alcohol and the skin or hair is wet following an injection, you will know that the injection was not done properly.
Although the above procedures may at first seem complicated and somewhat overwhelming, they will very quickly become second nature. Your dog will soon learn that once or twice each day it has to sit still for a few moments. In most cases, a reward of stroking results in a fully cooperative dog that eventually may not even need to be held.
How To Store Your Insulin Pens
Too much heat, cold, or sunlight can damage the insulin in your pens. Follow the instructions below to store your insulin pens.
- Keep your new, unused insulin pens in the refrigerator door. This keeps them from being pushed to the back of the refrigerator, where they can freeze.
- Keep the insulin pen youre currently using at room temperature . Once you use an insulin pen the first time, never put it back in the refrigerator.
- Never freeze your insulin pens.
- When youre going out in hot weather, dont let your insulin pen get too hot. Carry it in an insulated bag, or something similar, to keep it cool.
- If youre going to be out for a few hours, put a cold bottle of water in the insulated bag with your insulin pen. This will keep it from getting too hot for several hours.
- If youre going to be out for a longer time, you can put an ice pack in the insulated bag with your insulin pen. Wrap the ice pack or insulin pen in a towel to keep them from touching. If the pen touches the ice pack directly, the insulin can freeze.
Tips On How To Properly Administer Insulin And Considerations To Keep In Mind When Taking The Medicine
Probably the most well-known fact about diabetes is that those living with the disease frequently have to prick their fingers and inject themselves with insulin to maintain healthy glucose levels. For those that have been diagnosed with diabetes, they know that injecting insulin can be a daily task that, if not done correctly, can lead to more problems than solutions.
Insulin is not the only injectable medication that exists for diabetes patients; there are other medications, known as GLP-1, that are also injected. The use of these medications is increasingly common, and therefore it is extremely important to be aware of proper injection techniques in order to reduce the risk of problems associated with medication injection.
Injecting insulin can be done with a vial and syringe or an insulin pen. Studies have shown that insulin pens make the injection process easier for many patients. Needle length is an important factor to consider. New clinical evidence recommends using shorter needles that are 4 mm long. Similarly, the needle gauge is a factor that needs contemplation. Ideally, a short, thin needle works best for most individuals.
Insulin and other diabetes medicines are injected subcutaneously, or just below the skin. Research has shown that despite its short length, the 4 mm needle is long enough to adequately reach under the skin. For patients that are heavier, longer needle length may be required.
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Prepare The Insulin And Syringe
- Remove the plastic cap from the insulin bottle.
- Roll the bottle of insulin between your hands two to three times to mix the insulin. Do not shake the bottle, as air bubbles can form and affect the amount of insulin withdrawn.
- Wipe off the rubber part on the top of the insulin bottle with an alcohol pad or cotton ball dampened with alcohol.
- Set the insulin bottle nearby on a flat surface.
- Remove the cap from the needle.
If you’ve been prescribed two types of insulin to be taken at once , skip to the instructions in the next section.
- Draw the required number of units of air into the syringe by pulling the plunger back. You need to draw the same amount of air into the syringe as insulin you need to inject. Always measure from the top of the plunger.
- Insert the needle into the rubber stopper of the insulin bottle. Push the plunger down to inject air into the bottle . Leave the needle in the bottle.
- Turn the bottle and syringe upside-down. Be sure the insulin covers the needle.
- Pull back on the plunger to the required number of units .
- Check the syringe for air bubbles. Air bubbles in the syringe will not harm you if they are injected, but they can reduce the amount of insulin in the syringe. To remove air bubbles, tap the syringe so the air bubbles rise to the top and push up on the plunger to remove the air bubbles. Recheck the dose and add more insulin to the syringe if necessary.
- Remove the needle from the insulin bottle. Carefully replace the cap on the needle.
How I Rotate My Insulin Injection Sites
While I use my abdomen and arms for my rapid-acting injections, I use my glutes and lower back for all of my basal injections.
I have a very home-made but also very effective way of keeping track of my injections so I remember to rotate them.
To make sure that I do proper injection rotation, I have a piece of paper where I note down my injections . I usually switch from right to left side daily and will start with injecting right above the bikini line, then switch to below the bikini line, and lastly inject alongside the bikini line.
This rotation pattern takes me about a month to get through before I start all over again. So far, that has worked really well for me. I have no lumps and my insulin absorption is still really good after 20 years with diabetes.
Rotate Insulin Injection Sites
Because you will be injecting insulin on a regular basis for diabetes, you need to know where to inject it and how to rotate your injection sites. By rotating your injection sites, you will make your injections easier, safer, and more comfortable. If the same injection site is used over and over again, you may develop hardened areas under the skin that keep the insulin from being used properly.
Important: Only use the sites on the front of your body for self-injection. Any of the sites may be used if someone else is giving you the injection.
Follow these guidelines:
- Ask your doctor, nurse, or health educator which sites you should use.
- Move the site of each injection. Inject at least 1 1/2 inches away from the last injection site.
- Try to use the same general injection area at the same time of each day . Note: The abdomen absorbs insulin the fastest, followed by the arms, thighs, and buttocks.
- Keep a record of which injection sites you have used.
Common Insulin Injection Sites
When learning how to take insulin, you will be taught which areas of the body are appropriate sites to give an insulin injection, and the importance of rotating these sites. You should be able to pinch a fold of skin at the insulin injection site, and take care that you are not injecting insulin into the muscle.
Depending on the type of insulin you use, the area of your body that you inject insulin may affect how quickly its absorbed. The American Diabetes Association 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.
Below is an insulin injection site diagram and list of common sites:
Where Should I Inject The Insulin
Insulin is injected into the fat layer beneath the skin. The best places to give insulin are the belly, upper arms, thighs, and buttocks. There are different spots in each area where you can give the shot. You should change where you give the shots each time. For example, there might be 6 different places on the thigh that you can use. This way you can have a shot in over 50 different spots before having to use the same place again. This is called rotating the shots. Rotating injection sites helps prevent irritation and swelling.
- Do not give a shot into an area that is swollen or where there is a rash or sore.
- Do not give a shot just before a bath, shower, or hot tub. The warm water will draw more blood to the skin, causing the insulin to be absorbed more quickly. This can cause a serious low blood sugar reaction.
- Insulin is absorbed more quickly from the belly than from the arm and more quickly from the arm than from the thigh or buttock. This usually does not cause problems. If you have low blood sugar when you use some sites, you may want to use the belly or arm in the morning, and the thigh or buttock in the evening.
- If you inject insulin into an arm or leg that you will be using a lot during exercise, your body may absorb the insulin too fast. For example, if you are going to run, dont inject insulin into your leg. If you are going to play tennis, avoid injecting into your tennis arm.
Obligations That Come With Insulin
Insulin needs to be administered twice a day.
After your dog is diagnosed with diabetes, it will take some time until the vet is able to prescribe an adequate dosage of insulin, and there’s going to be some trial and error.
You or your vet will run tests on the dog’s glucose level several times a day or a week in order to see the reaction of your dogs organism to a particular dosage. The positive thing is that once a good dosage is established, the dog wont need the check-ups as often.
Insulin needs to be administered around the same time.
This means creating a schedule around your dogs injections. If you have frequent business trips, irregular working hours, or stay overtime often, you would need to think about the alternatives for keeping up with the schedule. You can ask a friend, family member or a pet sitter to administer it to your dog when you are unable.
Some dog owners feel anxious about giving a shot to their dog, especially because the dog is not thrilled about it either. But giving injections to dogs is fairly simple, and most people get used to it very quickly; it becomes a regular routine for them and their pet.
Do Check Your Blood Sugar Regularly And Write Down Each Measurement
Your insulin treatment involves much more than injecting insulin. You need to check your blood sugar level regularly using a blood glucose monitor. The constant need to test your blood sugar can feel like a burden, but its a crucial part of your diabetes care plan.
Blood sugar measurements can change depending on your stress level, how much exercise youre getting, illness, changes in your diet, and even hormonal changes during the month. Major changes could mean that you have to adjust your insulin dose.
Write down each measurement or record it in an app on your phone to show to your doctor. Your doctor needs this information to determine how much insulin is right for you.
Dont Switch Your Insulin Dose Or Stop Taking It Without Seeing Your Doctor First
Switching your insulin medication or changing the dose without asking a doctor can put you at risk for serious side effects and complications.
If you have type 2 diabetes, you should be seeing your doctor or endocrinologist for a checkup roughly every three to four months. At your appointment, your doctor can assess your individual insulin needs and give you proper training on new doses or dosing methods.