Insulin Treatment | Guidelines, Usage and Points to Remember

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Insulin Treatment | Guidelines, Usage and Points to Remember


This section provides a practical guide to starting insulin, from choosing the most appropriate course of treatment to managing supplies of medication and equipment.


  • Taking insulin helps you manage your blood sugar levels.
  • Everybody with type 1 and some people with type 2 diabetes needs to inject insulin to help manage their blood sugar levels.
  • You take insulin by injecting it using a pen, or by using an insulin pump. Pumps aren’t available to everyone – only for those who have type 1 diabetes.

Choosing a delivery device:

  1. Some ‘pens’ come ‘pre-loaded’ with insulin, and are disposable

Pre-loaded injection devices can be easier to use, however are more expensive.

  1. Cartridges of insulin that are inserted into a re-usable device

– Most cartridge pens are available on prescription.

Injection Technique:

When administering medication with a syringe, the needle should be inserted quickly and removed from the skin at the same angle it was inserted. Very young children less than 6 years old and very thin adults should use the 4-mm needle by liftings the skinfold and inserting the needle perpendicularly into it. When a syringe needle is used in children greater than 6 years old, adolescents, injections should always be given into a lifted skin fold to lower the risk of IM injection. Injecting at a 45-degree angle using a 6-mm syringe needle is an acceptable substitute for lifting a skinfold because the net penetration of a 45-degree injection using the 6-mm needle is approximately 4-mm. Others may inject using the 4-mm needle without lifting a skinfold.

When administering medication with a pen, after pushing the thumb button in completely, wait for a slow count to 10 before withdrawing the need to help reduce leakage and ensure injecting the full dose of the medication.

Injection Discomfort and Complications:

  • Take insulin and other injectable medication at room temperature.
  • Always use a new needle for each injection and new needles are lubricated and glide gently through the skin.
  • Remove air bubbles from the syringe prior to injecting.
  • Wait for the alcohol to evaporate completely from the injection site prior to injection.
  • Avoid the use of rubbing alcohol after the injection.
  • Insert the needle under the skin in a smooth but not jabbing movement.
  • Inject insulin slowly, count to 10 before removing the needle to receive the full dose.


Use the thumb and index finger to pinch up the subcutaneous fat, leaving the muscle behind. Using the whole hand tends to pull up the muscle.

  • Correctly lifted skin fold and Incorrectly lifted skin fold

Correctly lifted skin fold and Incorrectly lifted skin fold

    • Lifted skin fold and No lifted skin fold

    Lifted skin fold and no lifted skin tool


    There are a number of alternatives:

    • Abdomen – Faster absorption, usually plenty of subcutaneous fat, is making it easy to do a pinch up.
    • Thighs – slower absorption. Best with intermediate-acting insulin, or the evening dose of a twice-daily insulin regimen.
    • Arms – medium to fast absorption. Make sure there is sufficient fat, and use short needles.
    • Buttocks – Slowest absorption.

    Insulin Injection Sites


    Repeatedly injecting into the same small area results in lumps (lipohypertrophy) which hinder insulin absorption and can be unsightly. The alternative between the left and right side on a weekly basis, and rotates sites within the same area. Checks from lumps on a regular basis. This may take weeks or even months, depending on the severity of the lipohypertrophy.


    1. Exercise – Advise the person not to inject into their arm if they’re about to do the ironing, or into the thigh if planning to walk the dog or go shopping.
    2. Temperature – heat also speeds up the absorption of insulin. People should not inject immediately before or after a hot bath or shower because the blood vessels in our skin get wider when you are hot.
    3. Injecting through clothing – people feel they need to do this, for instance, while traveling or in social situations but it should be discouraged.


    • Spare insulin should be kept in the fridge between 4 and 8 degrees C.
    • Cold insulin may take longer to absorb and cause stinging.
    • Insulated pouches will keep insulin cool in hot weather.
    • The insulin or cartridge in use can be kept at normal room temperature for one month.
    • Keep the insulin away from the children.
    • Always check the expiry date.



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