Insulin Treatment | Guidelines, Usage and Points to Remember
A STEP-BY-STEP GUIDE TO STARTING INSULIN TREATMENT:
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:
- Some ‘pens’ come ‘pre-loaded’ with insulin, and are disposable
– Pre-loaded injection devices can be easier to use, however are more expensive.
- Cartridges of insulin that are inserted into a re-usable device
– Most cartridge pens are available on prescription.
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.
CORRECT ‘PINCH UP’:
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
- Lifted skin fold and No lifted skin fold
CHOOSING AN INJECTION SITE:
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.
ROTATING 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.
SOME POINTS TO REMEMBER:
- 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.
- 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.
- 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.