Injecting Insulin

Once you have your delivery device selected, your prescription filled, and your resolve set, you're ready to give yourself a shot. Before you start, wash your hands thoroughly and examine the bottle of insulin. If you are injecting a clear insulin like lispro, you should look for crystals, cloudiness, or debris, and dispose of the bottle if you find any.

For users of cloudy, long-acting insulins like NPH, you will have to mix the insulin gently in the vial by rolling it back and forth between your hands about twenty times. When the color appears even, it is mixed. Never shake the bottle, as this can damage the insulin.

You will also need three alcohol swabs, a syringe (or another device for injecting insulin), and a sharps disposal container.

Drawing Up the Insulin

For those of you who use a pen, pump, or jet injector, drawing up insulin will not be an issue. Still, it's a good idea to know how to do it in case you're ever without your regular supplies and need to use a syringe. Your diabetes educator and/or doctor will go over this procedure as well. Here are the basic steps:

  • Open the insulin vial or bottle and mark the date on the label.

  • Wipe off the top of the insulin vial with an alcohol swab.

  • Uncap both the plunger and the needle of the syringe.

  • Draw in air to the syringe by pulling out the plunger until the stopper reaches the unit mark of what your insulin dose will be.

  • Push the syringe needle down through the rubber stopper in the insulin vial. Do not press down the plunger yet.

  • After the needle is all the way in, push the plunger all the way down to inject the air into the bottle.

  • Turn the syringe and bottle upside down. Make sure that the tip of the needle is still submerged in the insulin. If it isn't, pull the syringe out slightly until it is.

  • Fact

    Oral and transdermal (skin patch) insulin may some day be pain-free treatment options for U.S. diabetes patients. Oral insulin, which is delivered in a spray, has shown the most promise of the three technologies in clinical trials, as the lining of the mouth absorbs the insulin effectively.

  • Slowly pull the syringe plunger out to draw the insulin until the stopper reaches the correct dosage mark.

  • Check for air bubbles. If there are some, push the insulin back in and redraw until none are visible.

  • Turn the bottle and syringe right-side up and carefully remove the syringe from the vial.

Choosing and Preparing a Site

Insulin should be injected into fat to do its job properly. This makes the fatty areas of the body — the butt, abdomen, thighs, and back of the upper arms — the most appropriate spots for giving injections. Don't choose your bicep, calf, or any other muscular area of your body. Muscle will accelerate the speed of your insulin action, and it hurts more too.

You can't inject yourself in the same spot every time. If you do, lumpy deposits of fat (lipohypertrophy) will form at the site and make injections increasingly less effective, as these deposits slow absorption of the insulin. Injection rotation doesn't require you to move from one side of the body to the other; just moving over by an inch or so will do the trick. However, you do need to have a method of keeping track of your rotation schedule.

Once you have a spot picked out, clean it thoroughly. You can also wipe it with an alcohol swab to sterilize the area, although this isn't required.

Good injection sites

Giving the Injection

Now the moment you've been waiting for — actually injecting the insulin. If you're like most people, you approach the first solo shot with trepidation and possible fear. Know that you can, and will, do it. Even the most squeamish, needle-fearing patients find that a little practice has them shoving in the syringe without a second thought.

Your diabetes educator or doctor will teach you the proper method of finding a good injection site and giving yourself a shot. In fact, you may be given a syringe of saline in the office to “practice” your technique with. After you've chosen an appropriate site, follow these simple steps for giving yourself a practically painless syringe injection:

  • When you clean the area, let the alcohol dry completely before injecting to avoid a nasty sting.

  • Grab a roll of fat (or flesh) between your thumb and forefinger with your nonshooting hand. You do not want to inject into muscle, so choose appropriately.

  • Hold the syringe like a dart, paper airplane, or anything else you'd want to sail through the air. Keep your thumb off the plunger until it's in.

  • My friend said that I could die if I injected an air bubble along with my insulin! Is that true?

    Your friend was probably referring to air embolism, which can occur when air bubbles are injected into the circulatory system and block a blood vessel (this is not necessarily fatal). Since insulin is injected into the subcutaneous fat, this isn't a risk. But bubbles are bad for another reason — they throw off your dosing.

  • Assess the area where you're injecting. If it's a fairly fatty site, you can use a 90-degree angle. Otherwise, you may have to try up to a 45-degree angle to avoid hitting muscle or blood vessels.

  • The key to pain-free injection is to stick the needle in completely and quickly. One caution: If you're giving insulin to a child, start a little slower. It may take some experimentation to find the speed that is least painful.

  • Depress the plunger with your thumb slowly and steadily. As you get accustomed to the “feel,” adjust your speed as needed.

  • Count to five before you pull out to avoid insulin leakage. Then pull out the syringe, let go of the site, and gently press against the site with an alcohol swab momentarily. You're done!

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