Insulin Techniques

Common Preferred Sites for injection include : Periumbilical region on abdomen > Thigh> Arms

The following figure demonstrates the sites where you can inject insulin.

BEFORE YOU BEGIN:

• Before drawing up insulin, it is important to know the dose and type of insulin needed.

• If more than one type of insulin is combined in one syringe, the person drawing up the insulin should calculate the total dose before drawing up the insulin. Some people, including young children and those with difficulty seeing or other disabilities, may need assistance.

• Gather injection supplies, including insulin bottle(s), syringe, alcohol swab, and diabetes logbook.

• If you use a bottle and syringe, be sure you are using the correct syringe for your type of insulin (if you use U-100 /40/500 insulin, use the specially marked syringe).

• Wash hands with soap and water or alcohol-based hand gel.

• If milky/NPH insulin used, gently turn the bottle up and down 20 times to mix it.

WHEN USING A VIAL AND INJECTION:

• Clean the rubber top of the insulin bottle(s) with an alcohol swab.
• New bottles of insulin may have a hard-plastic cap that must be snapped off to reveal the rubber top.
• Remove the syringe cap.
• Pull-on the plunger to draw air into the syringe, equal to the amount of insulin to be given. For example, if 10 units of insulin will be given, drawback 10 units of air.
• Insert the needle into the insulin bottle and depress the plunger, injecting the air into the bottle.
• Hold the bottle with one hand and turn it upside down, keeping the needle inside the bottle. Slowly pull the plunger back to draw the correct insulin dose into the syringe.
• Remove bubbles from the syringe, if needed. Bubbles are not harmful if injected subcutaneously, but they can decrease the amount of insulin in the syringe and potentially affect blood glucose levels.
• Draw up insulin slowly and steadily. Bubbles form in the syringe if it is drawn up too quickly. If bubbles are seen, push the insulin back into the bottle and slowly re-draw. Do this as many times as needed until the bubbles are gone.
• Draw two more units of insulin into the syringe than needed. If bubbles are seen, flick the syringe with the middle finger and thumb to make the bubbles rise. Once the bubbles are at the top, push the extra two units of insulin back into the bottle. Don’t forget to push the extra insulin back into the vial – even if there are no air bubbles in the syringe.

Injection technique

The following is a description of subcutaneous insulin injection:

• Choose the site to inject.
• It is not necessary to clean the skin with alcohol unless the skin is dirty.
• Pinch up a fold of skin and quickly insert the needle at a 90° angle. Keep the skin pinched to avoid injecting insulin into the muscle.
• Depending upon your body type, you may not need to pinch up a fold of skin.
• Push the plunger down completely to inject the insulin. Hold the syringe and needle in place for 5 to 10 seconds.
• Release the skin fold.
• Remove the needle from the skin.
• If blood or clear fluid (insulin) is seen at the injection site, apply pressure to the area for five to eight seconds. The area should not be rubbed, because this can cause the insulin to be absorbed too quickly.

If clear (REGULAR/PLAIN) and milky (NPH/INSULATARD) insulin are used, inject air into the cloudy insulin first, followed by the clear insulin. Leave the needle inside the clear insulin bottle.

Hold the bottle with one hand and turn it upside down, keeping the needle inside the bottle. Slowly pull the plunger back to draw the correct insulin dose into the syringe FROM THE CLEAR INSULIN AND THEN FROM THE MILKY ONE.

Rotation can be done at least 2 finger spaces away from previous site or at different site. For Eg : from Abdomen to thigh.

Rotation is important to prevent lipohypertrophy i.e. thickening of underlying fat as it may cause abnormal absorption of the insulin injected leading fluctuations in the sugar levels.