insulin_injection_how_to_aade

INSULINspace.liningINJECTIONspace.lining KNOW-HOW American Association of Diabetes Educators Supported by BD Diabetes Care 1 Congratulations for making the move to insulin therapy. It won’t be long before you start enjoying better blood sugar control, more energy, and a host of other benefi ts. The prospect of taking insulin injections may have you feeling a bit anxious. That’s OK! Just about everyone feels that way. Just know that your anxiety will vanish soon enough. Here are some valuable facts and tips to help make your transition to insulin smooth and easy. WAYS TO GIVE INSULIN Because insulin is broken down by digestive enzymes, it cannot be taken in pill form. Instead, it is delivered with a syringe into the layer of fat below the skin, also called the “subcutaneous” tissue. The layer of fat on the stomach, hips, thighs, buttocks and backs of the arms are common sites for injecting insulin. From there, the insulin absorbs into the blood- stream where it circulates to the cells throughout the body. The really good news about deliver- ing insulin into the layer of fat below the skin is that there are no nerve endings in this area, so injections are usually painless. There are a num- ber of options for adminis- tering insulin: SYRINGES Disposable plastic insulin syringes are still widely used, but the popularity of pens and pumps (see next page) is growing. Syringes vary in terms of how much insulin they hold as well as the length and thickness of the needle. Syringes can be used to deliver insulin directly into the layer of fat below the skin, or they can inject insulin into a temporary “port” that sits on the skin. The port, which is changed every 2-3 days, features a small flexible plastic tube that sits below the skin. A needle is used to place the tube under the skin, so only one needle stick is required every 2-3 days when a port is used. Learning How to Inject Insulin

Supported by BD Diabetes Care 2 American Association of Diabetes Educators insulin injection know-how learning how to inject insulin 2 PENS Insulin pens got their name because they are about the size and shape of a writing pen. They contain insulin (instead of ink) and have a dial for setting the dose. A dispos- able pen needle is attached to the end of the pen prior to injecting. As was the case with syringes, pen needles are available in a variety of lengths and thicknesses. Because they cut down on medical waste and are considered by most to be more convenient, accurate and easy to use than syringes, insulin pens are growing in popularity among people of all ages. PUMPS Insulin pumps are electronic devices that are worn continuously and deliver insulin into the fat layer below the skin by way of a flexible plastic tube (similar to the “port” described above). Insulin pumps are popular among those who require multiple daily injections of insulin. Safe and successful use of a pump requires considerable education and training, and their cost can be relatively high. Insulin pumps are not typically used by those who are new to insulin, but can be an eff ec- tive option once you have a bit more experience. 0- 1- 0- 0-

Supported by BD Diabetes Care 4 American Association of Diabetes Educators insulin injection know-how learning how to inject insulin 4 TO DRAW ONE TYPE OF INSULIN INTO A SYRINGE: L50195 Gather your insulin supplies: Get your insulin vial and a fresh syringe. Check the insulin vial to make sure it is the right kind of insulin and that there are no clumps or particles in it. Also make sure the insulin is not being used past its expiration date. L50195 Gently stir intermediate or premixed insulin: Turn the bottle on its side and roll it between the palms of your hands. Clear (fast-acting, long- acting) insulin generally does not need to be mixed. L50195 Prepare the insulin bottle: If the insulin bottle is new, remove the cap. It is not necessary to wipe the top of the bottle with alcohol as long as it is clean. L50195 Pull air into the syringe: Remove the cap from the needle. Pull back the plunger on the syringe to draw in an amount of air that is equal to your insulin dose. The TIP of the black plunger should correspond to the number on the syringe. L50195 Inject air into the vial: Hold the syringe like a pencil and insert the needle into the rubber stopper on the top of the vial. Push the plunger down until all of the air is in the bottle. This helps to keep the right amount of pressure in the bottle and makes it easier to draw up the insulin. L50195 Draw up the insulin into the syringe: With the needle still in the vial, turn the bottle and syringe upside down (vial above syringe). Pull the plunger to fill the syringe to the desired amount. L50195 Check the syringe for air bubbles: If you see any large bubbles, push the plunger until the air is purged out of the syringe. Pull the plunger back down to the desired dose. L50195 Remove the needle from the bottle: Be careful to not let the needle touch anything until you are ready to inject! INJECTION TECHNIQUE Technique is everything when it comes to making insulin injections easy.

Supported by BD Diabetes Care 5 American Association of Diabetes Educators insulin injection know-how learning how to inject insulin 5 WHEN COMBINING TWO TYPES OF INSULIN (INTERMEDIATE AND RAPID) IN THE SAME SYRINGE: L50195 Gather your insulin supplies: Get your insulin vial and a fresh syringe. Check the insulin vial to make sure it is the right kind of insulin and that there are no clumps or particles in it, and that the expiration date has not passed. L50195 Gently stir intermediate or premixed insulin: Turn the vial on its side and roll it between the palms of your hands. Clear (fast-acting, long-acting) insulin generally does not need to be mixed. L50195 Prepare the insulin vials: If the insulin vial is new, remove the cap. It is not necessary to wipe the top of the bottle with alcohol as long as it is clean. L50195 Inject air into the intermedi- ate insulin vial: Remove the cap from the needle. With the vial of insulin below the syringe, inject an amount of air equal to the dose of intermediate insulin that you will be taking. Do not draw out the insulin into the syringe yet. Remove the needle from the vial. L50195 Inject air into the rapid- acting insulin vial: Only inject an amount equal to the rapid- acting insulin dose. Leave the needle in the vial. L50195 Draw up the rapid-acting insulin: With the needle still in the vial, turn the vial upside down (vial above the syringe) and pull the plunger to fill the syringe with the desired dose. L50195 Check the syringe for air bubbles: If you see any large bubbles, push the plunger until the air is purged out of the syringe. Pull the plunger back down to the desired dose. L50195 Remove the needle from the vial: Recheck your dose. L50195 Draw up the intermediate- acting insulin: Insert the needle into the vial of cloudy insulin. Turn the vial upside down (vial above syringe) and pull the plunger to draw the dose of intermediate-acting

Supported by BD Diabetes Care 7 American Association of Diabetes Educators insulin injection know-how learning how to inject insulin 7 DELIVERING AN INJECTION: L50195 Select a site: Choose a spot on your skin that you can see and reach. It is important to not “overuse” any particular area of skin. See the information below on “rotating” injection sites. L50195 Make sure skin is clean: It is generally not necessary to wipe the skin with alcohol before injecting. Those at a high risk of infection should discuss site- preparation procedures with their healthcare team. L50195 Pinch the skin: Pinch a one-to- two-inch portion of skin and fat between your thumb and first finger. L50195 Push the needle into the skin: With your other hand, hold the syringe or pen like a pencil at a 90-degree angle to the skin and insert the needle with one quick motion. Make sure the needle is all the way in. L50195 Inject the insulin: Let go of the skin pinch before you inject the insulin. Push the plunger with your thumb at a moderate, steady pace until the insulin is fully injected. If using a syringe, keep the needle in the skin for 5 seconds. If using a pen, keep the needle in the skin for 10 seconds. L50195 Pull out the needle: Remove at the same 90-degree angle at which you inserted the needle. Press your injection site with your finger for 5-10 seconds to keep insulin from leaking out. L50195 Remove the needle: If using a pen, remove the needle from the pen by replacing the large cover and unscrewing. Leaving the needle on the pen can result in leakage or air bubbles. L50195 Dispose of your used needle: It is important to protect yourself, your loved ones, sanitation workers and pets from acciden- tal needle sticks. Do not recap syringes before throwing them away. Place used syringes and pen needles in a thick plastic container (sharps container, detergent bottle, etc.). When nearly full, close the container tightly with a screw-on cap and tape closed. Dispose according to standards set forth by your local department of sanitation. Correct (left) and incorrect (right) ways of performing the skin fold. The correct angle of injection when lift ing a skin fold is 90°

Supported by BD Diabetes Care 8 American Association of Diabetes Educators insulin injection know-how learning how to inject insulin 8 ROTATING INJECTION SITES: Insulin is injected into the fat layer below the skin on the abdomen (staying two fingers or a few inches away from the belly button), outer thighs, hips, buttocks, or backs of the arms. Although insulin injec- tions are usually painless, injecting the same spot repeatedly can cause inflammation or fat tissue break- down. Lipodystrophy, as this is called, can cause lumps/swelling and thickened skin, and it may keep insulin from absorbing properly. Nearly half of all people who take insulin develop lipodystrophy, particularly when injection sites are not rotated properly. Most forms of rapid and long-acting insulin absorb consistently from just about any body part, so feel free to use a variety of body parts for your injections, and use a variety of spots within each body part. Intermediate-acting (cloudy) insulin and premixed insulin absorbs diff erently in diff erent body parts. It is best to inject intermediate-acting insulin into one part of the body consistently, but use a variety of spots within that body part. NEEDLE RE-USE Use of a new, fresh syringe or pen needle for each injection is the best way to minimize discomfort and ensure the accuracy/eff ectiveness of the insulin dose. Using someone else’s needle puts you at danger of contracting Hepatitis and HIV. ABDOMEN THIGHS BUTTOCKS ARMS 1 6 11 2 7 12 3 8 13 4 9 14 5 10 15 5 6 15 4 7 14 3 8 13 2 9 12 1 10 11 Recommended way to rotate injection sites.