Many insulin product manufacturers put a lot of effort in making insulin administration as convenient and painless as possible. Nearly every day, a new type of product is introduced to the market.
Choosing injection site
There are various sites where insulin injection is advisable, including the buttocks, hips, legs and abdomen. Before an injection, the nurse will wipe the area with an alcohol solution, however, if the skin is clean, it isn’t necessary (in fact, some alcohol may be pulled in and cause some pain). If necessary, the insulin can be injected directly through the clothes. These are some variables that you should consider when choosing an injection site:
• The urgency of the situation: Injection on the abdomen offers the fastest response, followed by limbs and then followed by hip/buttocks. During an emergency, you should inject directly to the abdomen to ensure that the insulin is taken up quickly.
• Exercise: If you have run recently, injecting into your leg guarantees faster uptake.
• Similar site: Injecting on the same spot repeatedly, may slow the uptake, so you should rotate site.
• Depth of the injection: The shallower the injection, the slower the drug is taken up. It means during an emergency, you should administer a deeper shot.
Syringes and needles
These tools are becoming less commonly used during insulin administration. In many cases, pens are preferred because they are more convenient and you can easily adjust the correct dose. However, diabetes patient should still know how to measure the right dose and deliver it using syringe and needle, because there are times when pens are unavailable. There are various types of syringes and needles used, these are their common characteristics:
1. Gauge: Thinner needles have higher gauge number, 28 is the lowest and 31 is the highest. To minimize pain of insulin administration on children, you should use 31-gauge needle.
2. Insulin content: Syringes are sold in 1 ml, 0.5 ml and 0.3 ml sizes. You can reuse disposable syringe as long as it is clean and still sharp.
3. Needle length: You can buy either 5/16 or 1/2 inch needle, it is preferable for children to use shorter needle.
A new insulin bottle should have intact aluminum cap, break and discard it when you want to use the insulin. The rubber stopper under the cap allows the needle to penetrate, when you need to take the insulin. The rubber stopper is self-sealing, which prevent exposure to air and leaks after the needle is removed. Before using a bottle, always check for its expiration date and make sure it is stored in the refrigerator after used. Insulin bottle that is stored in the room temperature loses some of its potency and you should immediately discard insulin bottle that has been frozen.
Taking a shot
Whether it is regular or rapid-acting, the insulin should be clear. However NPH (intermediate-acting insulin) is cloudy and you need to shake it briefly to ensure the tiny articles are suspended evenly in the liquid. To avoid the risk of infection, you should wipe the cap with some alcohol before taking the insulin from the bottle. You should be sure that you use the right type of insulin.
For example, if you need to use 20 units of insulin, do the following:
1. Pull the syringe plunger until its end reaches the 20-unit mark, which is between 15 and 25 units.
2. When taking the insulin, you bottle should be turned upside down.
3. Push the plunger to force some air into the bottle and then pull until you reach the 20-unit mark again. Observe the result, while leaving the needle in the insulin bottle.
4. Make sure that there is no air bubble in the syringe, if you see some air, you should push the plunger until all insulin return to the bottle.
5. Pull the plunger back to the 25-unit mark, repeat the step 4 if you still see an air bubble.
6. Pull the syringe once you’ve done it correctly.
During an emergency, you should push the needle into the skin until it goes no further, to ensure faster uptake (make sure you use the right insulin needle to avoid hitting the bone or injecting the insulin into an internal organ). Push the syringe plunger until it reaches zero.
In some cases, you need to mix two types of insulin in a syringe, except the long action detemir and glargine insulin. Mixing insulin is often required when you need to mix rapid-acting and NPH insulin.
Here are the correct ways to mix insulin in a syringe (for example, when you need to use 15-unit or each type of insulin:
1. Wipe the caps of both bottles with some alcohol.
2. Pull the plunger until you reach the 30-unit mark on the syringe (the total units of insulin).
3. Turn the long-acting insulin bottle upside down, push 15-unit of air into the bottle, don’t pull the syringe back and withdraw the needle without taking any long-acting insulin inside the syringe.
4. Turn the rapid-acting insulin bottle upside down, push the remaining 15-unit of air inside the syringe into the bottle and pull until you get 15-unit of rapid-acting insulin inside the syringe.
5. Take the long-acting insulin bottle, turn it upside down, insert the needle and withdraw 15-unit of long-acting insulin.
The above steps may appear be tricky but necessary to prevent the rapid-acting insulin from being contaminated by additives inside the long-acting insulin.
Some people, especially children, are a little squeamish when they see a needle. Parents can use syringes with concealed needle, which use spring-loaded mechanism to reveal the needle. These products are:
• Autoject, Inject Ease and BD Inject Ease: spring-loaded plastic syringe holders.
• Instaject: A syringe with blood lancet device.
• NovoPen 3 PenMate and NeedleAid: Insulin pen with the needle hidden inside the syringe.
Other devices use different approach by magnifying the needle to help visually impaired patients, this will help them to hold the syringe firmly and direct the needle more accurately.
• BD Magni Guide, Tru Hand and Syringe Magnifier: Magnifying devices for insulin injection.
• Count-A-Dose: It helps you to get an accurate dose, as the device converts the plunger action into an audible click.
• Inject Safety Guard: It helps you to protect your hand when injecting the insulin.
• NeedleAid: It helps you stabilize the pen or syringe when injecting the insulin.
These tools are commonly available in pharmacies and drugstores.
Syringes and needles disposal
It’s important to dispose pens, syringes and needles properly, so others won’t reuse them accidentally. Some manufacturers offer containers for diabetes tools disposal:
• UltiGuard Syringes with Disposable Container: Syringes of various s that come with disposal units.
• BD Safe Clip: A container for up to 1,500 used needles.
• BD Home Sharps Container: It helps you to store 300 pen needles or 100 syringes.
When your container is full, it is inadvisable to throw it in the garbage can. You should send it to the waste processing center that can process used medical tools.