Getting Started With Insulin Injections - BD
Getting started withInsulin Injections
Table of ContentsIntroduction . . . . . . . . . . . . . . . . . . . . . . . .2Blood Glucose LevelsInsulin Injection Devices . . . . . . . . . . . . . . .3 Hyperglycemia. . . . . . . . . . . . . . . . . . . . .15Insulin Syringes Hypoglycemia. . . . . . . . . . . . . . . . . . . . . .16Table of Contents Choosing a syringe. . . . . . . . . . . . . . . . . . .4 Preparing a dose of insulin. . . . . . . . . . . . . .5 Mixing insulin in a syringe. . . . . . . . . . . . . . .7 Proper needle use. . . . . . . . . . . . . . . . . . .17 Proper disposal of your sharpsInsulin Pens Preparing a dose of insulin. . . . . . . . . . . . . .9Injection Technique Insulin injection1General Recommendations. . . . . . . . . . . . . . . . . . . .11 Needle length. . . . . . . . . . . . . . . . . . . . .12 Injection sites. . . . . . . . . . . . . . . . . . . . . .13 Insulin care and storage. . . . . . . . . . .18. . . . . . . . . . . . . . .19Patient Information . . . . . . . . . . . . . . . . .20
IntroductionThis “Getting Started withInsulin Injections” bookletaims to help you withpractical information aboutinsulin injections and goodinjection technique. It willreinforce the informationgiven to you when you werediagnosed or when youstarted taking insulin.showing you how to use yourinjection device and helping youwith your injection technique.Once you are at home, refer tothis booklet and the notes thathave been made to remindyourself of any aspect of yourcare.IntroductionYour diabetes nurse educatorwill have taken you throughthis “Getting Started withInsulin Injections” bookletexplaining your daily routine,2
Insulin Injection DevicesEach device has its own advantages and drawbacks. Ask your healthcare professional for adviceon which device (pen or syringe) best suits you.2 - Reuseable insulin pensto be used with insulincartridges3 - Pre-filled insulin pens,these are disposable51015202530UNITS351015202530Note: not all insulin cartridgescan be used with all insulinpens.UNITS51015202530UNITSInsulin Injection Devices1 - Insulin syringes to beused with insulin vialsSome insulin treatmentscombine an insulin pen for onetype of insulin and an insulinsyringe for another type or mayrequire two insulin pens for twodifferent insulin types.
Choosing a syringeInsulin syringes are available by prescription in 3 sizes: 0.3 ml, 0.5 ml and 1 ml. Choose a syringesize based on the dose (units) of insulin you require. It is easier and more accurate to measuresmaller doses with a smaller volume 0506070809010 1 ml insulin syringesThese syringes are graduatedin 2-unit intervals and areideal for doses over 50 TS102030405060708090105101520253035404550UNITS 0.5 ml insulin syringesThese syringes are graduated in1-unit intervals and are ideal fordoses between 30 units and 50units.Insulin Syinges 0.3 ml insulin syringesThese syringes are graduatedin 1-unit intervals and areideal for doses under 30units because of theirdiscrete size and easy 1 unitadjustment.4
Preparing a dose of insulinInsulin SyringesUsing proper technique to prepare an insulin dose helps ensure that you are receivingaccurate insulin injections.Gently roll vial of cloudyinsulin (premixed,intermediate- or long-actinginsulin) between your hands20 times to mix evenly. Nevershake.Note: Always check the labelon the insulin vial for anyspecial instructions and theexpiry date.5Remove the white cap coveringthe plunger, then carefullytwist and remove the orangeneedle cap without touchingthe needle.With the vial standing upright,insert the needle straightthrough the centre of therubber cap of the insulin vialand push the plunger down.Draw air into the syringe equalto the number of units ofinsulin needed.This injects air into the vial,making it easier for you todraw out the insulin.
Preparing a dose of insulinCheck for bubbles. Tapsyringe. Expel any bubblesand the extra insulin. Checkthat you have the correctamount for your dose.Note: Although air bubblesare not dangerous if injected,they may affect the accuracyof your insulin dose. If airbubbles remain, inject all ofthe insulin back into the vialand start again.Remove the needle fromthe vial and perform yourinjection.Insulin SyringesHold the vial and syringeupside down. Make sure thatthe point of the needle insidethe vial is well beneath thesurface of the insulin. Slowlypull the plunger, drawing thecorrect amount of insulin,plus a little extra, into thesyringe.Safely dispose of yourneedle and syringe usingthe techniques describedon page 18 of thisbooklet.6
Mixing insulin in a syringeInsulin SyringesRemove the white capcovering the plunger, thencarefully twist and remove theorange needle cap withouttouching the needle.Draw air into the syringe equalto the number of units ofcloudy (intermediate actinginsulin) needed.7With the vial standing upright,insert the needle straightthrough the centre of therubber cap of the cloudyinsulin vial and push theplunger down.This injects air into the vial,making it easier for you to drawthe insulin out of the bottlelater. Remove the needlewithout drawing any insulininto the syringe.Draw air into the syringe equalto the number of units of clearinsulin needed. Insert theneedle through the centre ofthe rubber cap of the clear(rapid acting analogue or fastacting insulin) vial and injectthe air.
Mixing insulin in a syringeWhen mixing two types of insulin within one syringe, it is important to draw up your clear rapidacting analogue or fast-acting insulin before your cloudy intermediate-acting insulin.Insulin SyringesHold vial and syringe upsidedown and keep the point of theneedle well beneath the surfaceof the insulin. Slowly pull theplunger, drawing the correctamount of clear insulin, plus alittle extra, into the syringe.Check for bubbles. Tap syringe.Expel any bubbles and the extrainsulin. Check that you have thecorrect amount for your clearinsulin dose. Remove the needlefrom the vial.Gently roll the vial of cloudyRemove the needle from theintermediate- or long-acting insulinvial and perform yourbetween your hands 20 times toinjection.mix evenly. Never shake. Insert theneedle straight through the centreSafely dispose of your needleof the rubber cap of the cloudyand syringe using theinsulin vial and turn it upside down.techniques described on pageSlowly and carefully pull the18 of this booklet.plunger, until you have the TOTALnumber of units needed (cloudy clear).Note: If you accidentally draw up too much cloudy insulin, discardthe mixture and begin again. Do not re-inject back into the vialsince it has been mixed with the clear insulin.8
Preparing a dose of insulinNot all insulin cartridges can be used in all insulin pens (please refer to the insulin manufacturer’sinstructions).Insulin PensConsult your manual forinstructions on how to properlyrefill your insulin pen. Insert anew insulin cartridge if required(refillable).9Quickly but gently, bend andextend your arm 20 times tomix insulin (premixed,intermediate- or long-actinginsulin) evenly. Never shake.If insulin does not lookthoroughly mixed, roll the pen10 times between your hands.Take off the cap of your insulinpen. Screw a new needle ontoyour pen.
Preparing a dose of insulinSet your dose using the dial andperform your injection.Always remove the needleafter each injection andsafely dispose of your needleand syringe using thetechniques described on page18 of this booklet.Insulin PensCheck insulin flow (prime).Using the dial found on theend of your pen, dial 2 units.Hold the pen with the needlepointing upwards and slowlypress down on the injectionbutton. A drop of insulinshould appear; repeat this stepuntil a drop appears.10
Insulin injectionProper insulin absorption occurs when it is delivered to the fat layer (subcutaneous tissue) foundbetween your skin (dermis) and your muscle.Skin (dermis)Injection TechniqueFat layer (subcutaneous tissue)MuscleThe depth of thesubcutaneous tissue may bedifferent between individualsand from one injection site toanother. Talk to yourhealthcare professional aboutthe injection technique that isbest for you. Ask questionsand have him/her walk youthrough your injectiontechnique on a regular basis.11Lifting your skin into a foldbefore injecting with an 8 mmor 12.7 mm needle will helpyou avoid delivering insulin intoyour muscle by accident.Use only the thumb, index andmiddle finger to perform acorrect lifted skin fold.Lifting the skin may not berequired if you are using a veryshort needle, such as the 5 mmpen needle.
Needle lengthYour healthcare professional can recommend a needle length and injection technique that is mostappropriate for you.5mm mini8mm short12.7mm originalFollow these general recommendations to ensure proper insulin absorption and to avoid anintramuscular injection:5mm8mmInjection techniquerecommendationsChoose the right pen needlewithout alifted skin foldChoose the BD Ultra-Fine III Mini Pen Needle if you: want the shortest pen needle available are muscular or have low to moderate body fat are selecting the pen needle for a child don't want to pinch up90ºChoose the BD Ultra-Fine III Short Pen Needle if you: are like most patients – it's a size that's appropriatefor many people90ºwith alifted skin fold12.7mm90ºwith alifted skin foldChoose the BD Ultra-Fine Original Pen Needle if you: take large doses of insulin have dexterity issues12Injection TechniqueNeedle length
Injection sitesRate of insulin absorption varies between injection areasInjection TechniqueUpper ArmsMedium rateThighs andButtocksSlowest rateAbdomenFastest and mostconsistent rateAmount and speed of absorption may differ between areas, which may affect your glycemiclevels. Remain within one area (e.g. abdomen) as much as possible. Follow a site rotation patternto avoid injecting the same site too often.13
Injection sitesThe upper arms are the nextbest area for insulin absorption.This site is harder to reach,which makes it more difficult toinject yourself correctly.The outer thighs and buttocksdo not absorb insulin quickly.Exercise may affect the rate ofabsorption. This site shouldnot be used often.Repeatedly using the same site for insulin injections may lead to thedevelopment of fatty lumps or “lipos” caused by “lipodystrophy.”“Lipos” can be disfiguring, and may lead to improper insulinabsorption.14Injection TechniqueThe abdomen is the bestarea for insulin absorption.Avoid injecting within twoinches of your belly button.
HyperglycemiaChanges and imbalances in your health, diet, exercise, or medications may cause your blood sugarlevels to rise or fall. If you learn how to recognize the first signs, you can treat yourself quickly or gethelp before your condition worsens.Hyperglycemia (High Blood Glucose)Blood Glucose LevelsBlood glucose levels above 11 mmol/LCauses Stress from an illness(e.g. infections, fevers) Emotional stress (e.g. conflicts withfamily, problems at school or work) Pregnancy Eating too much food Not exercising as much as planned Not enough insulin (type Idiabetes) Insulin is not effective(type II diabetes)15First signs Increased thirst Urinating more often TirednessSigns of severe high bloodglucose (ketoacidosis) Heavy, laboured breathing Breath that smells fruity Very dry mouth High levels of ketones in the urine Nausea, vomiting or abdominalpainWhat to do Test blood glucose level frequently. If it is over 13.3 mmol/L, test yoururine for ketones. If blood glucose is under 13.3mmol/L and there are no ketonesin your urine, try exercising. If ketones are present, do notexercise. Call your healthcare professionalimmediately. Drink fluids without sugar if youare able to swallow.
HypoglycemiaHypoglycemia (Low Blood Glucose)Blood glucose levels below 4 mmol/LFirst signs Sweating Headache Heart beating quickly Hunger Shakiness, light-headedness andweakness Fatigue Mood changesSigns of severe low bloodglucose Confusion or disorientation Unconsciousness SeizuresWhat to do Test your blood glucose level. Eat or drink a form of sugar.2-3 BD Glucose Tablets3 4 cup of juice or pop1 tbsp of honey Wait 10-15 minutes, then test again. Repeat if it remains too low.Tell friends and family what todo if you become unconscious: Call your healthcare professional. Never give you fluids or food bymouth. Give Glucagon according to packageinstructions.16Blood Glucose LevelsCauses Not eating enough food Missed or delayed meal Exercising without takingprecautions Exercising more than usual Taking too much insulin
General RecommendationsProper needle useNew needleTip damagecaused by re-use17Use needles only onceThin-wall needle technology has made it possible to develop thinnerneedles with the same rate of insulin flow, which are easier and morecomfortable to use. These newer needles, however, are more fragile andare designed for single use only.There are no benefits to re-using needles, only risks.Inaccurate doses: Reused needles can leak fluid or allow air into thecartridge. This can affect the concentration of insulin and lead toinaccurate doses.Painful injections: New needles have a silicone coating, which is removedwith use. Without this layer of lubrication, injection can be painful.Broken needles: Thin needles are weakened by reuse and can actuallybreak, leaving fragments of metal in the skin.Avoid injecting through clothesInjecting insulin through clothing using a syringe or pen is not advised. It is difficult to perform a correct lifted skin fold when injectingthrough clothes. Clothing fabric removes the silicone coating and can damage theneedle tip, which increases pain and discomfort when injecting. It is not possible to inspect the injection site for bleeding, insulinleakage or infection when injecting through clothes.
Proper disposal of your sharpsContact your local garbage removal office or health department for informationon safe disposal. The following guidelines may be helpful:Put your used syringes, needlesand lancets into a BDTM SharpsContainer or a hard plastic ormetal container with a screw-onlid. When the container is full,seal the lid securely and disposeof it following your city’sguidelines.General RecommendationsRemove the needle fromyour syringe or pen using aBD Safe-ClipTM, which storesone year's supply ofneedles.Never handle someoneelse’s syringe or pen needleunless you have been trainedby a healthcare professional inproper injection technique,handling methods anddisposal.Accidental needle stick injuriesmay cause serious infections.Keep this container away fromchildren.Never throw used syringes,syringe needles, penneedles or lancets in theregular garbage.Do not put the filled containerinto or near your recycling bin.For more information on how todispose of syringes, needles orlancets, call BD toll-free at1-888-BD-CARES (232-2737).18
General RecommendationsInsulin care and storageFor better comfort and insulin efficiency, take insulin out of the refrigerator at least one hourbefore your injection; cold insulin may sting and slows insulin absorption rates.Unopened insulin vials or cartridges should be stored in the refrigerator between 2ºC and 8ºC.Opened insulin vials or cartridges can be safely stored at room temperature for up to one month(please refer to insulin manufacturer’s recommendations).Never use insulin after the expiry date and avoid exposure to extreme temperatures.Below 0ºC Insulin is destroyed19Above 30ºC Insulin’s effectivenessbegins to decrease
Patient InformationName:Date of Birth:Address:Telephone Number:Name of insulin(s):Insulin dose:Patient InformationUseful numbersDiabetes specialist nurse:Telephone:Hospital consultant:Telephone:GP / Practice hone:BD, BD Logo and all other trademarks are the property of Becton, Dickinson and Company. 2005 BD. Franklin Lakes, NJ 0741720
Notes21
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Becton Dickinson Canada Inc.Oakville, ON L6H 6R51.800.268.5430# ID1105Ewww.BDdiabetes.com
This “Getting Started with Insulin Injections” booklet aims to help you with practical information about insulin injections and good injection technique. It will . discrete size and easy 1 unit adjustment. 0.5 ml insulin syringes These syringes are graduated in 1-unit intervals and are ideal for doses between 30 units and 50
Appendix D: Insulin Pump Order Form Appendix E: S.C. Insulin Pump Order Form Appendix F (a): Home Insulin Doses on Injections – Basal/Bolus Regimen Appendix F (b): Homes Insulin Doses on Injections - Sliding Scale/Pre-Mixed Appendix F (c): Home Insulin Does on Pump
Multiple Daily Injections vs. Insulin Pump Insulin Absorption Long-acting insulin absorption may vary 10-52% -Unpredictable. -Tight control very difficult. Fast-acting insulin absorption varies less than 3% -Very predictable. -Allows for tighter control. 3 injections: NPH N at bkfst N at supper NPH at bedtime Without diabetes .
Insulin NPH and insulin regular (HumuLIN 70/30) Insulin NPH and insulin regular (NovoLIN 70/30) Concentrated insulin Insulin regular (HumuLIN R U-500) 11. Please select the statement(s) that best describe(s) the distribution of insulin used for subcutaneous admi
humalog mix 75/25 kwikpen humulin 70/30 humulin 70/30 kwikpen humulin n humulin n kwikpen humulin r humulin r u-500 (onentrated) humulin r u-500 kwikpen insulin aspart insulin aspart flexpen insulin aspart penfill insulin aspart protamine/insulin aspart insulin aspart protamine/insulin aspart flexpen insu
to the top of an insulin vial to help users draw insulin into a syringe by increasing stability. To use, open the lid, insert the needle and syringe into the cap, draw the insulin, and then remove the needle from the cap for injection. Available in blue and orange, to help distinguish different types of insulin. Securitee Blanket (regato .
1. Which are the necessary supplies needed for an insulin injection by pen? Select all that apply. A. Alcohol swab B. Insulin vial C. Pen needle D. Syringe E. Blood glucose meter 2. Which are the necessary supplies needed for an insulin injection by syringe? Select all that apply. A. Pen needle B. Syringe C. Scissors D. Insulin vial E. Alcohol .
However, few evidence-based guidelines for IM injections are available, and discrepancies within nursing textbooks have been noted. 10-13 In addition, current guidelines do not address administration of large-volume injections. The dorsogluteal site for IM injections is the one nurses have the most experience using, as this is what is tradi-File Size: 256KBPage Count: 6Explore furtherLarge-volume IM injections: A review of best practices .www.oncologynurseadvisor.comInjection Safety CDCwww.cdc.govGUIDELINES ON THE ADMINISTRATION OF INTRAMUSCULAR www.olchc.ieSECTION 20: PEDIATRICS: Medication: Intramuscular .www.vnhcsb.orgIntramuscular injection: Locations and administrationwww.medicalnewstoday.comRecommended to you b
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