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Posts Tagged ‘Insulin Administration’

The Basics on Insulin Administration. By Our Student Pharmacist, RJ Rosia.

Insulin injections can be confusing and dangerous if you are unsure on how to properly give the injection. Insulin is a very effective medicine to lower blood sugar for people with diabetes. Because it works so well, however, there are some risks with using insulin.

Having too much insulin can lower your sugar levels below the desired amount and can cause you to not feel like yourself.

Symptoms of low blood sugar are:

  • dizziness
  • shakiness
  • mood swings
  • increased hunger

Because of these symptoms, it is important that everyone knows how to use their insulin correctly to help limit these symptoms from happening.

Injection technique:

It is important to inject insulin under the skin and to not inject directly into the muscle. Pinching the skin can help with making sure the needle does not reach all the way to the muscle.

The best areas to inject are:

  • the abdomen area around the belly button
  • the thighs
  • the back of the upper arms

Make sure to rotate injection sites so the area doesn’t become too sore from multiple injections.

 

You can inject directly at a 90-degree angle as long as the needle length is short enough. Some needles are very short and don’t require pinching of the skin.

A new needle or syringe should be used with every injection. Reusing the same needle can cause the injection to hurt more. The needle is also no longer sterile after being used once.

Having a sharps container at home is also a great way to prevent needles from poking people. These containers can be bought at most drug stores. Another option for a homemade sharps container is to use an old milk jug or laundry detergent bottle to discard the used needles.

Once the sharps container becomes full, it can be sealed with tape and labeled SHARPS and can be placed in the normal garbage in Franklin county.

Steps to inject using vials:

  • Wash hands before starting.

  • Roll bottle if necessary (cloudy insulin).

  • Use an alcohol swab to clean the top of the vial every time it is used.

  • Using the syringe plunger, pull back the desired number of units before the needle is put into the top of the vial.

  • Place the needle into the vial. Go straight into the vial, not at an angle.

  • Push the plunger down to inject the air from the syringe, then pull back the desired amount of insulin.

  • Once the syringe is at the correct amount, remove from the vial. Make sure to remove air bubbles. Usually a tap at the end of the syringe can help remove any bubbles.

  • Use an alcohol swab on the site you are injecting. Pinch the skin and inject the insulin.

  • Once all of the insulin is injected, remove the needle and dispose of it in a sharps container.

Steps to inject using pens:

  • Wash hands before starting.

  • Remove cap from insulin pen and wipe the stopper at the end with an alcohol swab.

  • Take out a new pen needle and attach it to the end while screwing the needle into place.

  • Remove the outer shell around the needle.

  • Prime the insulin pen accordingly to make sure insulin is coming out of the needle.

  • Dial the insulin dose desired and wipe the area you plan to inject with an alcohol swab.

  • Inject the insulin under the skin and hold for about 10 seconds to make sure the full dose has been given.

  • Once the injection is complete, place the cap back on the needle and remove. Then place into a sharps container.

Types of insulin:

There are many different types of insulin available and each one works slightly differently depending on when the insulin releases in your body. It is important to take the correct insulin dose at the correct times or there is a chance that your blood sugar could go too low.

Rapid acting insulin works very quickly, within 15 minutes, and lasts for about three hours. This type of insulin is taken before a meal. This insulin is also called “bolus insulin”.

 Products available are:

  • Humalog, Admelog (insulin lispro)

  • Novolog, Fiasp (insulin aspart)

  • Apidra (insulin glulisine)

Long-acting insulin provides insulin coverage for 24 hours and can be given one or two times a day. This insulin starts to take effect in about two hours and maintains a steady supply of insulin throughout the day. This insulin is also called “basal insulin”.

Products available are:

  • Lantus, Basaglar (insulin glargine)

  • Levemir (insulin detemir)

  • Tresiba (insulin degludec)

Short-acting insulin works similarly to rapid-acting, although it lasts for a little longer in the body. This insulin starts to take effect 30 minutes after injecting and can last up to six hours, but the peak of effect is about 2-3 hours after injection.

Products available are:

  • Humulin R (insulin regular)

  • Novolin R (insulin regular)

Intermediate-acting insulin works like long-acting, but does not last the whole day. Two doses are usually needed throughout the day. This insulin lasts for about 10-16 hours.

Products available are:

  • Humulin N (insulin NPH)

  • Novolin N (insulin NPH)

Pre-mixed insulin has a combination of two different types within one vial or pen. Pre-mixed insulin contains fast-acting as well as intermediate-acting in a fixed ratio. A patient usually take two doses a day, before breakfast and dinner.

Products available are:

  • Novolog Mix 70/30

  • Novolin Mix 70/30

  • Humalog Mix 75/25 and 50/50

  • Humulin Mix 70/30 and 50/50

Storage:

Insulin pens and vials should remain in the fridge until they are ready to be used. Once a vial or pen is in use, it is okay to leave it out of the fridge, but it must be used within 28 days or it will expire and not be safe to use (Levemir lasts up to 42 days once it has been punctured).

Do not leave pens or vials in areas where they can get hot, such as your car or outside in warm weather. Do not freeze them.

When to use each one?

Fast acting insulin should be taken before food following the directions from your prescriber.

Long-acting insulin can be taken either in the morning or at bedtime.

The premixed insulins should be taken before breakfast AND before dinner to get complete coverage throughout the day.

If you have any more questions or concerns about insulin, you can always stop by your local pharmacy and a pharmacist or intern can help you with the best way to administer the insulin.

There are also other medications that help lower your blood sugar. Talking to your doctor about the different options available is the first step to controlling diabetes.

References: 

https://www.bd.com/resource.aspx?IDX=11020&CMP=PIG

https://www.diabete.qc.ca/en/living-with-diabetes/care-and-treatment/drugs-and-insulin/all-about-injections/

http://archives.diabetesforecast.org/2018/06-nov-dec/how-to-properly-inject.html

Pictures:

https://www.diabete.qc.ca/en/living-with-diabetes/care-and-treatment/drugs-and-insulin/all-about-injections/

http://ddi.ucsd.edu/learn/terminology.html