Insulin Injection Tips

According to The Diabetes, Attitudes, Wishes and Needs (DAWN) study, resistance to starting insulin therapy is a major problem among patients and providers/physicians. The DAWN study revealed insulin therapy begins later in U.S. that most other countries.

Why do people avoid using insulin?

Patients may feel that insulin therapy indicates a failure, or may also worry about hypoglycemia, injection pain, weight gain and inconvenience. Providers, on the other hand, may feel they lack adequate resources and time to optimize insulin therapy.

The importance of insulin

Type 2 diabetes is a progressive disease that results in a progressive decline of beta cell (cells in the pancreas that produce insulin) function. Most people with type 2 diabetes will eventually require insulin therapy.

Insulin can be administered in three different ways: injection, insulin pump or inhaled. Of the three methods, injection is the most common. Insulin injections are given using either an insulin syringe or insulin pen.

Meeting with a certified diabetes educator (CDE) is a great way to learn how to properly give an insulin injection and to ease some of the fears/concerns you may have prior to starting insulin therapy.

Tips for insulin injections

The focus of this article is on insulin injections. Proper insulin injection technique is vital to optimize blood glucose control, reduce discomfort, minimize infection and prevent scar tissue from developing.

Where can you give an insulin injection?

• Abdomen (the abdomen is the area were insulin is absorbed the fastest and most predictable)
• Back of the upper arms
• Upper buttocks or hips
• Outer portion of the thighs
• Areas to avoid: 2 inches around the navel, scar tissue, and moles (skin can be tougher in those areas resulting in unpredictable insulin absorption)

Before you give an insulin injection...

• Wash your hands with soap and water
• Clean injection site with rubbing alcohol
• Clean off insulin vial or top of insulin pen with rubbing alcohol
• Inspect insulin to make sure it is not cloudy (unless you are using NPH) and there are no particles
• Check expiration date
• Ensure that you are using the correct insulin (this is especially pertinent to those who use more than one type of insulin to manage their diabetes).
• Double check your dose to ensure you are giving the accurate amount. If a family member or friend is available, ask them to double check.

Tips on injection technique

For specific guidelines and demonstration on drawing up insulin from a vial or how to use an insulin pen, ask your doctor to meet with a Certified Diabetes Educator.

• In preparation for injection, both insulin syringes and insulin pens should be primed with 2 units of insulin. This will avoid injecting air (injecting air will result in a portion of the insulin dose not be received, thus, likely causing hyperglycemia).
• Insulin should be injected into the subcutaneous tissue (layer of fat just below the skin). If insulin is injected into the muscle, the injection will be more painful and the insulin will be absorbed faster. This may result in hypoglycemia.
• Once insulin has been injected, hold needle under skin for 8 to 10 seconds with finger on plunger to ensure full dose is delivered. Then slowly remove needle from skin.

Can I reuse insulin syringes or pen needle tips?

Per the FDA, insulin syringes and pen needle tips are for single use only. Repeated use of the same insulin syringe or pen needle tip increases the risk of contamination and increasing the risk of infection. Repeated use of the same insulin syringe or pen needle tip will dull the needle making injections more painful.

Tips for reducing injection discomfort

• If rubbing alcohol is used to clean skin, make sure alcohol has dried before giving injection
• Use room temperature insulin
• Use the thinnest needle and shortest needle possible
  • Needle thickness is measured by gauge. The larger the number, the thinner the needle.
  • Needles sizes come in variable lengths from 4 mm to > 12 mm
    • According to the International Scientific Advisory Board: There is no medical reason to use a needle longer than 8 mm.
  • Avoid intramuscular injections by using the shortest needle possible
  • Do not reuse syringes or pen needle tips

Tips for avoiding lipohypertrophy

Lipohypertrophy is the most common local complication of insulin use. It is a build up of fat that feels like grapes under the skin. Lipohypertrophy has been linked to poor blood sugar control and may reduce insulin absorption by as much as 25 percent.

• Rotate injection sites
• Use a new syringe or pen needle tip with each injection. 

Tips on storing insulin

Unopened insulin should be refrigerated at 36 to 46 degrees Fahrenheit. It is good until the printed expiration date on the insulin box. Opened insulin can be kept at room temperature (59-86 degrees Fahrenheit) for approximately 1 month (this may vary depending on the type of insulin you use. Make sure to double check with manufacturer). DO NOT expose insulin to extreme temperatures. Freezing, extreme heat or direct sunlight will cause insulin to breakdown thus not working well to lower blood glucose.

Injection helpers

Such aids may be helpful for those with needle anxiety, visual impairment or dexterity problems. Below is an abbreviated list of some products on the market.

• Count-A-Dose (Prodigy)
  • Allows persons with visual impairment to fill syringe safely and accurately
• Magni-Guide (BD)
  • Plastic tube fits over syringe to magnify its markings and helps hold the syringe and vial together while drawing insulin
• Injection Safety Guard (Apothecary)
• • Fits over the cap of an insulin vial to prevent accidental needle sticks
• Securitee Blanket
  • Insulin vial protector that fits around insulin vial making it easier to grip
• I-port Advance (Medtronic)
  • Injection aid that minimizes the number of needle injections
• Autoject 2 (Owen Mumford)
  • Auto-injector device for a variety of syringes. Users deliver insulin with a single button push without having to see a needle.
• Shotblocker (Bionix Medical Technologies)
  • Reducing injection site discomfort

Have you recently started insulin therapy?  Please share your experience with the type2diabetes.com community!