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Drawing Up Insulin And Insulin Injections

Published:
6-April-2005

Tips for giving a child shots

By H. Peter Chase, M.D.

Where To Inject The Insulin

Insulin is injected into the fat layer beneath the skin. Proper techniques must be learned so that the insulin is not injected too close to the outer skin (which may cause a lump, pain, or a red spot) or too deep into the muscle (which may cause pain or the insulin to be absorbed too quickly). The only problem if this were to ever happen would be that the insulin would last only a matter of minutes rather than hours. Also it is not true that injecting a bubble of air into someone (even into an artery or vein) would harm them. These are common, but unnecessary worries.

Injection Sites

The best places to give insulin are the abdomen, arms, thighs, and buttocks. Rotation of the insulin sites used to be a frequent area of conflict between parents and children. It is now possible to select two or three of the usual four areas for injections and to skip areas that are not well tolerated. Injections should be moved around within the sites that are used. If there are swollen (hypertrophied) areas, injections should not be given to those sites, as the insulin may be absorbed at a different rate.

Insulin is absorbed more rapidly from the abdomen than from the arm, and more rapidly from the arm than from the thigh or buttock. However, the differences are not great for most people. Some people who do notice a difference will use one site for morning shots and another site for dinner shots. For example, the abdomen or arm might be used in the morning when more rapid insulin uptake is desired. The thigh or buttock may be used in the evening when less rapid insulin uptake is desired so that the insulin will last through the night.

There is some increase in uptake of insulin when a shot is given in an area that is then exercised. Injecting into an arm or leg which will be used in an activity may result in low blood sugars during exercise. Therefore, if you are to play tennis, don't inject into the arm that will be used to swing the racquet. More blood will go to this arm during the exercise and more insulin will be absorbed into the blood. A low blood sugar could occur.

Insulin should not be injected just prior to a bath, shower, or hot tub. The warm water will draw more blood to the skin, causing a rapid absorption and resulting in a serious low blood sugar.

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Drawing Up The Insulin

  • Get everything together: alcohol, cotton, insulin, and a syringe.
  • Wash your hands.
  • Push the plunger of the disposable syringe up and down before drawing in the insulin. This will help soften the rubber at the end of the plunger and smooth the plunger action.
  • Wipe the top of the insulin bottle(s) with alcohol.
  • Before you insert the needle into the bottle, draw back the plunger to the number of units of long acting (cloudy) insulin to be used.
  • Insert the needle through the rubber top of the bottle of long acting insulin with the bottle right-side-up on a counter. Inject the same number of units of air as the number of units of insulin to be drawn out. It can remain sitting upright on the counter while the air is injected. Do not bubble air through the insulin. If you are using more than one type of insulin, always remember to inject air into the bottle of cloudy/long-acting insulin first . Then, remove the needle from the bottle.
  • Next, draw back the same number of units of air as the amount of Regular and/or Humalog insulin to be drawn from the bottle. Insert the needle and inject the air into the bottle of short-acting insulin. Prior to this point you have not drawn any insulin into the syringe.
  • If both Regular and/or Humalog Insulin are to be drawn up, either can go into the syringe first (but both should go in prior to the long-acting insulin).
  • Turn the bottle upside down and withdraw the amount of clear/short-acting insulin needed. You may have to push the insulin back into the bottle several times to remove air bubbles. (If you are using more than one type of insulin, do this only with the first insulin) To get the correct dose, align the top edge (the very end) of the rubber plunger tip with the desired mark on the syringe. Air bubbles can change the insulin dose but will not harm your body. By drawing the short-acting insulin into the syringe first, you will prevent a drop of the cloudy/long-acting insulin from getting into the bottle of short-acting insulin. If a bottle of short-acting insulin does become cloudy, throw it out.
  • Turn the bottle of cloudy/long-acting insulin gently up and down with 10-12 twists of the wrist to thoroughly mix. This must be done even if the cloudy insulin was mixed at the beginning. Some settling of the insulin occurs in this short time. This could result in some difference in the concentration of the insulin.
  • Insert the needle into the bottle of long-acting insulin, turn the bottle upside down, and carefully withdraw the amount desired, again aligning the top edge (the very end) of the plunger with the desired dosage mark on the syringe. Know the total amount of the two or more insulins so that you will know the right point to stop on the syringe. Many people make mistakes in adding, so you should double-check this total.

Blood sugars should be watched carefully when the insulin bottle is almost empty. If the blood sugars start to be unusually high or low, the last bit of insulin should be discarded.

In summary, BE PRECISE ABOUT THE DOSAGE. An overdose can cause an insulin reaction or low blood sugar. If you ever give an incorrect dose, be sure to notify your diabetes care provider.

How To Inject The Insulin

  • Choose the injection site. Use a good site rotation plan.
  • Make sure the site is clean.
  • Pinch the skin and fat tissue between the thumb and first finger. It is generally best to push the needle all the way into the skin. If the needle is not in far enough, the insulin may not be injected into the fatty layer. If it goes into the layer directly under the skin rather than the fatty layer, it will sting and may cause a bump or redness and itching. Let go of the pinched tissue before injecting the insulin , or you will be squeezing the insulin out at the same time you are trying to inject it. This is one of the most common reasons for a drop of insulin leaking from the injection site (leak back). After you let go of the pinch, check again to make sure the needle is still all the way in.
  • Inject the insulin by pushing the plunger down with a SLOW and steady push as far as it will go. AFTER THE INSULIN IS IN, WAIT FIVE TO TEN SECONDS BEFORE REMOVING THE NEEDLE. COUNT SLOWLY TO FIVE. THIS WILL HELP PREVENT INSULIN FROM LEAKING FROM THE INJECTION SITE. A loss if one drop of insulin may be equal to two to five units. Loss of insulin is a common reason for variation in blood sugar levels.
  • After injection, place a finger or a dry cotton swab over the site of the injection. Hold for a few seconds to prevent any bleeding. Rub the site gently to close the needle track.
  • Observe for a drop of insulin (leak back); note in your record log if a drop of insulin is present.

It is wise to have insulin doses posted on the refrigerator door or some other obvious place to prevent confusion. Children below the age of 10 years do not usually have the fine motor abilities and concern for accuracy to draw up insulin by themselves.

By H. Peter Chase, M.D.
Barbara Davis Center for Childhood Diabetes
Department of Pediatrics