Give Yourself Insulin

Nearly three million people in the United States use insulin to treat either type 1 or type 2 diabetes.. In people with diabetes, the pancreas does not produce enough insulin to manage the carbohydrates, sugars, fats, and proteins in your diet. The use of insulin in people that suffer from type 1 diabetes is an absolute necessity in order to sustain life. Many people with type 2 diabetes often reach a point where medication, diet, and exercise, are not enough to control blood sugar levels, and begin a regimen that includes insulin administration. The correct administration of insulin takes a solid understanding of the type of insulin you are using, your method of administration, and a commitment to follow recommended safety precautions to prevent harm or injury. Consult with your doctor for a thorough demonstration before attempting to administer insulin.

Steps

Monitoring Your Blood Glucose Levels

1. Check your blood glucose level. Follow the same procedure each time to check and document your blood glucose levels.
   • Wash your hands thoroughly with soap and water, and dry them with a clean towel.
   • Insert a test strip into your blood glucose meter device.
   • Use your lancet device to obtain a small drop of blood from the fleshy part of your finger.
   • Some newer devices can obtain a droplet from other areas such as your forearm, thigh, or fleshy areas on your hand.
   • Refer to the user manual to proceed properly according to the way your device works. Most devices are spring loaded that help to reduce the pain of pricking your skin.
   • Allow the blood droplet to contact the test strip at the indicated place either before or after it is inserted in the meter, again depending on the way your device works.
   • Your blood glucose level will appear in the window of your device. Record your blood glucose level on your log, along with the time of day you checked it.
2. Keep a log. Checking your blood glucose is the primary tool for both you and your doctor to use in determining the most appropriate dose of insulin you need.
   • By keeping a log of your blood glucose levels, and other variables such as alterations in your diet or additional injections prior to meals or special events where you will consume sugary foods, your doctor can help to improve the control of your diabetes.
   • Take the log with you to each appointment for your doctor to review.
3. Compare your level to the target range. Your doctor or diabetic healthcare provider advise you on the targets for your blood glucose levels specific to your condition.
   • General target ranges include 80 to 130mg/dl if taken before a meal, and less than 180mg/dl if taken one to two hours after a meal.
   • Remember that monitoring your blood glucose levels are extremely helpful in tailoring your overall treatment plan, but they are not a judgment of how well you are taking care of your condition. Do not let the results frustrate you.
   • Talk to your doctor if your levels are consistently higher than recommended so you and your doctor can adjust your insulin dose accordingly.

Giving Yourself Insulin Using a Syringe

1. Gather your supplies. Insulin administration using a syringe and needle is still one of the most common methods people use to take their insulin.
   • Start by making sure you have everything you need, including your insulin syringe and needle, alcohol pads, the insulin, and a sharps container nearby.
   • Remove the insulin vial from the refrigerator about 30 minutes before it is time for your dose to allow the insulin to reach room temperature.
   • Check the dating on your insulin vial before you proceed. Do not use expired insulin or insulin that has been opened for more than 28 days.
2. Wash your hands thoroughly with soap and water. Dry them completely with a clean towel.
   • Be sure your injection site is clean and dry. Clean the area with soap and water if needed before you begin.
   • Avoid wiping the area with alcohol. If you do wipe the area with alcohol, give the area time to air dry before you administer the dose.
3. Inspect your insulin. Many people use more than one type of insulin. Look carefully at the label to be sure you have the correct product for the scheduled dose.
   • If the insulin vial is in a container or has a cover, remove it and carefully wipe the bottle with an alcohol wipe. Let the bottle air dry, and do not blow on it.
   • Inspect the liquid inside. Check for any visible clumps or particles floating inside the vial. Be sure the vial is not cracked or damaged.
   • Insulins that are clear should not be shaken or rolled. As long as they remain clear they can be given without mixing.
   • Some types of insulin are naturally cloudy. Cloudy insulins should be gently rolled between your hands to mix them properly. Do not shake the insulin.
4. Fill the syringe. Know the dose you need to administer. Remove the cap from the needle, taking care not to touch the needle with your fingers or to any surface in order to keep it sterile.
   • Pull back the plunger of the syringe to the same mark as the amount of insulin you intend to remove from the vial.
   • Push the needle through the top of the vial, and push the plunger to inject the amount of air you just put in the syringe.
   • Keeping the needle in the vial and the syringe as straight as possible, turn the bottle upside down.
   • Hold the vial and syringe in one hand, and gently pull back on the plunger to withdraw the exact amount of insulin needed with the other.
   • Check the liquid in the syringe for air bubbles. With the needle still inside the vial and still holding it upside down, gently tap the syringe to move air bubbles to the top part of the syringe. Push the air back into the vial, and withdraw more insulin if needed to be sure you have the correct amount in the syringe.
   • Carefully pull the needle from the bottle, and place the syringe on a clean surface without allowing the needle to touch anything.
5. Avoid putting more than one type of insulin in a single syringe. Many people use different types of insulin to cover their blood sugar needs for a longer period of time.
   • If you use more than one type of insulin for each injection, the insulins must be drawn up into the syringe in a specific order and according to your doctor’s instructions.
   • If your doctor has instructed you to use more than one type of insulin at a single injection, draw the insulins up exactly as your doctor directed.
   • Be sure you know the the amount of each insulin you need, which product to put in the syringe first, and the total amount of insulin that should be in the syringe when you are finished drawing up both insulins.
   • The shorter acting insulin product, which is clear, is drawn into the syringe first, followed by the longer acting product, which is cloudy. You should always go from clear to cloudy when mixing the insulin.
6. Give your injection. Avoid scars and moles by one inch, and do not give insulin within two inches of your navel.
   • Avoid bruised areas or areas that are swollen or tender.
7. Pinch the skin. The insulin is to be administered into the fat layer just under the surface of the skin. This is called a subcutaneous injection. Creating skin folds by gently pinching the skin helps to prevent injecting into muscle tissue.
   • Insert the needle at either a 45 degree or 90 degree angle. The angle of the needle insertion depends on the injection site, the thickness of the skin, and the length of the needle.
   • In some cases where the skin or fatty tissue is thicker, you may be able to insert the needle at a 90 degree angle.
   • Your doctor or diabetic healthcare provider will guide you in understanding the areas on your body that should be pinched and the angle of insertion for each injection site.
8. Inject your dose using a quick dart-like motion. Push the needle all the way into the skin and slowly push the plunger of the syringe to deliver your dose. Be sure the plunger is completely depressed.
   • Leave the needle in place for five seconds after injecting, then pull the needle out of the skin at the same angle it went in.
   • Release the skin fold. In some cases, diabetic healthcare providers recommend releasing the skin fold just after needle entry. Talk to your doctor about your insulin injections specific to your body.
   • Sometimes insulin leaks from the injection site. If this is the case with you, then gently press the site for several seconds. If this problem continues, talk to your doctor.
9. Place the needle and syringe into a sharps container. Keep the sharps container in a safe place away from children and pets.
   • Both needles and syringes are only to be used once.
   • Each time a needle punctures the top of the vial and the skin, the needle becomes dulled. Dulled needles cause more pain, plus they carry a much greater risk of infection.

Using a Pen Device to Inject Insulin

1. Prime the pen device. Allowing a few drops of insulin to drop from the needle tip ensures there are no air bubbles and nothing is obstructing the flow of insulin.
   • Once your pen is ready to use, dial the dose you need to administer.
   • Using a fresh needle, a primed device, and the correct dose dialed on the pen device, you are ready to administer the injection.
   • Follow your doctor's instructions on pinching the skin and the angle of entry in order to more effectively administer the insulin.
2. Administer the insulin. Once you have pushed the thumb button completely in, count slowly to ten before withdrawing the needle.
   • If you are administering a larger dose, your doctor or diabetic healthcare provider may instruct you to count beyond ten to ensure the dose is properly delivered.
   • Counting to ten or beyond ensures that you get the full dose intended and helps to prevent leakage from the injection site when you withdraw the needle.
3. Use your pen only for your own injections. Insulin pens and cartridges should not be shared.
   • Even with fresh needles, there is still a significant risk of transferring skin cells, disease, or infection from one person to another.
4. Dispose of your used needle. As soon as you have given yourself the injection, promptly remove and discard the needle.
   • Do not leave the needle attached to the pen. Removing the needle prevents insulin from leaking from the pen.
   • Removing the needle also prevents air and other contaminants from entering the pen.
   • Always discard used needles appropriately by placing them in a sharps container.

Rotating Your Injection Sites

1. Keep a chart. Many people find it helpful to keep a chart of the sites as they are used so they can routinely rotate their injection sites.
   • The areas of your body that are most suitable for insulin injections include the abdomen, the thigh, and the buttocks. The upper arm area can also be used if enough fatty tissue is present.
2. Rotate your injections clockwise at each site. Develop a system that works for you to consistently rotate your injection sites. Continue to move around your body using new sites for each injection.
   • Using a clockwise strategy is helpful for many people to help rotate their injection sites.
   • Use a chart or drawing of your body areas to identify the sites you just used or are planning to use. Your diabetic healthcare provider or doctor can help you develop a system to rotate your injection sites.
   • Inject into your abdomen, two inches away from your navel and not too far towards your sides. Looking into a mirror, begin on the upper left of the injection area, move next to the upper right area, then lower right, then lower left.
   • Move to your thighs. Begin closest to your upper body, then move the next injection site further down.
   • In your buttocks, start with your left side and closer to your side, then move towards your midline, then to the right side and towards the midline, then to the areas closer to your right side.
   • If your arms are appropriate according to your doctor or healthcare provider, move systematically either up or down with injection sites in those areas.
   • Keep track of the sites as you use them in a systematic manner.
3. Minimize the pain. One way to help minimize the pain upon injection is to avoid injections at hair roots.
   • Use needles with shorter lengths and smaller diameters. Shorter needles help to minimize the pain and are appropriate for most people.
   • Acceptable shorter needle lengths include those that are either 4.5 mm, 5 mm, or 6 mm in length.
4. Pinch your skin properly. Some injection sites or needle lengths work best if you gently pinch the skin to create skin folds.
   • Use only the thumb and index finger to lift the skin. Using more of your hand causes muscle tissue to be lifted and increases the risk of injecting your insulin into muscle tissue.
   • Do not squeeze the skin fold. Gently hold the skin in place to give the injection. Squeezing tightly can cause more pain and possibly interfere with the dose delivery.
5. Choose the best needle length for you. Shorter needles are appropriate for most patients, can be easier to use, and are less painful. Consult with your doctor about which needle is appropriate for you.
   • The purpose of using shorter needles, pinching the skin, and injecting at a 45 degree angle is to avoid injecting the insulin into muscle tissue.
   • Consider the need to use skin folds as you rotate your injection sites. Injecting into areas with thinner skin layers and more muscle tissue often require pinching the skin and injecting at an angle.
   • Talk to your doctor or diabetic healthcare provider for instruction on the areas of your body that would need for the skin to be pinched to create skin folds even when using the shorter needle lengths.
   • In many cases, there is no need to lift or pinch the skin when using the shorter needles.
   • Injections with the shorter needles can often be given at a 90 degree angle when there is enough fatty tissue present at the injection site.

Using Other Methods to Administer Insulin

1. Consider using an insulin pump. Insulin pumps consist of a small catheter inserted into your skin with a small needle, which is held in place with an adhesive dressing. The catheter is attached to a pump device unit that holds, and delivers your insulin through the catheter. Using pumps have both advantages and disadvantages. Some advantages to using an insulin pump include the following:
   • Pumps eliminate the need for insulin injections.
   • Insulin doses are more accurately delivered.
   • Pumps often improve the longer term management of diabetes as indicated by blood level measurements of your hemoglobin A1c.
   • Pumps provide constant insulin delivery in some cases which eliminates the swings in your blood glucose levels.
   • They make it easier to deliver an extra dose when needed.
   • People that use pumps have fewer hypoglycemic episodes.
   • Pumps allow more flexibility in when and what you eat, and allow you to exercise without the need to consume extra carbohydrates.
2. Recognize the disadvantages of insulin pumps. According to the American Diabetes Association, even though there are disadvantages to using an insulin pump, most people that use one agree that the positives outweigh the negatives. Some disadvantages to using an insulin pump include the following:
   • Pumps are reported to cause weight gain.
   • Serious reactions including diabetic ketoacidosis can occur if the catheter unknowingly becomes dislodged,
   • Insulin pumps can be expensive.
   • Some people find it troubling to be connected to the device, which is usually worn on a belt or top of a skirt or pants, practically all the time.
   • Insulin pumps often require hospitalization for a day or more for the catheter to be inserted, and for you to be properly trained on how to use it.
3. Adjust to your pump. Using an insulin pump alters your daily routines.
   • Develop a routine to limit the time you turn it off, or take it off.
   • Have back-up pens or insulin vials and syringes available if the pump is not working properly.
   • Learn to account for extra carbohydrates consumed in order to adjust the dose delivered through your pump.
   • Keep accurate records of your blood glucose levels. Daily records with additional notes of exercise times and extra foods consumed are best. Some people record information three days each week, spread out through the week, to provide a good balance of information.
   • Your doctor will use your logs to adjust your insulin dosing and improve the overall care of your condition. Usually about three months of of average blood sugar levels will give your doctor a good idea of how well your diabetes is controlled.
4. Ask your doctor about a jet injector. Insulin jet injectors do not use needles to get the insulin dose through the skin. Instead, insulin jet injectors use strong air pressure, or blasts of air, to spray the insulin through your skin.
   • Jet injectors are very expensive and somewhat complicated to use. This form of technology is new. Talk with your doctor if you are considering this method of delivering your insulin dose.
   • In addition to their high cost, some risks have been identified such as improper dose delivery and trauma to the skin.
   • Research is ongoing to determine the risks and benefits of administering insulin in this manner.
5. Use inhaled insulin devices. Some forms of rapid-acting insulin are now available in the form of inhalers, similar to the inhalers used to treat asthma.
   • Inhaled insulin is to be administered just before meals.
   • You will still need to administer your primary long-acting insulin by another method.
   • Several manufacturers have made insulin inhalers available in the United States, but the research in this area is ongoing. Much is still to be learned about the risks and benefits of using insulin by the inhaled method.

Following Recommended Safety Precautions

1. Ask your doctor for a demonstration. Do not rely on articles or videos online to teach you how to administer insulin, whether it's via a syringe, inhaler, or another device. Your doctor can answer any questions and show you the correct way to use your device (for instance, with shots she will need to show you at which angle you should insert the needle). Your doctor will also give you your exact dosage and all the necessary prescriptions.
2. Avoid using any insulin product if you are allergic. Seek medical attention immediately if you experience an allergic reaction.
   • Some insulins are derived from animal sources, most commonly pork, and may cause allergic reactions in people that have severe allergies.
   • Common allergic reactions to insulin include local and systemic reactions. Local reactions occur as redness, minor swelling, and itching at the injection site. This type of skin reaction resolves in a few days to weeks.
   • Systemic allergic reactions can present as a rash or hives that covers large portions of the body, difficulty breathing, shortness of breath, wheezing, decreased blood pressure, increased heart rate, and sweating. This is a medical emergency and you should call 911 or have someone take you to the emergency room if it is close by.
3. Do not administer insulin if you are having a hypoglycemic event. Hypoglycemia occurs when your blood sugar level is too low. Insulin will make hypoglycemia worse; instead, you will need to consumer quick-acting carbohydrates or simple sugars.
   • Low blood sugar interferes with your brain’s ability to function properly.
   • Symptoms of hypoglycemia can include dizziness, trembling, headache, blurred vision, having trouble concentrating, confusion, and sometimes trouble with speaking. Other symptoms can include tremor, heavy sweating, increased heart rate, feeling anxious, and hunger.</ref>
   • Using fast-acting insulin in the midst of a hypoglycemic event will quickly drop your blood sugar even further and result in severe confusion, inability to communicate, and loss of consciousness.
   • If you mistakenly administer insulin when you are having a hypoglycemic event, quickly alert friends or family to seek medical attention, or call 911 if you are alone. Severe hypoglycemia events are serious and life-threatening situations.
   • You can begin to reverse the reaction by drinking orange juice, taking prepared glucose tablets or gel, or quickly begin to consume some form of sugar.
4. Monitor your skin for lipodystrophy. Lipodystrophy is a reaction that sometimes occurs on the skin where frequent insulin injections are given.
   • Symptoms of lipodystrophy include changes in the fatty tissues just under the surface of the skin. Unwanted changes that indicate lipodystrophy include both thickening and thinning of the fatty tissue in the injection site areas.
   • Check your skin regularly for lipodystrophy as well as inflammation, swelling, or any signs of infection.
5. Discard used needles properly. Never put syringes or needles in the regular trash.
   • Sharps, including used needles, lancets, and syringes, are considered to be biohazardous waste since they came in direct contact with someone's skin or blood.
   • Always dispose of needles that are used or damaged in a sharps container. Sharps containers are designed to be a safe way to dispose of syringes and needles.
   • Sharps containers are available for purchase at your local pharmacy, or online.
   • Review your state’s biohazardous waste guidelines. Many states have specific recommendations and programs that can help you develop a regular system for disposing of biohazardous waste.
   • Work with a mail back kit. Some companies offer to supply you with the appropriate sizes of sharps containers, and agree to set up an arrangement for you to safely mail those containers back to them when they are full. The company will dispose of the biohazard materials appropriately, according to EPA, FDA, and state requirements.
6. Never re-use or share a needle. Once the injection has been given, discard the needle and syringe in a sharps container. When an insulin pen is empty, discard the device in the sharps container.
   • A needle that has pierced your skin, or the skin of someone else, is not only dulled, but contaminated with possibly serious and contagious diseases.
7. Do not change insulin brands. Some insulin products are very similar but not exact. Talk to your doctor before you make any changes in your insulin regimen, including switching brands.
   • Even though some brands are similar, your doctor has chosen the brand that best suits your needs, and your dose has been adjusted to the way that product reacts in your body.
   • Use the same brand of syringes and needles. It is easy to become confused and administer the wrong amount if the syringes and needles look different.
8. Never use insulin that has expired. Check the expiration date on your insulin product often. Avoid using insulin that has passed its expiration date.
   • While the potency may be close to the potency when purchased, there is a risk that you will not get enough from using products that have expired, contaminants may be present, or particles may have formed inside the vial.
9. Discard insulin that has been open for 28 days. Once the first dose has been used from an insulin product, it is considered open.
   • This includes insulin that has been properly stored in the refrigerator or at room temperature. Since the top of the insulin vial has been punctured, there is an increased risk of contaminants inside the vial, even if you have stored it properly.
10. Know your products and your dose. Be familiar with the brand of insulin you use, your dose, and the brand of additional supplies you use.
    • Be sure you consistently use the same size insulin syringes and needles that were prescribed for you.
    • Using a U-100 syringe in place of a U-500 syringe can be extremely dangerous, and vice versa.
    • Talk to your doctor or diabetic healthcare provider if you notice any changes in your products or have any questions.

Related Articles

• Understand the Difference Between Type 1 and Type 2 Diabetes
• Give Insulin Shots
• Give Glucose to a Diabetic
• Fill a Syringe

Sources and Citations

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