Getting started withInsulin Injections

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Tabl

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sTable of Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . .2

Insulin Injection Devices . . . . . . . . . . . . . . .3

Insulin Syringes

• Choosing a syringe . . . . . . . . . . . . . . . . . . .4

• Preparing a dose of insulin . . . . . . . . . . . . . .5

• Mixing insulin in a syringe . . . . . . . . . . . . . . .7

Insulin Pens

• Preparing a dose of insulin . . . . . . . . . . . . . .9

Injection Technique

• Insulin injection . . . . . . . . . . . . . . . . . . . .11

• Needle length . . . . . . . . . . . . . . . . . . . . .12

• Injection sites . . . . . . . . . . . . . . . . . . . . . .13

Blood Glucose Levels

• Hyperglycemia . . . . . . . . . . . . . . . . . . . . .15

• Hypoglycemia . . . . . . . . . . . . . . . . . . . . . .16

General Recommendations

• Proper needle use . . . . . . . . . . . . . . . . . . .17

• Proper disposal of your sharps . . . . . . . . . . .18

• Insulin care and storage . . . . . . . . . . . . . . .19

Patient Information . . . . . . . . . . . . . . . . .20

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IntroductionIntroduction

This “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.

Your diabetes nurse educatorwill have taken you throughthis “Getting Started withInsulin Injections” bookletexplaining your daily routine,

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.

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Insu

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Dev

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Each device has its own advantages and drawbacks. Ask your healthcare professional for adviceon which device (pen or syringe) best suits you.

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1 - Insulin syringes to beused with insulin vials

2 - Reuseable insulin pensto be used with insulincartridges

3 - Pre-filled insulin pens,these are disposable

Some insulin treatmentscombine an insulin pen for onetype of insulin and an insulinsyringe for another type or mayrequire two insulin pens for twodifferent insulin types.

Note: not all insulin cartridgescan be used with all insulinpens.

Insulin Injection Devices

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InsulinSyinges

Choosing a syringe

Insulin 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 syringe.

• 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.

• 0.5 ml insulin syringesThese syringes are graduated in1-unit intervals and are ideal fordoses between 30 units and 50units.

• 1 ml insulin syringesThese syringes are graduatedin 2-unit intervals and areideal for doses over 50 units.

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Preparing a dose of insulin

Remove the white cap coveringthe plunger, then carefullytwist and remove the orangeneedle cap without touchingthe needle.

Draw air into the syringe equalto the number of units ofinsulin needed.

With the vial standing upright,insert the needle straightthrough the centre of therubber cap of the insulin vialand push the plunger down.

This injects air into the vial,making it easier for you todraw out the insulin.

Using 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.In

sulin

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InsulinSyringes

Hold 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.

Check 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.

Safely dispose of yourneedle and syringe usingthe techniques describedon page 18 of thisbooklet.

Preparing a dose of insulin

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Remove 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.

With 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 fast-acting insulin) vial and injectthe air.

Mixing insulin in a syringeIn

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Syrin

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InsulinSyringes

Hold 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 cloudyintermediate- or long-acting insulinbetween your hands 20 times tomix evenly. Never shake. Insert theneedle straight through the centreof the rubber cap of the cloudyinsulin vial and turn it upside down.Slowly and carefully pull theplunger, until you have the TOTALnumber of units needed (cloudy +clear).

Remove the needle from thevial and perform yourinjection.

Safely dispose of your needleand syringe using thetechniques described on page18 of this booklet.

Mixing insulin in a syringe

When mixing two types of insulin within one syringe, it is important to draw up your clear rapid-acting analogue or fast-acting insulin before your cloudy intermediate-acting insulin.

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.

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Insu

linPe

nsPreparing a dose of insulin

Not all insulin cartridges can be used in all insulin pens (please refer to the insulin manufacturer’sinstructions).

Consult your manual forinstructions on how to properlyrefill your insulin pen. Insert anew insulin cartridge if required(refillable).

Quickly 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.

InsulinPens

Check 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.

Set your dose using the dial andperform your injection.

Preparing a dose of insulin

Always remove the needleafter each injection andsafely dispose of your needleand syringe using thetechniques described on page18 of this booklet.

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Insulin injection

The 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.

Lifting 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.

Proper insulin absorption occurs when it is delivered to the fat layer (subcutaneous tissue) foundbetween your skin (dermis) and your muscle.

Skin (dermis)

Fat layer (subcutaneous tissue)

Muscle

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InjectionTechnique

Needle length

Your healthcare professional can recommend a needle length and injection technique that is mostappropriate for you.

5mm mini 8mm short 12.7mm original

Follow these general recommendations to ensure proper insulin absorption and to avoid anintramuscular injection:

Needle length Choose the right pen needle

5mm 90º without alifted skin fold

8mm 90ºwith alifted skin fold

12.7mm 90ºwith alifted skin fold

Choose 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 up

Choose the BD Ultra-Fine™ III Short Pen Needle if you:• are like most patients – it's a size that's appropriate

for many people

Choose the BD Ultra-Fine™ Original Pen Needle if you:• take large doses of insulin• have dexterity issues

Injection techniquerecommendations

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Injection sites

Rate of insulin absorption varies between injection areas

Amount 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.

AbdomenFastest and mostconsistent rate

Thighs andButtocksSlowest rate

Upper ArmsMedium rate

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Injection sites

The abdomen is the bestarea for insulin absorption.Avoid injecting within twoinches of your belly button.

The 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.

InjectionTechnique

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Hyperglycemia

Changes 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 levels above 11 mmol/L

Causes• Stress from an illness

(e.g. infections, fevers)• Emotional stress (e.g. conflicts with

family, problems at school or work)• Pregnancy• Eating too much food• Not exercising as much as planned• Not enough insulin (type I

diabetes)• Insulin is not effective

(type II diabetes)

First signs• Increased thirst• Urinating more often• Tiredness

Signs 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 abdominal

pain

What to do• Test blood glucose level frequently.• If it is over 13.3 mmol/L, test your

urine for ketones.• If blood glucose is under 13.3

mmol/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.

Bloo

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Hypoglycemia (Low Blood Glucose)Blood glucose levels below 4 mmol/L

Causes• Not eating enough food• Missed or delayed meal• Exercising without taking

precautions• Exercising more than usual• Taking too much insulin

First signs• Sweating• Headache• Heart beating quickly• Hunger• Shakiness, light-headedness and

weakness• Fatigue• Mood changes

Signs of severe low bloodglucose• Confusion or disorientation• Unconsciousness• Seizures

What 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 by

mouth.• Give Glucagon according to package

instructions.

BloodG

lucoseLevels

Hypoglycemia

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Proper needle useG

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Tip damagecaused by re-use

Use needles only once

Thin-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 clothes

Injecting 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.

New needle

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GeneralRecom

mendations

Proper disposal of your sharps

Contact your local garbage removal office or health department for informationon safe disposal. The following guidelines may be helpful:

Remove the needle fromyour syringe or pen using aBD Safe-ClipTM, which storesone year's supply ofneedles.

Never throw used syringes,syringe needles, penneedles or lancets in theregular garbage.

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.

Keep this container away fromchildren.

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).

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.

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Gen

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Insulin care and storage

For 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 destroyed Above 30ºC Insulin’s effectivenessbegins to decrease

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PatientInform

ationPatient Information

Name: Date of Birth:

Address:

Telephone Number:

Name of insulin(s):

Insulin dose:

Useful numbers

Diabetes specialist nurse: Telephone:

Hospital consultant: Telephone:

GP / Practice Nurse: Telephone:

Pharmacy: Telephone:

Telephone:

Telephone:

BD, BD Logo and all other trademarks are the property of Becton, Dickinson and Company. © 2005 BD. Franklin Lakes, NJ 07417

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Notes

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Becton Dickinson Canada Inc.Oakville, ON L6H 6R51.800.268.5430www.BDdiabetes.com# ID1105E