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Giving yourself an Insulin Shot

If you have type 1 diabetes-or if you have type 2 diabetes and oral medications are not controlling your blood sugar, you have to take insulin. If you have gestational diabetes, you may need to take insulin if diet and exercise have not been able to keep your blood sugar levels within your target range.

The way that you insert your syringe or pen needle into your skin in order to get a proper dosage of insulin is called your insulin injection technique. Your DIABETES EDUCATOR can help you to learn an injection technique that will make your insulin therapy as effective and successful as possible.

Here are tips on how you can give yourself insulin, the right way.

Injection tip 1 – Avoid areas with relatively higher concentrations of blood vessels and nerves that might get poked accidentally. Knowledge of the insulin depth and correct pinch up are important factors in the techniques of subcutaneous injection.

A) Insulin Depth
Injecting at the proper depth is an important part of good injection technique. Most healthcare professionals recommend that insulin be injected in the subcutaneous fat, which is the layer of fat just below the skin.

If you inject too deep, the insulin could go into muscle, where it’s absorbed faster but might not last so long. If the injection isn’t deep enough, the insulin goes into the skin, which affects the insulin’s onset and duration of action.

B) Correct Pinch Up
Most people pinch up a fold of skin and insert the needle at a 90° angle to the skin fold. To pinch your skin properly, follow these steps:

Squeeze a couple of inches of skin between your thumb and two fingers, pulling the skin and fat away from the underlying muscle. (If you use a 5 millimeter mini-pen needle to inject, you don’t have to pinch up the skin when injecting at a 90 degree angle; with this shorter needle, you don’t have to worry about injecting into muscle.)

The angle you should use to insert the syringe or pen needle into your body depends on your body type, the injection site (if you inject into an area of the body that has less fat, you may need to inject at less than a 45 degree angle, to avoid injecting into a muscle), and the length of the needle that you use (inject at 90° angle if 5mm or 8mm needle is used).

Injection tip 2 – Alternate injection sites within the preferred areas rather than between them.

1. The abdomen, except for a two-inch circle around the navel.
2. The top and outer thighs. Avoid injecting too close to the bony area above the knee.
3. The outer, upper arms. Use the outer back area of the upper arm where there is fatty tissue.

Reasons why the abdomen is preferred:

  • There is usually abundant subcutaneous fat.
  • It is easier to do a pinch-up.
  • The fastest absorption is from abdomen.

Reasons why the arm is the least preferred site:

  • There is usually a thin layer of subcutaneous fat.
  • A pinch-up is absolutely necessary for each injection.

Injection tip 3—Choose to use a different area for each insulin.

A) Rotating Your Injection Sites
If you inject insulin three or more times a day then it’s a good idea to rotate your injection sites.

B) Smart Tips for Site Rotation Work with your doctor and track your blood glucose levels carefully when you begin practicing site rotation.

  • Do not inject close to the belly button and areas close to moles or scars. The tissue there is tougher, so the insulin absorption will not be as consistent.
  • If you inject in the upper arm, use only the outer back area (where the most fat is).
  • If you inject in the thigh, stay away from the inner thighs. If your thighs rub together when you walk, this might make the injection site sore.
  • Do not inject in an area that will be exercised soon. Exercising increases blood flow, which causes long-acting insulin to be absorbed at a rate that’s faster than you need.
  • You can reduce injection pain by choosing a needle length and gauge that are right for you.
  • Move to a new injection site every week or two.
  • Rotate the sides (right, left) of your body where you inject within your injection sites.

Injection tip 4 – Be consistent.
Insulin enters the blood more quickly from some areas than others. So, your blood sugar may be higher or lower depending on what area is used. Ideally you want your insulin to be absorbed at about the same rate each time you inject. This makes for more consistent and predictable control of blood sugar, avoiding dips and peaks.

Most insulin enters the blood:

  • Fastest from the abdomen (stomach)
  • A little slower from the arms
  • Even more slowly from the legs
  • Most slowly from the buttocks

You can use the difference in absorption rates to plan where you’re going to inject your insulin. For example:

  • Rapid-onset insulin can be injected into your abdomen just before or right after you eat a meal to take advantage of the abdomen’s fast absorption rate.
  • NPH insulin can be injected into a different site (arms, thighs, or buttocks), to take advantage of the slower absorption rate while you sleep.

If you mix two types of insulin in one shot, you can inject into the abdomen, arm, thigh, or buttocks.

Common Injection Challenges
A) Bleeding at the Injection Site
It’s normal for a small amount of blood to appear when you inject insulin. This bleeding, which is usually caused when the syringe punctures a tiny blood vessel, can be stopped by putting pressure on the injection site with your finger or a cotton ball.

B) Getting a Comfortable Injection
Most insulin injections don’t hurt. However, if you frequently experience pain while injecting, try the following:

  • Check with your healthcare professional to make sure that your injection technique is correct.
  • Wait until the alcohol from the swab has dried completely on your skin before injecting.
  • Be sure you’re not bending the needle when you remove the cap.
  • Inject your insulin when it’s at room temperature. Cold insulin hurts.
  • Keep the muscles in the injection area relaxed during injection.
  • Never use your needles more than once. Reusing a needle can bend or dull the tip, which will increase the pain, and could cause it to break off and become lodged in your skin.
  • Larger insulin doses hurt more than injections of small amounts. To minimize injection pain, ask your doctor if you can try injecting more frequently throughout the day with a smaller amount of insulin.
  • Penetrate your skin quickly. Avoid injecting into muscle by pinching up your skin before injecting into the fold of skin that you pinch up.

C) Insulin Dripping from a Pen Needle after Injection
If you use a pen and insulin drips from the pen needle after you remove it from the injection site, you haven’t received the full dose that you need. To be sure you get your complete dose, wait at least five seconds after you inject before removing the needle (10 seconds for doses of 25 units or more, or when 30 or 31 gauge needles are used).

Also, never carry a pen with the needle attached – this causes air to enter the cartridge, slowing the time it will take for you to get your insulin dose.

D) Insulin Leakage at the Injection Site
If insulin leaks from your skin after you remove the needle from the injection site, speak with your healthcare professional about using a longer needle or using a different injection site. You may also not be pinching up the skin correctly. Make sure that you release the pinch before you remove the needle from the skin.

E) Skin Problems at Injection Sites
Skin irregularities can sometimes occur at injection sites due to changes in the subcutaneous fat, of which there are three types.

Fat hypertrophy (also known as “lipohypertrophy” or “insulin hypertrophy”) appears as soft, often “grape-like” lumps at the injection sites. This unusual condition may be caused in some people by the natural effects of insulin (one of which is to cause fat to grow) or by reuse of needles. To prevent the further development of hypertrophy, rotate injection sites and don’t reuse needles.

Fat atrophy (also known as “lipoatrophy”) is a loss of fat under the skin’s surface. This rare condition appears as a dip in the skin and has a firm texture. It occurs much more commonly with impure insulins.

Scarring of the fat (also known as “lipodystrophy”) is caused when you inject too many times into the same site or when you reuse a needle. To prevent lipodystrophy:
• Rotate your injection sites
• Rotate where you inject within your injection sites
• Rotate the sides (right, left) of your body where you inject within your injection sites

F) Risks of Needle Reuse
The tips of needles may become damaged after just one injection.
• The tip of a reused needle can be weakened to the point where it breaks off and gets stuck under your skin.
• A reused needle doesn’t inject as easily or as cleanly as a new one and can cause pain, bleeding, and bruising and formation of lumps at injection sites.

A Note About Used Needles
Most states require that you store used needles and pen needles in a hard container. An empty liquid detergent bottle is a good example (per your local regulations).

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