Insulin Injection Technique

The insulin needs to go into the fat layer under the skin. Pinch the skin and put the needle in at a 45º angle. If your skin tissues are thicker, you may be able to inject straight up and down (90º angle). Check with your provider before doing this. Push the needle all the way into the skin.

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Robert Roscoe, BSc. Pharm, ACRP, CDE, CPT, Pharmacist and Certified Diabetes Educator goes through the steps of proper injection technique when administering insulin.

Quiz: Do You Understand Safe and Effective Insulin Injection Techniques?

Test your knowledge by answering the following questions:

Questions
True
False
1

Never use the same needle more than twice for an insulin injection.

Explanation:
It’s very important that you use a new needle each time that you’re going to do an injection and prime your pen.
2

Lipohypertrophy is the accumulation of fat and scar tissue at an injection site.

Explanation:
If you repeatedly inject insulin in the same location on your body, fat and scar tissue can accumulate (lipohypertrophy).
3

Rotating within your sites is a good way to prevent lipohypertrophy.

Explanation:
To prevent lipohypertrophy, always rotate your sites and rotate within your sites.
4

If you do have lipohypertrophy, using that site again right away can help break up scar tissue.

Explanation:
If you do have lipohypertrophy, ensure it’s resolved before you start to use that site again.
5

You should slide in your insulin injection rather than jamming it in.

Explanation:
Instead of jamming in your insulin injection, think about sliding it in as you would into butter.
(Answer all questions to activate)

Lori Berard, RN, CDE, Diabetes Educator, goes through the steps of how to inject insulin safely and effectively.

Safe and Effective Insulin Injection Technique

Before you give your insulin injection, the first thing that you should do is gather your supplies and wash your hands. The next step is preparing your insulin pen for injection. It’s very important that you use a new needle each time that you’re going to do an injection, and also it’s really important that you prime your pen.

So typically, we prime the pen with two units, but some manufacturers recommend three. Know what your pen recommends for a priming dose. What you do is you take off the outer cap of the pen needle. After you’ve screwed it on, you take off the outer cap, you take off the inner cap.

You dial in whatever the recommendation is from the manufacturer, whether it’s two or three units. Holding the pen upright, you depress the plunger until you see a drop of insulin at the tip of the pen. Return the dose to zero, and now you’re ready to prepare your dose.

After your pen is primed, you should dial in the dose that you’re required to take. Next, you’re going to pick the site that you’re going to use. Make sure the site is clean, and that you’re not injecting into any area of lipohypertrophy. Then, you’ll inject your pen needle in a 90-degree angle into the site that you’ve chosen, depress the plunger, hold it down for 10 seconds.

Once that’s done, you’ll remove the insulin pen in the same angle in which you inserted it. Your injection is now complete, next you should take your outer cover of your pen needle to remove the pen needle and put it in the sharps container.

So, helpful tips for you as you move forward with your injections is always rotate your sites and rotate within your sites. There’s a lot of space that you can use within each injection zone. Also, you want to make sure that you’re using a clean needle each time that you’re injecting, and if you have any questions about that you should be asking your healthcare provider. Diabetes Now Insulin Injection Technique Patient Communication System

Presenter: Lori Berard, Nurse, Winnipeg, MB

Local Practitioners: Nurse

Robert Roscoe, BSc. Pharm, ACRP, CDE, CPT, Pharmacist and Certified Diabetes Educator, talks about what lipohypertrophy is and how to avoid getting them when injecting insulin.

So it’s really important to watch your sodium intake when it comes especially to heart failure.

Fluid retention is one of the biggest issues that we have with heart failure patients. And we have the fluid that builds up in our feet, our legs, and our belly. And that makes you feel very full and bloated and uncomfortable, as well as the fluid that builds up in your lungs which makes it difficult for you to breathe.

As far as how much salt you should have in your diet, we do recommend a diet of less than 2,000 milligrams of sodium, recognizing that the average North American diet has about four to five thousand milligrams.

You know, you find most of our sodium is hidden in those processed foods. So things like processed meats or if it comes in a – we always say if it comes in a bag, a box, or is pre-packaged, it probably has more than 70 percent of the daily recommended allowance of sodium in it.

So really avoiding those pre-packaged products. Shop around the outside of the grocery aisle. Look for that fresh produce. If fresh isn’t available – fresh is always best – but if it’s not available, have a look down the frozen food aisle for the frozen veggies. And usually those have a lot less sodium than the canned products.

So if you’re looking for additional resources if you’re having a challenging time, you know monitoring the salt in your diet, talk to your family physician and ask for a referral to your local dietitian. They’re your best resource when it comes to learning how to read labels and reducing salt in your diet. Diabetes Now Insulin Injection Technique Patient Communication System

Robert Roscoe, BSc. Pharm, ACRP, CDE, CPT, Pharmacist and Certified Diabetes Educator, talks about how to properly rotate insulin injection sites in order to avoid developing lipohypertrophy.

Lori Berard, RN, CDE, Diabetes Nurse Educator, goes over a variety of frequently asked questions when it comes to injecting insulin properly.

Injecting Insulin Properly - Frequently Asked Questions

We’re often asked why the FIT recommendations include 4-, 5- and 6-millimetre needles when we know that the shorter the better. Well, we have to do that because people across the country don’t necessarily have access to 4-millimetre needles, so we really want them to be using the shortest needle possible.

Then the other thing that comes up as a frequently asked question is if someone’s BMI is higher, does that mean they need the longer needle? And in fact, no. Research has shown that using a 4-millimetre needle in people with high BMI results in as good of glucose control as using a longer needle, so short is fine for all.

We continue to learn more about insulin injections all the time, and recently we’re starting to understand what force does to the injection. So what does that mean? If you jam your insulin injection into your tissue, you in fact increase your risk of hitting muscle. You also then squish your fat or subcutaneous tissue, and that can affect the way that you are absorbing your insulin. So, our recommendation to you is instead of jamming in your insulin, you want to think about sliding it in, like sliding it into butter.

One of the questions I’m asked very frequently is when should I split someone’s insulin dose? There’s evidence for the older human insulins that if you in fact split the insulin dose then you get a better time-action profile. The bigger the dose, the smaller the peak with human insulins.

So, that’s why we split NPH regular insulins. But, with the newer basal insulin analogs, there’s no evidence that you need to split the dose. In fact, you only split the dose as a function of the device. So, if the dose is higher than the amount that the device will deliver, then you need to split the dose.

Sometimes, you’re splitting the dose because it’s for comfort. The dose is big and it’s uncomfortable, so splitting it into two smaller injections can be more comfortable. And occasionally, under medical supervision, the dose is split to achieve specific glucose targets.

Most recently, we’ve seen the introduction of GLP-1 receptor agonists and insulin in a single delivery device. What that means is that we have to think about how we should be injecting these combination products.

So, first of all, insulin is part of that combination. So, good injection technique including proper rotation, and using a fresh needle each time. Second, is these devices often come with their own needles. So, we need to respect that, because often the size of the needle is related to the size of the molecule that’s being delivered.

If the needle looks like it might be too long for your body type, talk to your healthcare professional about how you can properly use that injection needle to deliver your dose. We continue to learn more about lipohypertrophy all the time, so some recent studies have helped us to understand how long it might take for lipohypertrophy to resolve. It’s about three to six months, in most cases, but everybody’s lipohypertrophy is different.

What’s important is that you remember a few things. Moving away from your areas of lipohypertrophy can mean that you will actually need less insulin. So, talk to your healthcare team about how to safely move into fresh tissue. The other thing is that you want to make sure that you’re having your area assessed, to make sure that there is no more lipohypertrophy before you start to use it again.

Injection technique matters, but it should be individualized, so make sure that you talk to your diabetes healthcare team about an injection technique and rotation pattern that works for you. Diabetes Now Insulin Injection Technique Patient Communication System

Presenter: Lori Berard, Nurse, Winnipeg, MB

Local Practitioners: Nurse

Understanding Proper Insulin Injection Technique

Well the first thing you really should do is just gather all your supplies and bring them to one area. Once you have that done then really what you should be doing is washing your hands to make sure you’re getting ready to do the injection.

The third thing you should do is kind of look at your site, to inspect it to make sure it’s nice and clean. Usually your day-to-day hygiene is enough, you really don’t need alcohol swabs. And then once you have the injection site picked out, then you get prepared to get the injection ready.

In relation to your dose, the first thing you need to do is prepare the pen. You would take your pen and get a new needle tip, you would insert the needle tip onto the pen, being sure that you go at a straight angle an not to bend the inner needle tip of the needle-tipped pen.

The next thing that you would do is you would prime the pen based on the manufacturer’s recommendation. Most manufacturers recommend a two-unit prime, so you would dial two or three units on your pen, hold the pen upright so that you can see the needle tip in front of you, and then press on the plunger until it goes to zero. But keep an eye on the needle tip. If you see a few drops of insulin, then you know that the pen is working well and that you’re ready to do your dose.

In relation to getting ready to do your dose, you would now have the pen primed and now you would finally dial the dose that you need to inject. You would go into your skin at a 90-degree angle and just slide it into the skin if you’re using a short needle.

If you happen to be very thin, or also prefer to use a longer needle, you may have to be instructed on how to do this at an angle, so you may have to check with your healthcare team. Once underneath the skin, you would press on the plunger until it goes to zero. At that point you would wait 10 seconds before removing the needle and come out at the same angle that you went into.

Once you’re finished your injection and you’ve withdrawn the needle, you would take the outer cap which you took off earlier, and place back over the needle, and then unscrew the needle tip to remove it from the pen. At that point, you would put it into a sharps disposal, and bring it to the pharmacy for safe disposal at a later date.

So, when you’re doing your injections it’s important to remember number one to rotate your injection sites. This means you can use different locations or rotate within the areas that you’re injecting. The second important part is to remember to use your insulin pen needle only once, as it reduces the chance of developing complications.

How you inject your insulin is as important as the insulin that you inject. So, it’s important to know the steps that should be properly followed. For more information I would suggest that you can talk to your endocrinologist or your family doctor, but also your diabetes healthcare team, which also includes diabetes nurse educators, certified diabetes educators, pharmacists and dietitians as well for further information. Diabetes Now Insulin Injection Technique Patient Communication System

Presenter: Mr. Robert Roscoe, Pharmacist, Rothesay, NB

Local Practitioners: Pharmacist

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