Featured Speaker

Mr. Robert Roscoe

BSc. Pharm, ACPR, CDE, CPT Pharmacist Rothesay, NB


Rob Roscoe, New Brunswick BSc Pharm, ACPR, CDE, CPT Independent Clinical Community Pharmacist, R-2 Consulting Ltd Team Member, Saint John Regional Diabetes Education Center Expert Committee Member, 2013/2018 Canadian Diabetes Association Clinical Practice Guidelines

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

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.

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

Local Practitioners: Pharmacist

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.

Insulin is best absorbed when it’s injected into healthy tissue. When you inject in the same spot over time, you develop something called lipohypertrophy, or lipos, or scar tissue, which is a thick, rubbery tissue develops in a subcutaneous area where you do your injections.

Also, when you don’t rotate your injection sites well, they can also develop with these types of circumstances. When insulin is injected into a lipo, it’s not absorbed as well as it is into healthy tissue. And because it’s not absorbed as well, it doesn’t have the same action as you would expect.

So, people that inject into lipohypertrophies can actually expect to have more wider ranges of highs and low numbers, but more importantly, can have unexpected low blood sugar numbers. Rotating your insulin injections is something important, and everybody should develop a plan that they can follow. You can simply do it by one of two methods. One is to change your site, so you can go from maybe the belly or abdomen to using your leg, to using your upper buttocks.

Another method is to use a certain area of the body, so if you choose to use the abdomen, you have to remember to rotate within that area as well. And rotating in that area is just as simple as moving your finger one width apart, or two centimetres, away from the previous injection.

By doing this we’re going to hopefully reduce the incidence of having lipohypertrophy. The important thing is that you really have to develop a method that you can follow yourself. One suggested method that is used commonly is to look at your belly and divide it into four parts. You would use one of those parts per week, but in that area where you’re injecting that’s where it’s important again to rotate. Make sure that you’re moving one injection to the next injection by that one-finger length apart.

This means is not the only method we could use to rotate our insulin sites, but it’s one that’s usually suggested, but talk to your healthcare team, as they may be able to have other suggestions you might be able to find easier to follow.

Proper site rotation and injection technique should require you to look at the sites you’re going to use for injection, which means you should look at those sites before doing your injection. What we’re really looking for is any unusual bumps and lumps, maybe red areas, puffiness, things along that area. But you should check with your diabetes team as well, as they should be checking these things as well.

One thing we want to tell you though is that you can do these on your own. There’s a couple of methods you could do to do this. One is just simply standing in front of a mirror and looking to see if there’s any different sites that may look a little different. But think of where you’re doing your injections.

Secondly, is that sometimes they’re better felt than seen, so sometimes it’s better to actually have a rub in those areas to see if something feels a little bit different. But the whole idea is to come up with a plan and do check them out on a regular basis, and to remind your healthcare team also to help you identify and check these as well.

Avoiding lipohypertrophies is a key component to insulin injection. So proper technique is key. Number one, by making sure you have a good rotation practice and avoiding repeated injections at the same site is important. Secondly is a re-use of needle tips. They’re designed to be used only once, and using them repeatedly gives a risk factor in developing lipohypertrophies.

For more information, I would make sure you contact your endocrinologist or specialist and family doctor, but sometimes more importantly your diabetes healthcare team. These include diabetes nurse educators, certified diabetes educators, pharmacists, dietitians and diabetes nurse educators.

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

Local Practitioners: Pharmacist

Robert Roscoe, Pharmacist and Certified Diabetes Educator

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