If you have type 1 diabetes, or if you have type 2 and have recently begun injecting insulin, you may have a bit of trouble getting used to the process of preparing and administering your own insulin shots. Andrea Penney, RN, CDE, of the Joslin Diabetes Center, says that injection technique is important to master not only for accurate dosing, but for comfort, too. "With proper practice and good technique, you can avoid pain during an injection," she states.
Penney sat down with us recently to answer some common questions about insulin injection. If after reading and practicing insulin injections you still find you’re having trouble, Penney suggests seeing a Certified Diabetes Educator for more assistance.
Q: How do I decide where to inject?
A: People often select injection sites based on many factors: accessibility, presence of fatty tissue, and rate of insulin absorption (which will be discussed shortly). As a result, popular sites for injection include the stomach, outer thigh, the back of the arm (between the shoulder and the elbow), or the upper outside "wallet" area of the buttock (but not into the lower buttock area).
Q: Once I decide on a location for an injection, how do I pick the right "spot"?
A: Here are some easy guidelines:
-Stomach If you’re going to inject into the stomach, stay at least two inches away from the bellybutton and/or any scars you may already have when using the abdomen for injections.
For an injection in your thigh, inject at least four inches or about one hand’s width above the knee and at least four inches down from the top of the leg. Do not inject insulin into your inner thigh because of the large number of blood vessels and nerves in this area.
The area between the shoulder and elbow on the outside of the arm is usually fine for injections. Injecting into the arm can be difficult, however, because you often cannot pinch enough of an injection site without the aid of your free hand. One option for injecting into the arm with less pain is to apply pressure to the arm from a fixed surface to create an injection site, and then use your free hand to inject. This injection technique usually provides a painless experience.
If you plan on injecting your insulin into the buttocks, avoid the lower portion.
Q: What is the best injection technique?
A: You may cleanse the injection site with an alcohol swab prior to injecting. "After selecting and cleaning an injection site, firmly--but not tightly--pinch up an area about 2-3 inches wide. Inject at a ninety degree angle while the skin is pinched. Leave the needle in while you relax the pinch. Then count to five slowly (count to ten for the Lantus pen). Then remove the needle. Do not massage the area after the injection," advises Penney.
Penny also advises people not to worry if they have a tiny amount of bleeding. "If this occurs," she states, "simply apply direct pressure on the injection site for about thirty seconds."
"You should not have a lump on your skin after injecting insulin. If this happens, either you need to refine your injection technique or you may need a longer needle," states Penney.
Q: Can I inject within the same area?
A: When rotating sites within one injection area, keep injections about an inch (or two finger widths) apart. Try not to inject the same spot twice in two weeks. If you continue to inject in the same area without rotating, you may develop scar tissue.
According to Joslin’s Diabetes Deskbook, "localized irritation can occur from frequent injections, and in frequently injected areas the skin can become thickened and scarred, delaying absorption." You can avoid the development of extensive scar tissue development by rotating sites, says Penney.
Q: Does insulin work differently depending on where it is injected?
A: According to Joslin’s Diabetes Deskbook, the rate of insulin absorption is different depending on where you inject—so the answer is ‘yes’. The book ranks the following sites according to how quickly they absorb the insulin injected:
Q: How do I store insulin?
A: Unopened insulin must be stored in the refrigerator. Once opened, insulin may be kept at room temperature or in the refrigerator. Please read the package insert on the storage of your prescribed insulin once it has been opened. All vials of insulin except for Levimir should be discarded after 28 days. Insulin pens expire between 10-42 days depending on the type of insulin. Never freeze insulin.
Q: Are there any special considerations for injections and physical activity?
A: Yes. Physical activity--and even massage--can speed up the absorption of insulin. If you plan on strenuous physical activity shortly after injecting insulin, don’t inject in an area affected by the exercise. For example, if you plan to play tennis, don’t inject into your racquet arm. If you plan to jog or run, don’t inject into your thighs. As always, keep tabs on your blood glucose, especially during times like these, to make sure you don’t get too low.
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