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Pro Tips (and Tricks) for Easier and Better Insulin Injections

ABDOMEN

THIGHS

BUTTOCKS

ARMS 1-

Recommended injection sites 0-

0- WHERE 1- IS THE BEST PLACE TO GIVE INJECTIONS? Insulin and other injected about the same regardless of where are meant to be deliv- they are injected. However, for best ered into the layer just under results it is important to stick with a the skin. Popular areas to inject consistent body part for your include the abdomen (staying two injections in order to avoid varia- fingers or a few inches away from tions in insulin action. Ultimately, the belly button), outer thighs, hips, the choice is up to you. Select a upper buttocks, lower back, and part of your body that you can see, backs of the arms. Modern insulin reach, and access easily. But be products are well absorbed and act sure to use a number of different

1 | Copyright © 2020 Association of Diabetes Care & Education Specialists. All rights reserved. Supported by an Reproduction or republication strictly1 prohibited2 3 without4 prior5 written permission. 5 4 3 educational2 grant1 from BD 6 7 8 9 10 6 7 8 9 10 11 12 13 14 15 15 14 13 12 11 insulin injection

know-how ABDOMEN pro tips and tricks for easier THIGHS

and better BUTTOCKS insulin injections spots within that body part. This is With this type of pattern, you’ll stay called “rotating” injection sites. on the left side of your abdomen for ARMS Injecting into the same spot too 12 days and then switch to the right often can cause skin problems and side for 12 days. That way, each spot can impair your body's ability to has 24 days to “heal” before you absorb the insulin. use it again! Regardless of which For example, if you choose to use body part and rotation pattern you your abdomen, rotate (change) choose, avoid spots on your skin injection spots on a daily basis like that have scar tissue, moles, swell- these: ing/, or unusual changes in appearance or texture.

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Recommended way to rotate injection sites.

2 | Copyright © 2020 Association of Diabetes Care & Education Specialists. All rights reserved. Supported by an Reproduction or republication strictly prohibited without prior written permission. educational grant from BD pro tips and tricks for easier and better insulin injections

insulin injection know-how pro tips and tricks for easier and better insulin injections IS THERE A TRICK FOR DO I HAVE TO KEEP MY INSULIN REMEMBERING TO TAKE REFRIGERATED ALL THE TIME? MY INJECTIONS? Yes and no. Insulin is a large Missed injections (or taking injec- molecule that breaks down gradu- tions much too late) can cause ally when exposed to warm temper- serious blood (blood sugar) atures. It is best to keep your extra management problems. Research insulin and other injected diabetes has shown that missing just one medications refrigerated. However, insulin injection per week can raise once you begin to use a vial or pen, your A1c by more than 0.5%! it is usually fine to keep it at room Here are some techniques for temperature for up to a month. Do helping you to remember to take not store your insulin near extreme your injections: heat (above 86°) or extreme cold (below 36°). (3) Never store insulin  Attitude is important, so take in the freezer, direct sunlight, or in your diabetes seriously! the glove compartment of a car.  Write down your injection doses All insulin vials and pens should be after taking them replaced monthly, if not more often,  Use reminder alarms on a watch to ensure that they are working at or mobile phone full potency. Be sure to check the expiration date before opening the  Take your injection at the same box, and do not use insulin past its time that you perform another expiration date without your physi- daily task, such as taking oral cian’s approval. Examine the insulin medications or brushing your closely to make sure it looks normal. teeth Clear insulin should not have  Keep your injection materials in or discoloration, and cloudy a strategic location so that you insulin should not have clumps or notice them at the right times pieces stuck to the sides of the  If you take insulin at mealtimes, vial/pen. take it before (with your doctor’s approval).

3 | Copyright © 2020 Association of Diabetes Care & Education Specialists. All rights reserved. Supported by an Reproduction or republication strictly prohibited without prior written permission. educational grant from BD insulin injection know-how pro tips and tricks for easier and better IS IT NECESSARY TO MIX INSU-  Inject your insulin at room insulin injections LIN BEFORE INJECTING IT? temperature. Cold insulin has a In general, clear insulin does not tendency to sting. When using a need to be mixed before injecting. pen or vial for the first time, This includes , take it out of the fridge a half rapid-acting insulin analogs (aspart, hour early so that it has time to lispro and glulisine) and long-acting warm up to room temperature. basal insulin (glargine and detemir).  Relax the muscles in the area However, any vial or pen that where you are injecting. Tense contains NPH — including premixed muscles make the nerves in the formulations such as 75/25 and area more sensitive. 70/30 — must be mixed until they are uniformly cloudy before inject-  For those with limited body fat, ing. The best way to ensure an even it may be necessary to pinch the mixture is to roll the pen or vial area where you will inject so between your palms ten times, then that the skin surface is hard. inspect to make sure there are no This ensures a quick, clean “clumps” settling at the bottom. injection. A quick needle Injecting insulin that is not properly insertion causes the least mixed can result is serious high or amount of pain. low blood glucose.  If you clean your skin with an alcohol pad, wait until it has dried HOW CAN I KEEP THE completely before you inject. INJECTIONS FROM HURTING? In most cases, insulin injections hurt  Doses of 30 units or more may very little, if at all. However, there cause pressure to build up are a few things you can do to make under the skin. Ask your physi- the injections as painless as cian if you can split large doses. possible:  Avoid injecting into sensitive

 Use fresh needles for each muscle by using a short needle injection. Even after just one or (6mm or less). two uses, and pen  Choose the thinnest needle needles can become dull. Sharp possible. Remember, the needles cause the least amount higher the gauge, the thinner of trauma to the skin. the needle.

4 | Copyright © 2020 Association of Diabetes Care & Education Specialists. All rights reserved. Supported by an Reproduction or republication strictly prohibited without prior written permission. educational grant from BD insulin injection know-how pro tips and tricks for easier and better insulin injections  If pain persists despite using IS IT OK TO THROW MY USED these techniques, try rubbing NEEDLES IN THE TRASH? ice on your skin for a few min- There are two things to consider utes before injecting, or ask when it comes to disposing sharp your doctor about using an objects (often referred to as sharps) injection port instead of inject- such as , pen needles and ing directly into your skin. lancets:

WHAT SHOULD I DO IF INSULIN Local ordinances LEAKS OUT AFTER THE Every municipality has its own rules INJECTION? about the handling of medical Occasionally, insulin may leak out of waste. Check with your local the skin after you remove the department of sanitation for details. needle, even if you have left the Each state also has established needle in the skin for 5-10 seconds. guidelines regarding sharps dis- Research has shown that the posal. The Centers for Disease amount of insulin lost in these Control (CDC) has more informa- situations is usually minimal and will tion about safe needle disposal in probably not affect blood glucose your area: www.cdc.gov/ management. Unless large drops needledisposal. appear that run down your skin, you The safety of those around you should not have to worry about replacing what is lost. Being a responsible person with diabetes means taking steps to However, to ensure accurate and ensure the safety of family, friends, consistent dosing, it is best to do domestic employees, sanitation what you can to prevent leakage. workers and yes, even pets. Acci- Here are a few tricks: dental needle sticks can produce 1. When injecting, release the serious pain and infections. One “pinch” on your skin before way to protect those around you is pressing down on the plunger. to place your used syringes, pen

2. Keep the needle in your skin a needles and lancets in a non-clear few seconds longer than usual. heavy-duty plastic jug with a secure screw-on cap. Don’t bother recap- 3. If leakage occurs often, insert ping the needles… just throw them the needle and inject at a into the jug, and keep the jug in an 45-degree angle rather than out-of-the-way place. When the jug going straight into the skin.

5 | Copyright © 2020 Association of Diabetes Care & Education Specialists. All rights reserved. Supported by an Reproduction or republication strictly prohibited without prior written permission. educational grant from BD insulin injection know-how pro tips and tricks for easier and better insulin injections is full, seal the cap with strong tape surface. Glucose management does and dispose according to local not suffer when switching from long regulations (usually it is OK to just to short needles, even in those who place in your normal trash). When are considered obese. Needles that traveling, bring a smaller container are too long can cause accidental with you for your used items, and injection into muscle, which alters bring it home with you for safe the normal action of the disposal. and can be quite painful. Another way to protect those For these reasons, most healthcare around you is to purchase and use a organizations now recommend the device that clips, catches, and use of shorter needles. Rarely is contains the needles. Do not break there a medical reason to use the needles off with your fingers, as needles longer than 6mm. For you can easily stick yourself. And do those with a great deal of fat not use scissors to clip off needles below the skin, use of short — the flying needle could hurt needles also eliminates the someone or become lost. need to pinch the skin when administering the injection. ARE LONGER NEEDLES BETTER THAN SHORTER NEEDLES? Good news! In almost all cases, shorter needles are better than longer ones. For insulin to work, it only needs to get into the fat layer below the skin. While the amount of fat varies from person to person, skin thickness tends to be about the same — around 2mm. So needles that are at least 4mm long do the job quite well, producing normal absorption/action and no increase in leakage back onto the skin

6 | Copyright © 2020 Association of Diabetes Care & Education Specialists. All rights reserved. Supported by an Reproduction or republication strictly prohibited without prior written permission. educational grant from BD