Josefina E.

Florendo, RN, MAN

Insulin Injection Certification Workshop:Insulin Injection Techniques

INSULIN TECHNIQUES Objectives

At the end of the presentation, the participants will be able

to:

1 . State ways to administer insulin safely;

2. Identify interventions to prevent problems associated with
insulin administration;
3. Demonstrate the competencies expected in the
administration of insulin.
Josefina E. Florendo, RN, MAN

INSULIN Insulin Preparations

 Most powerful and effective pharmacologic tool available Class Agents

to treat diabetes.
Human insulin Regular, NPH, lente
 Its potential to lower plasma glucose levels is limited only
by hypoglycemia. Insulin analogues Aspart, Glulisine, Lispro,
Glargine, Detemir
 Sustained near-normal blood sugar to prevent the onset
Premixed insulin Human 70/30, 50/50
and progression of long-term complications is the major
Humalog mix 75/25
treatment goal of insulin therapy. Novomix 70/30

INSULIN ADMINISTRATION Insulin Administration Devices

 Insulin therapy is used to achieve

and sustain target-level glycemic

 Delivered using various devices

Josefina E. Florendo, RN, MAN
Insulin Injection Certification Workshop:Insulin Injection Techniques

Insulin Administration Devices Insulin Pen

Insulin pens
reusable pen
Faster and easier
than syringes
Improve patient attitude
and adherence

Have accurate dosing

mechanisms, but
inadequate mixing may
Hides needle to reduce anxiety
be a problem
disposable pens

Insulin Pump Insulin Pump

Continuous
subcutaneous insulin
infusion (CSII)
External, programmable
pump connected to an
indwelling subcutaneous
catheter to deliver rapid- External, programmable
acting insulin pump connected to an
indwelling subcutaneous
catheter to deliver rapid-
acting insulin

Insulin Administration Devices INSULIN ADMINISTRATION

Inhaler

 Technique employed in administration

may affect absorption rate and
eventually the blood glucose levels.

Designed for people with:

Poor eyesight No longer available
Dexterity problems
Learning difficulties
Josefina E. Florendo, RN, MAN
Insulin Injection Certification Workshop:Insulin Injection Techniques

Injection Tips Insulin Tips

 Do NOT wipe the needle with alcohol  Absorption differs in various areas of the human
as it removes the protective coating. body.

The coating makes injection easier  The new shot can be given in the area with the
and less painful distance of 1 to 2 fingers from the site where
the last shot was given.

Site Selection/ Rotation Insulin Tips

 Injecting any insulin at the same site

repeatedly over time or blunting a needle
with re-use can cause a lipodystrophy:
either lipoatrophy or lipohypertrophy.
Either makes absorption unreliable.

Varying the injection site can cause variability

in action profile.

Lipodystrophy Insulin Tips

 Eliminate bubbles

 Keep vial upright

 Draw insulin slowly
 Re-inject insulin into vial when air bubble
 get into the syringe
 Tap the syringe with a finger or two to remove
air bubbles while holding it upright
Josefina E. Florendo, RN, MAN
Insulin Injection Certification Workshop:Insulin Injection Techniques

Insulin Tips Insulin Tips

 In mixing clear and cloudy insulin, bubbles can be removed Cold Insulin
from the clear insulin, which is drawn first. but can't remove
bubbles after both insulins are in the syringe. Bring to room temperature to prevent sting

* Remove from fridge before administration

Insulin can’ t be pushed back into the bottle of cloudy insulin, * Warm capped syringe with hands
from the syringe which already contains clear insulin. This would
* Do not warm insulin using stove or
cause two problems:
* Y ou won't get the full amount of clear insulin microwave
that you need
* It will change the insulin in the cloudy insulin bottle
(because some clear insulin has been mixed into it)

Insulin Tips Injection Tips

 Do Not Use Insulin If:

 bottle appear to be frosted
 clear insulin that looks discolored, turned
cloudy, or hazy
 cloudy insulin that is appears yellowish or
remains lumpy or clotted after mixing
Injection leakage
 Cause holding pinch too long when shot is given
 Pinch forces some of the insulin back from the newly
created hole in the
 Short needle can cause insulin leakage

Bleeding at Site of Injection

Preventing leakage
Release pinch or
squeeze
Count to 10 before
removing the needle
 usually caused when the syringe
punctures a tiny blood vessel
 can be stopped by putting pressure on the injection site
with finger or a cotton ball.
Be sure that you:
 Don't rub the spot.
 Maintain light pressure with your finger to prevent bruising.
 If a bruise does appear, don't use that injection site again
until the bruise is gone.
Josefina E. Florendo, RN, MAN
Insulin Injection Certification Workshop:Insulin Injection Techniques
To keep your blood glucose on target follow
these two rules for proper site rotation:
 Same general location at the same time
each day.
 Rotate within each injection site.
Injection Site
 Do not inject close to the belly button. Do not inject close to moles or
scars. The tissue there is tougher  insulin absorption will not be as
consistent.
 Injecting in the upper arm, use only the outer back area (where the most
fat is). It is hard to pinch the upper arm when doing self injection. Try
pressing upper arm against a wall or door.
 When injecting in the thigh, stay away from the inner thighs. If thighs
rub together when walking, if 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 needed.
Insulin Absorption
 Fastest from the abdomen
 A little slower from the arms
 Even slower from the legs
 Slowest from the buttocks
Insulin Absorption
 Insulin is absorbed fastest when injected into the subcutaneous tissue in the
abdomen (stomach), and somewhat less quickly in the upper arms, thighs, and
buttocks/hips.
The difference in absorption rates can be used to plan where to inject insulin.
For example:
 Rapid-onset insulin can be injected into the 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.
Insulin Absorption
 Inject breakfast and lunch bolus doses into the abdomen
because Insulin is absorbed fastest when injected into this
area.
Fast absorption is needed at mealtimes to cover the
carbohydrates you are about to eat.
 The supper or bedtime dose of long-acting insulin could
be injected into the thigh, buttocks, or upper arm so the
long-acting insulin can take effect gradually and cover
needs throughout the night.
Exercise can affect
the absorption rate
 playing basketball after injecting choose a site other
than the shooting/dribbling arm, since injecting there can
increase the absorption rate.
 If it is preferred to inject near a part of body used when
exercising  wait at least 45 minutes after injecting
before starting activity.