INTRODUCTION TO INSULIN

Transcription

1 INTRODUCTION TO INSULIN This section will give you some practical advice about using insulin. Your diabetes team will answer any particular questions that you may have e.g. dose of insulin. TYPES OF INSULIN Insulin is given by injection. Research continues to look at alternative methods of giving insulin, but until these alternatives are found, injections remain the only way of getting insulin into you. The most commonly used insulin is Human insulin. This is manufactured in the laboratory and is not obtained from human beings. Animal insulin is still available but is not commonly used. There are many types of insulin. Each insulin has: - An onset of action (the time that it takes for the insulin to start working after it is injected under the skin) A peak of action (when the insulin is working hardest to lower your blood glucose) A duration of action (the length of time for which the insulin works) This table gives usual action times for some commonly-used insulins: Insulin Onset Peak Action Duration Humalog 0-15mins 30mins-2hrs 3-5hrs Novorapid 0-15mins 30mins-2hrs 3-5hrs Glulisine 0-15mins 30mins-2hrs 3-4hrs Humulin S 30mins 2-4hrs 6-8hrs Actrapid 30mins 2-4hrs 6-8hrs Insulatard 1-3hrs 6-12hrs 18-24hrs Humulin I 1-3hrs 6-12hrs 18-24hrs Glargine 1-3hrs none 24hrs Detemir 1-3hrs none 18-24hrs Mixtard 30 30mins 2-8hrs 18-24hrs NovoMix mins 2-4hrs 8-12hrs Humalog mix mins 2-4hrs 8-12hrs Please note: - The above usual action times for the insulins described will vary slightly from person to person. 1

2 Insulin can be injected once, twice, three times or four times daily. Your diabetes team will discuss with you which types of insulin and how often you should inject each day, taking into account factors such as lifestyle etc. STORAGE Store your insulin in the fridge, but not in the freezer compartment. In-use cartridges, disposable pens or vials are stable for up to 4 weeks if stored outside the refrigerator, i.e. room temperature (not above 25ºC). Do not place the reusable pens in the fridge. Do not leave insulin near a fire, radiator or in strong sunlight. Make sure you have spare insulin, but avoid over stocking. Always ensure your insulin is in date. Always check that your insulin cartridge is not cracked before you insert it into your pen device. SUPPLY Insulin is available on prescription from your G.P. The majority of G.P. practices require 48 hours notice for repeat prescriptions. If your diabetes is treated with insulin or tablets you are exempt from prescription charges. Please ask at your chemist for the appropriate form to complete to apply for a medical exemption certificate. INJECTING INSULIN Insulin injections if given correctly are usually pain free. It is true to say that most people after they have given their first insulin injection comment I didn t feel a thing, why have I been worrying so much? If you are about to start insulin we hope these true comments will encourage you. Pen injection devices If you need to start insulin you will be given a pen injector device. This may be a reusable device or a throw away device. Do not worry; your Diabetes Specialist Nurse (DSN) will explain the pen devices to you in more detail. Pen needles Pen needles are only available on prescription from your G.P. The most commonly used length of pen needle is 8mm, but your DSN will inform you of the best needle length for you. One needle should be used for one injection. Syringes Syringes are not widely used, but are available and if it is thought to be more appropriate for you to use a needle and syringe your DSN will discuss this with you in more detail. 2

3 INJECTION SITES: Insulin is injected into fat (sub-cutaneous tissue). The usual sites are abdomen (tummy), upper thigh (top of the leg) and buttocks (bottom). It is important to avoid injecting into the same place too often, as this could cause unsightly lumpy areas (lypohypertrophy) to develop Injecting into an overused area of lypohypertrophy may cause the insulin to not work properly and this will affect blood glucose control. Your DSN will discuss all aspects of injecting insulin with you in more detail. INJECTION TECHNIQUE: These are general hints to help you perform a successful injection using a pen injector device. Check insulin dose Prepare insulin pen as instructed by diabetes nurse Gently mix cloudy insulin prior to injection Pinch up fold of skin Insert needle to its full length at 90 degrees into this fold of skin (the DSN will show you) Depress the end of the pen; this will give you the insulin. Count to 10 and remove needle from you Dispose of needle safely DISPOSAL OF NEEDLES: Place all used needles and lancets into a sharps bin. Sharps bins 1litre are available from your GP on prescription. Return the sharps bin to your GP for safe disposal when it is full. It is the responsibility of the person who prescribed your sharps bin to organise disposal of it. A BD needle clipper, available on prescription from your GP, can be used to clip the needle off. The hub of the needle needs to be placed into the sharps bin. The BD needle clipper holds 200 needles and when full needs to be placed into the sharps bin. IT IS EXTREMELY IMPORTANT TO DISPOSE OF YOUR NEEDLES PROPERLY SO YOU DO NOT INJURE ANYBODY ELSE. FREQUENTLY ASKED QUESTIONS: I have noticed that after my injection I sometimes bleed from the injection site. Occasionally you may bleed from an injection site. Do not panic. You have not done any damage to yourself. If this happens, just hold a finger firmly over the area for a few seconds. You will not have lost any insulin. Avoid using that site for a few days. 3

4 I have noticed a small bruise develop after I have done my injection. Occasionally a bruise may appear at an injection site. Do not worry; avoid the area until the bruise has gone. Make sure you are changing the needle after each injection and make sure you are not too heavy handed with yourself when you inject! Avoid injecting near obvious small blood vessels (capillaries) close to the surface of the skin. If this problem persists please discuss with your DSN. Does insulin have any side effects? The job of insulin is to lower your blood glucose. If your blood glucose drops too low, less than 4.0mmols you will experience a hypo (hypoglycaemia). (See the leaflet Hypoglycaemia What is it?) Do I need to carry anything with me now that I m on insulin? Yes, it is important to have glucose tablets (lucozade tablets) in your pocket or bag. These can be bought at a newsagents or chemist. It is also important to carry identification, either an I.D. card or a medic alert/sos talisman or Do I need to inform anyone that I am taking insulin? If you drive see link to diabetes and driving. Certain employers will need to be informed, see link to diabetes and jobs. Your doctor or nurse will inform your G.P. What do I do if my pen injector device breaks or if I lose it? It is extremely important that you ensure you have a spare pen injector device. These are available on prescription from your G.P. If you have to use your spare pen injector ensure you replace it immediately. Where do I get future supplies of equipment in relation to my insulin treatment? All items are available on prescription from your G.P. Here is a common list of items often asked for which you may find useful. NOVOPEN 3 / HUMAPEN LUXURA B.D. MICROFINE + 8mm NEEDLES (1 BOX) B.D. NEEDLE CLIPPER SHARPS BIN 1 LITRE 4

5 BLOOD TESTING EQUIPMENT E.G. LANCETS AND BLOOD TESTING STRIPS (Please see the leaflet Glucose Monitoring) KETONE TESTING STRIPS Your diabetes nurse will advise you specifically what to ask your G.P. for and advise you if there is anything extra to be obtained e.g. Glucagen kit, GlucoGel (Please see the leaflet Hypoglycaemia What is it?). Can I still go on holiday abroad? Yes. (Please see the leaflet Holidays and Travel). Author: - Diabetes Multidisciplinary Team. Version no 1.Issue Date: - June 2004.Review Date: - June 2006 Author: - Diabetes Multidisciplinary Team. Version no 2.Issue Date: - Jan Review Date: - Jan