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1 HED\ED:NS-BL 037-3rd

2 Insulin Insulin is produced by the beta cells in the islets of Langerhans in the pancreas. When glucose enters our blood, the pancreas should automatically excrete the right amount of insulin to move glucose into our cells. People with type 1 diabetes produce no insulin. People with type 2 diabetes do not always produce enough insulin. When we eat, our bodies break food down into organic compounds, one of which is glucose. Storage Of Insulin You may store insulin for a period of time until the expiry date has been reached. You should not use insulin past the expiry date. The effective way for you to store insulin is on its side in the refrigerator. The refrigerator should be between 2 and 8 C. Never freeze the insulin. The bottle of insulin that is being used may be kept out of the refrigerator but must not be exposed to extreme temperatures. Insulin kept out of the refrigerator must be discarded after one month. We should record the date when we open the insulin bottle and we should not use it after 5 weeks from that date. Examine the bottle closely to make sure the insulin looks normal before you draw the insulin into the syringe. We can storage insulin pen out side the refrigerator at room temperature but do not store your insulin near extreme temperature. The cells of our bodies use glucose as a source of energy for movement, growth, repair, and other functions. But before the cells can use glucose, it must move from the bloodstream into the individual cells. This process requires insulin. Insulin comes as a solution (liquid) and a suspension (liquid with particles that will settle on standing) to be injected subcutaneously under the skin. Insulin is usually injected several times a day, and more than one type of insulin may be needed. Your doctor will tell you which type(s) of insulin to use, how much insulin to use, and how often to inject insulin. Insulin Syringe Your insulin comes in vials, you will need to use syringes to inject your dose. Be sure that you know whether your insulin is U-100 or U-500 and always use the same brand and model of needle and syringe. Ask your diabetic educator, doctor, or pharmacist if you have questions about the type of syringe you should use. Carefully read the manufacturer s instructions to learn how to draw insulin into a syringe and inject your dose. Ask your health care provider if you have questions about how to inject your dose. The decision as to which insulin to choose is based on an individual s lifestyle, a physician s preference and experience, and the person s blood sugar levels. Among the criteria considered in choosing insulin are: How soon it starts working (onset). When it works the hardest (peak time). How long it lasts in the body (duration). 2 Insulin Injection Insulin Injection 3

3 Drawing Insulin Into The Syringe If you use only one type of insulin at a time, do the following: 1- Get the supplies you will need: insulin bottle, syringe, alcohol swabs. 8- Push the needle into the bottle top and inject the air into the bottle. 9- With the needle still in the bottle, turn the bottle and syringe upside down. Pull the plunger to fill the syringe with just a little more than the insulin dose you need. 2- Wash your hands with soap and water. Dry your hands well. 3- Check the label on the insulin bottle to make sure you are using the right kind, and to make sure it has not expired. 4- Turn the bottle on its side and roll it between the palms of your hands. 10- Check for air bubbles. If you see any bubbles, tap the syringe with your finger to make them rise to the top. Slowly push in the plunger just enough to push out the air and the extra insulin. Tiny air bubbles are not dangerous, but they will decrease the amount of insulin in the syringe. 11- Remove the needle from the bottle and carefully lay the syringe down so that the needle does not touch anything. Having HTN and high cholesterol. How to Draw Two Types Of Insulin Into a Syringe 5- Clean the rubber stopper with an alcohol pad. If you use two types of insulin at one time, do the followings: 1- Gather your insulin bottles, syringe, and alcohol pads. 6- Remove the cap from the needle. 2- Wash your hands with soap and water. Dry your hands well. 7- Pull back the plunger on the syringe to draw in an amount of air that is equal to your insulin dose. 3- Check the label on the insulin bottle to make sure you are using the right kind. And to make sure it has not expired. 4 Insulin Injection Insulin Injection 5

4 4- Turn the NPH bottle on its side and roll it between the palms of your hands. 5- Clean the rubber stopper with an alcohol pad. 6- Remove the cap from the needle. Sites Of Injection Insulin is injected or infused into the fatty tissue just under the skin. The body areas used most commonly for insulin injections are the abdomen, buttocks, and thighs. The upper arms may be used as well. To avoid skin problems inject at least a finger s width away from your last injection. To avoid absorption problems, do not inject near moles, scars, or nerve. 7- Pull back the plunger on the syringe to draw in an amount of air that is equal to your insulin dose. 8- Push the needle into the NPH bottle top and inject the air into the bottle. How to Inject The Insulin? 1- Choose your injection site. 2- You may clean the area with an alcohol, Make sure the area is clean. 9- Then Push the needle into the RI bottle top and inject the air into the bottle. 3- Pinch skin and fat between your thumb and first finger. 10- With the needle still in the bottle, turn the bottle and syringe upside down. Pull the plunger to fill the syringe with just a little more than the insulin dose you need. 11- Check for air bubbles. If you see any bubbles, tap the syringe with your finger to make them rise to the top. Slowly push in the plunger just enough to push out the air and the extra insulin. Tiny air bubbles are not dangerous, but they will decrease the amount of insulin in the syringe. 4- With your other hand, hold the syringe at a 90 degree angle (45 degree angle for children or thin people). Push the needle all the way into the skin. If the needle is not in far enough, the insulin may not be injected into the fatty layer. Let go of the pinched tissue before injecting the insulin. 5- Press the plunger with your thumb using a slow and steady push until the insulin is gone. Insulin syringes should only be used once. Throw away used needles and syringes safely in a hard container that the needles can not stick through. Close the container tightly with a screw-on cap. Do not recap the syringe before throwing it away. Keep the container out of reach of children and pets. 12- Remove the needle from the bottle then take the NPH bottle and turn it up-down to make sure its mix and pull the plunger to add the NPH insulin to the syringe. 6- Pull out the needle at the same angle you put it in. Press your injection site for a few seconds to keep insulin from leaking out. 6 Insulin Injection Insulin Injection 7

5 Insulin Pen Insulin pen devices are unique in that they combine the insulin container and the syringe in a single unit. Their compact size provides extremely accurate insulin delivery. Advances in the technology of needle manufacturing continue to make needles more comfortable to use. With all these refinements combined, insulin pens improve the likelihood that patients will adhere more closely to recommended insulin dosing schedules. 5- Put Penfill into the Penfill holder. The colour coded cap goes in first. 6- Screw the mechanical section and the Penfill holder tightly together. 7-Clean the rubber membrane on Penfill with a swab soaked in disinfectant. How To Use NovoPen? Insulin pen devices are unique in that they combine the insulin container and the syringe in a single unit. Their compact size provides extremely accurate insulin delivery. Advances in the technology of needle manufacturing continue to make needles more comfortable to use. With all these refinements combined, insulin pens improve the likelihood that patients will adhere more closely to recommended insulin dosing schedules. 1- Take NovoPen out of its case by pressing the top of the cap. 8-Take the protective tab off a NovoFine needle and screw the needle tightly onto the colour-coded cap. Pull off the outer and inner needle caps. 9-Dial 3 units, holder gently with your finger a few times. Press the push button right in. A drop of insulin should appear at the needle tip. 2- Twist and pull off the cap. Put the cap to one side. 10- Dial the number of units you need to inject. 3- Unscrew the Penfill holder. 11- Turn the cartiage up side down on its side and roll it between the palms of your hands. 4- Then turn the return mechanism to the right until the piston rod is completely inside it. Never push the piston rod back. 12-To inject, press the push button as far as it will go. After injection the needle should remain under the skin for at least 6 seconds. 8 Insulin Injection Insulin Injection 9

6 13- If you dial a larger dose than you need to pull the mechanical section and the Penfill holder apart, as shown in the picture while holding them apart, press the push button back to 0 against a hard surface and release your grip. Then You can then dial the correct number of units. Sick day s management 14- Do not try to inject an insulin suspension (longer-acting insulin) if you can see the rubber piston in the small inspection window, we should change the insulin from the pen after the rubber arrives to the small window as shown in the picture. Important Point Insulin is the only way to treat type 1 diabetes mellitus and it should not be stopped for any reason or exchanged with OHA (oral hypoglycemic Agent). Diabetic patients should always carry a sweet in case of hypoglycemia (Low blood sugar). Diabetic patients should know the type of insulin that they use and the time relationship between the insulin and meals and when to take the insulin before meals. 1. You may need to increase or decrease the insulin dose daily depending on the blood glucose monitoring at home. 2. Check your blood sugar every 4 hours even the if your sugar is normal. Be careful to draw the exact dose of insulin when you use it every time. You must rotate your injection sites. Be a ware of the fact that insulin absorption is increase during physical exercise. 3. Do not stop taking your insulin, even when you have nausea or anorexia. 4. Check the ketones level in the urine if the reading of blood sugar more than 250 mg\dl. 5. Eat frequent small meals contain carbohydrates and drink plenty of liquids. 10 Insulin Injection Insulin Injection 11

7 For further information, please contact Nursing Services (OPD) Tel: Ext: 1103 For comments and suggestions, please contact: Health Education Department Tel: Ext:1242\ Insulin Injection

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