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Insulin

Diabetes Treatment

What Is Insulin?

Immediately following a meal, food that is eaten, particularly carbohydrates, quickly breaks down into a specific type of sugar called glucose that is absorbed into the bloodstream. This rapid rise in blood glucose causes insulin to be released from the pancreas. The insulin allows cells in the body, such as muscle cells, to absorb the glucose to use as a source of energy. Insulin has other effects, but mainly it controls how the body utilizes glucose.

In people with diabetes, if the body does not produce enough insulin or does not use it efficiently, blood glucose levels increase and the cells go without the glucose they need to function properly. If blood glucose levels remain too high over time, a state known as hyperglycemia, this may increase the risk of heart disease, stroke, and other health problems.

To overcome the problems associated with high blood glucose levels, people with Type 1 diabetes require insulin by injection or by using an insulin pump. Those with Type 2 diabetes may respond to lifestyle changes to reduce high blood glucose levels, such as diet and exercise, or they may require pills, insulin, or a combination of medicines.

Insulin is a hormone that is produced naturally in our bodies. Its main role is to allow cells throughout the body to uptake glucose (sugar) and convert it into a form that can be used by these cells for energy. Naturally occurring human insulin is made by beta cells within the pancreas, but people with diabetes have little or no natural insulin release.

Insulin is mostly used to treat type 1 diabetes but can be used in people with type 2 diabetes if insulin levels remain low despite the use of other types of medications. Insulin may also be given to pregnant women who develop a type of diabetes during pregnancy called gestational diabetes.

Insulin is available as synthetic human insulin (made in a laboratory but resembles naturally occurring human insulin), insulin analogs (human insulin that has been genetically modified), and biosimilars. Insulin analogs are better than standard human insulin at mimicking natural insulin release. It is easier to predict how fast and how quickly they will be absorbed (taken up by the cells in the body) and how long they will last. Biosimilars can be used in place of brand name insulins and usually cost less.

Insulins are typically classified as rapid-acting, regular or short-acting, intermediate-acting, long-acting, and ultra-long acting. Combination insulin's, that mix together different types, for example, rapid-acting insulin with intermediate-acting insulin, are also available

What Are the Different Types of Insulin?

Many forms of insulin treat diabetes. They're grouped by how fast they start to work and how long their effects last.

The types of insulin include:

Rapid-acting: Usually taken as a bolus before a meal to cover the blood glucose elevation from eating or to correct for high blood glucose. This type of insulin is often used with longer-acting insulin, which is used to cover the body’s metabolic need for insulin.

Short-acting: Usually taken as a bolus about 30 minutes before a meal to cover the blood glucose elevation from eating or to correct for high blood glucose. Short-acting insulin is different different from Rapid-acting in its Onset and Peak. This type of insulin is often used with longer-acting insulin, which is used to cover the body’s metabolic need for insulin.

Intermediate-acting: Usually taken twice a day as a combination bolus and basal insulin. This type of insulin is often combined with Rapid-acting or Short-acting insulin to cover meals before and/or after its Peak.

Long-acting: Usually taken once or twice a day as a basal insulin to cover the body’s metabolic need for insulin. This type of insulin is often combined, when needed, with Rapid-acting or Short-acting insulin as a bolus before meals or to correct for high blood glucose.

Combinations/pre-mixed: There are several forms of premixed insulin, including Humulin, Novolog, and others. These varieties combine short-acting and intermediate-acting insulins in one bottle or insulin pen, which some people find easier to administer.

Inhaled insulin: This became available in 2015 and is used in combination with long-acting insulin. Afrezza has an onset of 12 to 15 minutes, a peak of 30 minutes, and duration of three hours.

What is glargine insulin used for?

Glargine insulin is a type of long-acting insulin, which lasts for about 1 day.

How to Take Types of Insulin

There are several options for taking insulin. Each method for administering insulin has its own technique. Your doctor can help you choose the one that works best for you.

What are the different ways to take insulin?

The way you take insulin may depend on your lifestyle, insurance plan, and preferences. Talk with your doctor about the options and which one is best for you. Most people with diabetes take insulin using a needle and syringe, insulin pen, or insulin pump. Inhalers and insulin jet injectors are less common ways to take insulin. Artificial pancreas systems are now approved by the U.S. Food and Drug Administration (FDA). Talk with your doctor to see if an artificial pancreas is an option for you.

Needle and syringe

You can give yourself insulin shots using a needle and syringe. You draw up your dose of insulin from the vial—or bottle—through the needle into the syringe. Insulin works fastest when you inject it in your belly, but your doctor may recommend alternating the spot where you inject it. Injecting insulin in the same spot repeatedly could cause the tissue to harden, making it harder to take shots in that area over time. Other spots you can inject insulin include your thigh, buttocks, or upper arm, but it may take longer for the insulin to work from those areas. Some people with diabetes who take insulin need 2 to 4 shots a day to reach their blood glucose targets. Others can take a single shot. Injection aids can help you give yourself the shots.

Pen

An insulin pen looks like a writing pen but has a needle for its point. Some insulin pens come filled with insulin and are disposable. Others have room for an insulin cartridge that you insert and replace after use. Many people find insulin pens easier to use, but they cost more than needles and syringes. You may want to consider using an insulin pen if you find it hard to fill the syringe while holding the vial or cannot read the markings on the syringe. Different pen types have features that can help with your injections. Some reusable pens have a memory function, which can recall dose amounts and timing. Other types of “connected” insulin pens can be programmed to calculate insulin doses and provide downloadable data reports, which can help you and your doctor adjust your insulin doses. An insulin pen is a convenient way to take insulin.

Pump

An insulin pump is a small machine that gives you steady doses of insulin throughout the day. You wear one type of pump outside your body on a belt or in a pocket or pouch. The insulin pump connects to a small plastic tube and a very small needle. You insert the plastic tube with a needle under your skin, then take out the needle. The plastic tube will stay inserted for several days while attached to the insulin pump. The machine pumps insulin through the tube into your body 24 hours a day and can be programmed to give you more or less insulin based on your needs. You can also give yourself doses of insulin through the pump at mealtimes. Another type of pump has no tubes. This pump attaches directly to your skin with a self-adhesive pad and is controlled by a hand-held device. The plastic tube and pump device are changed every several days.

Inhaler

Another way to take insulin is by breathing powdered insulin into your mouth from an inhaler device. The insulin goes into your lungs and moves quickly into your blood. You may want to use an insulin inhaler NIH external link to avoid using needles. Inhaled insulin is only for adults with type 1 or type 2 diabetes. Taking insulin with an inhaler is less common than using a needle and syringe.

Jet injector

If you’re afraid of needles or find injections too uncomfortable, you might consider using a jet injector. This device uses high-pressured air to push insulin through your skin into your bloodstream, without needles. However, jet injectors can be expensive and more complicated to use than syringes or pens.

Artificial pancreas

An artificial pancreas is a system of three devices that work together to mimic how a healthy pancreas controls blood glucose in the body. A continuous glucose monitor (CGM) tracks blood glucose levels every few minutes using a small sensor inserted under the skin that is held in place with an adhesive pad. The CGM wirelessly sends the information to a program on a smartphone or an insulin infusion pump. The program calculates how much insulin you need. The insulin infusion pump will adjust how much insulin is given from minute to minute to help keep your blood glucose level in your target range. An artificial pancreas is mainly used to help people with type 1 diabetes.

Best insulin injection sites

The place on the body where you give yourself the shot may matter. You'll absorb insulin the most evenly when you inject it into your belly. The next best places to inject it are your arms, thighs, and buttocks. Make it a habit to inject insulin at the same general area of your body, but change up the exact injection spot. Some doctors recommend spacing out injection sites by at least the width of one finger or slightly more if you use an insulin pump. This helps lessen scarring under the skin. If you develop hard lumps in your injection site, you may have scarring and need to use a different injection site.

Which is the least painful spot to inject insulin?

One small study found that people with diabetes considered insulin injections in the belly to be less painful than injections in the upper arm or thigh. However, these patients also said that they didn’t think insulin injections were very painful to begin with. The belly is also the best place to inject insulin, since you absorb the medicine more evenly. Be sure to insert the needle at least a few inches from your belly button.

Characteristics of Insulin Action

There are three characteristics that define how insulin medication function:

Onset: How long it takes for the insulin to start lowering blood glucose

Peak time: Time after administration when the insulin is the most effective at lowering blood glucose

Duration: How long the insulin keeps lowering blood glucose

Insulin is prescribed by matching the characteristics of a particular insulin with the individual needs of the patient. Some people are on only one kind of insulin, while others take a combination of insulin medication to customize good glucose control.

What Type of Insulin Is Best for My Diabetes?

As with any aspect of your diabetes management, your healthcare professional will work closely with you to identify and prescribe the right type of insulin for your needs. There are multiple factors they will consider when choosing and adjusting your insulin regimen, including:

What type of diabetes you have

Your degree of insulin deficiency

Your suspected degree of insulin resistance

Your preference for eating times

Your physical activity levels

Your blood glucose readings throughout the day

Any other health issues you may have, and/or short-term illnesses

Your A1C levels

Whether you’re willing to take insulin multiple times a day

Your diabetes management goals

Your waking and sleeping patterns

Your hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) patterns

The variability of your lifestyle and/or physical activity on a day-to-day basis

Your doctor may prescribe more than one type. You might need to take insulin more than once daily, to space your doses throughout the day, or to add other medicines.

Afrezza, a rapid-acting inhaled insulin, is FDA-approved for use before meals for both type 1 and type 2 diabetes. The drug peaks in your blood in about 15-20 minutes and it clears your body in 2-3 hours. It must be used along with long-acting insulin in people with type 1 diabetes.

This chart covers the different brands of insulin, how long it takes for each to start lowering blood sugar, when the peak of action will occur, and how long it will continue to work. Read the product information provided with your medication and follow the instructions from your healthcare provider and pharmacist for using insulin.

Brand Name	Generic Name	Type	Onset	Peak	Duration
Apidra	Insulin Glulisine	Rapid Acting	15 minutes	1 hour	2-4 hours
Humalog	Insulin Lispro	Rapid Acting	15 minutes	1 hour	2-4 hours
NovoLog	Insulin Aspart	Rapid Acting	15 minutes	1 hour	2-4 hours
Humulin R	Human Regular	Regular - Short Acting	30 minutes	2-3 hours	3-6 hours
Novolin R	Human Regular	Regular - Short Acting	30 minutes	2-3 hours	3-6 hours
Humulin N	NPH	Intermediate Acting	2-4 hours	4-12 hours	12-18 hours
Novolin N	NPH	Intermediate Acting	2-4 hours	4-12 hours	12-18 hours
Lantus, Semglee	Insulin Glargine	Long Acting	Several hours	No peak	24 hours
Humulin, Novolin 70/30		Combination/Pre-Mixed	30 minutes - 1 hour	3.5 hours	18-24 hours
Novolog Mix 70/30		Combination/Pre-Mixed	Less than 15 minutes	1-4 hours	Up to 24 hours
Humalog Mix 75/25 or 50/50		Combination/Pre-Mixed	Less than 15 minutes	1-6 hours	13-22 hours
Toujeo	Insulin Glargine u-300	Ultra Long-Acting	6 hours	No peak	Up to 36 hours
Afrezza		Inhaled	12-15 minutes	30 minutes	1.5-4 hours
Tresiba	Insulin degludec	Long acting	Several hours	No peak	42 hours

Bolus Insulin

Bolus insulin, or a “bolus” refers to insulin that is fast acting and is given to cover the carbohydrates in a meal or to bring down high blood glucose. Bolus insulin include Humalog, Novolog Fiasp, and Apidra.

Basal Insulin

Basal insulin refers to insulin that is long acting and used to to keep blood sugar stable in between meal and correction boluses and at night. The body needs some insulin even when no food is being consumed to fuel your brain and essential organs. As a result, a longer acting insulin is typically combined with a fast acting in order to manage blood sugars throughout all hours of the day and night. Basal insulin include Lantus, Levemir, Tresiba and Toujeo.

Inhalable Insulin

There is currently one type of inhalable insulin on the market called Afrezza. Inhalable insulin is a man-made insulin with is inhaled through the nostrils by way of a nebulizer device (like asthma medications). It is considered a mealtime insulin and is to be taken at the start of a meal.

When to Take Insulin

Follow your doctor's guidelines on when to take your insulin. The time span between your shot and meals may vary depending on the type you use.

In general, though, you should coordinate your injection with a meal. You want to time your shot so that the glucose from your food gets into your system at about the same time that the insulin starts to work. This will help your body use the glucose and avoid low blood sugar reactions. From the chart above, the "onset" column shows when the insulin will begin to work in your body. You want that to happen at the same time you're absorbing food. Good timing will help you avoid low blood sugar levels.

Rapid acting insulins: About 15 minutes before mealtime

Short-acting insulins: 30 to 60 minutes before a meal

Intermediate-acting insulins: Up to 1 hour prior to a meal

Premixed insulins: Depending on the product, between 10 minutes or 30 to 45 minutes before mealtime

Exceptions to Insulin Dosing and Timing

Long-acting insulins aren’t tied to mealtimes. You’ll take detemir (Levemir) once or twice a day no matter when you eat. And you’ll take glargine (Basaglar, Lantus, Toujeo) once a day, always at the same time. Deglutec is taken once a day, and the time of day can be flexible. But some people do have to pair a long-acting insulin with a shorter-acting type or another medication that does have to be taken at mealtime.

Rapid-acting products can also be taken right after you eat, rather than 15 minutes before mealtime. You can take some of them at bedtime.

For more information about when to take insulin, read the "dosing and administration" section of the insulin product package insert that came with your insulin product, or talk with your doctor.

Types of Insulin Side Effects

Common insulin side effects

In a recent survey, gastrointestinal side effects, loss of appetite, and dark urine were the most commonly reported side effects of insulin.

Injection site reactions (redness, swelling, or itching)

Injection site lipodystrophy (skin thickening or pits at site)

Myalgia (muscle pain)

Pruritus (itching)

Rash

Upper respiratory infection

Weight gain

Headache

Peripheral edema (swelling of lower legs or hands)

Hypersensitivity reaction (allergic reaction)

Flu-like symptoms

Serious reactions (may need to seek medical help)

Hypoglycemia (low blood sugar)

Hypokalemia (low blood potassium levels)

Hypersensitivity reaction (allergic reaction)

Anaphylaxis (severe allergic reaction requiring immediate medical help)

How does insulin work?

Immediately following a meal, food that is eaten, particularly carbohydrates, quickly breaks down into a specific type of sugar called glucose that is absorbed into the bloodstream. This rapid rise in blood glucose causes insulin to be released from the pancreas. The insulin allows cells in the body, such as muscle cells, to absorb the glucose to use as a source of energy. Insulin has other effects, but mainly it controls how the body utilizes glucose.

In people with diabetes, if the body does not produce enough insulin or does not use it efficiently, blood glucose levels increase and the cells go without the glucose they need to function properly. If blood glucose levels remain too high over time, a state known as hyperglycemia, this may increase the risk of heart disease, stroke, and other health problems.

To overcome the problems associated with high blood glucose levels, people with Type 1 diabetes require insulin by injection or by using an insulin pump. Those with Type 2 diabetes may respond to lifestyle changes to reduce high blood glucose levels, such as diet and exercise, or they may require pills, insulin, or a combination of medicines.

How to store insulin

Keep all medicines out of the reach and sight of children.

Store unopened insulin in a refrigerator until you are ready to use it. Do not freeze insulin.

Once your insulin is in use you can keep it for a few weeks at room temperature, as long as you keep it below 25°C and away from direct heat and sunlight. Check the label for details of how long it can be kept unrefrigerated and do not use it after this time.

Types of Insulin FAQs

How many types of human insulin are there?

There are five general types of insulin made for treating diabetes. All types of insulin help cells use glucose for energy. The different types of insulin vary according to how rapidly they go to work and last in the body. The five main types of insulin are:

Rapid-acting insulin is usually taken right before a meal and stays active for several hours.

Short-acting insulin is usually taken before a meal, too, but takes somewhat longer to work.

Intermediate-acting insulin works for about half a day.

Long-acting insulin provides about a day’s worth of coverage.

Premixed insulin is a combination of intermediate- and short-acting insulin.

How long does Novolog last?

Novolog (the brand name for insulin aspart) lasts 3 to 5 hours. Novolog is a rapid-acting insulin. It begins working in as little as 10 minutes and reaches peak effectiveness in 40 to 50 minutes.

Which insulin is best?

No form of insulin is best. Each category of insulin has unique properties that determine how long it takes to work, reach its peak effectiveness, and stop working. Using a combination of different types of insulin can help you control blood sugar.

Does type 2 diabetes require insulin?

People with type 2 diabetes who can’t control their blood sugar by making lifestyle changes and taking other diabetes treatments may need to use insulin. Some people with type 2 diabetes use insulin and other diabetes treatments.

Is Lantus a long-acting insulin?

Lantus is a long-acting insulin. Its effects last up to 1 day. There are other types of long-acting insulin's, including Basaglar and Toujeo.

What to Ask Your Doctor About Insulin

Has your doctor prescribed insulin to help manage your type 1 or type 2 diabetes? You’ll want to know how and when to take it, what side effects could happen, and what other changes you may need to make.

Use this list of questions as a starting point when you talk with your doctor.

What type of insulin do I need?

Insulin comes in four basic forms:

Rapid-acting insulin starts to work within 30 minutes after injection. Its effects only last 2 to 3 hours.

Regular- or short-acting insulin takes about 30 minutes to work and lasts for about 3 to 6 hours.

Intermediate-acting insulin takes up to 4 hours to work fully. It peaks anywhere from 4 to 12 hours, and its effects can last for about 12 to 18 hours.

Long-acting insulin begins to work in about 2 hours and then lasts up to a full day, steadily without a real peak.

Your doctor can tell you which type will work best with your diabetes type and blood sugar level.

How should I give myself insulin?

You can inject or inhale it.

To inject insulin, you can use a syringe, pen, or pump. There is also a needle-free option called a jet injector. Pens are the easiest to use, pumps deliver insulin continuously, and syringes are the least expensive.

Find out how many times a day you'll need to inject, and how much insulin to inject in each dose. If you use an insulin pump, ask your doctor when you'll need to give yourself an extra amount of insulin (bolus).

If you have type 1 diabetes, you may need up to three or four injections daily. People with type 2 diabetes may need just one shot of insulin a day, possibly increasing to three or four injections.

There is also a rapid-acting inhaled insulin that you can use before meals only. If you have type 1 diabetes, you must also use long-acting insulin.

Talk with your doctor about the pros and cons of each method. The decision may come down to cost, so find out which method your insurance will cover. If you don't have insurance or your plan won't pay for the type of insulin delivery method you prefer, ask your doctor about programs that can help you cover the cost.

When should I take my insulin?

There isn’t one simple answer to this question. It depends on things such as:

The type of insulin you use (fast-acting, premixed, etc.)

How much and what type of food you eat

How much exercise you get

Other health conditions you have

The type of insulin delivery system (such as shots, pump, or inhaler) you use

Your doctor may want you to take insulin a half-hour before meals, so it's available when sugar from food enters your bloodstream. Find out exactly when during the day you need to take each of your injections, and what to do if you forget to give yourself an injection.

If I inject insulin, does it need to be in a certain part of my body?

Most people inject it into their lower belly area, since it’s easy to reach. (Be sure to stay at least 2 inches from the belly button.) You can also inject insulin into your arms, thighs, or buttocks.

Ask your doctor or diabetes educator to show you the right way to inject, including how to keep your needle and skin clean to prevent infections. Also learn how to rotate the injection site so you don't develop hard, fatty deposits under the skin from repeated injections.

Does insulin affect other medicines I take?

Some drugs can intensify low blood sugars caused by insulin. Tell your doctor about all the medicines you take, even those you bought without a prescription.

What can I eat while taking insulin?

Ask your doctor for food recommendations to help your insulin work best. For instance, you’ll want to know how much to eat at each meal, which types of foods are best for you to eat, whether you need to have snacks, and when you should eat. If you drink alcohol, ask your doctor if that’s OK while you’re taking insulin, and what your limit should be.

What is my target blood sugar level?

Your doctor should tell you how often you need to check your blood sugar using your blood glucose meter. Find out your target blood sugar range before and after meals, as well as at bedtime.

For most people with diabetes, the targets are:

70 to 130 milligrams per deciliter (mg/dL) before meals

Less than 180 mg/dL 2 hours after a meal

Print a copy of the Blood Sugar Log for your use

Ask what to do if your blood sugar doesn’t stay within range, and how often you need to have your A1C level tested.

What side effects could I have from the insulin?

The most common side effects are low blood sugar and weight gain. Ask your doctor what others you might have, and what to do if you get them.

How should I store my insulin?

Most insulin makers recommend storing it in the refrigerator, but injecting cold insulin can be uncomfortable. Make sure it’s at room temperature before injecting. Ask your doctor whether to store your insulin in the fridge or at room temperature. Also find out how long your insulin will last, and how to tell if it has gone bad.

Can I reuse syringes?

Doing so can lower your costs, but it is not without risk. Ask your doctor if that’s safe for you, and how to keep your syringes clean so you don’t get an infection. If you throw out your syringes after each use, ask how to safely dispose of them.

Questions Your Doctor Might Ask You

How do you feel while taking your insulin?

Have you noticed any side effects?

How are you responding to your insulin dose? Are you having any problems with high or low blood sugar?

Have you had any trouble using your insulin syringe, pen, or pump?

Do you know how to store and dispose of your used syringes or needles?

If you have any questions between doctor visits, write them down so you remember to ask them next time. Your doctor can check on your progress so that you can successfully manage your diabetes.

Giving Yourself an Insulin Shot for Diabetes

Insulin Pen Needles

Needles come in different lengths and different gauges. Here is a picture to show the different options available

For those with diabetes, an insulin shot delivers medicine into the subcutaneous tissue -- the tissue between your skin and muscle. Subcutaneous tissue (also called "sub Q" tissue) is found throughout your body.

Please follow these steps when using an insulin syringe.

Note: these instructions are not for patients using an insulin pen or a non-needle injection system.

Gather Insulin Supplies

Select a clean, dry work area, and gather the following insulin supplies:

Bottle of insulin

Sterile insulin syringe (needle attached) with wrapper removed

Two alcohol wipes (or cotton balls and a bottle of rubbing alcohol)

One container for used equipment (such as a hard plastic or metal container with a screw-on or tightly secured lid or a commercial "sharps" container)

Wash hands with soap and warm water and dry them with a clean towel.

Prepare the Insulin and Syringe

Remove the plastic cap from the insulin bottle.

Roll the bottle of insulin between your hands two to three times to mix the insulin. Do not shake the bottle, as air bubbles can form and affect the amount of insulin withdrawn.

Wipe off the rubber part on the top of the insulin bottle with an alcohol pad or cotton ball dampened with alcohol.

Set the insulin bottle nearby on a flat surface.

Remove the cap from the needle.

Note: If you've been prescribed two types of insulin to be taken at once (mixed dose), skip to the instructions in the next section.

Draw the required number of units of air into the syringe by pulling the plunger back. You need to draw the same amount of air into the syringe as insulin you need to inject. Always measure from the top of the plunger.

Insert the needle into the rubber stopper of the insulin bottle. Push the plunger down to inject air into the bottle (this allows the insulin to be drawn more easily). Leave the needle in the bottle.

Turn the bottle and syringe upside-down. Be sure the insulin covers the needle.

Pull back on the plunger to the required number of units (measure from the top of the plunger).

Check the syringe for air bubbles. Air bubbles in the syringe will not harm you if they are injected, but they can reduce the amount of insulin in the syringe. To remove air bubbles, tap the syringe so the air bubbles rise to the top and push up on the plunger to remove the air bubbles. Recheck the dose and add more insulin to the syringe if necessary.

Remove the needle from the insulin bottle. Carefully replace the cap on the needle.

How to Measure a Mixed Dose of Insulin

Your doctor may prescribe two types of insulin to be injected at once for diabetes. This mixed dose may provide better blood sugar control for some people.

Please follow these steps when injecting a mixed dose of insulin:

Follow the preparation steps described above for both bottles of insulin.

Draw the required number of units of air into the syringe by pulling the plunger back. Draw air into the syringe equal to the amount of cloudy (intermediate or long-acting) insulin needed. Always measure from the top of the plunger (the edge closest to the needle).

Insert the needle into the rubber stopper of the cloudy insulin bottle. Push the plunger down to inject air into the bottle (this allows the insulin to be drawn more easily). Do not withdraw the insulin into the syringe at this time. Take the needle out of the bottle.

Draw the required number of units of air into the syringe by pulling the plunger back. Draw air into the syringe equal to the amount of clear (short-acting) insulin needed. Always measure from the top of the plunger.

Insert the needle into the rubber stopper of the clear insulin bottle. Push the plunger down to inject air into the bottle (this allows the insulin to be drawn more easily).

Turn the bottle and syringe upside-down. Be sure the insulin covers the needle.

Pull back on the plunger to the required number of units of clear insulin needed (measure from the top of the plunger, the edge closest to the needle).

Check the syringe for air bubbles. Air bubbles in the syringe will not harm you if they are injected, but they can reduce the amount of insulin in the syringe. To remove air bubbles, tap the syringe so the air bubbles rise to the top and push up on the plunger to remove the air bubbles. Recheck the dose and add more insulin to the syringe if necessary.

Remove the needle from the clear insulin bottle and insert it into the rubber stopper of the cloudy insulin bottle.

Turn the bottle and syringe upside-down. Be sure the insulin covers the needle.

Pull back on the plunger to the required number of total units of insulin needed (measure from the top of the plunger).

Important: This must be an exact measurement. If you withdraw too much cloudy insulin, the total dosage in the syringe must be discarded. Be careful not to push any of the clear insulin from the syringe into the cloudy insulin. If there are large air bubbles after mixing the insulin in the syringe, discard this dosage and start the procedure again. Do not push the insulin back into the bottle.

Carefully replace the cap on the needle.

You are now ready to inject the insulin. Follow the steps listed below.

Rotate Insulin Injection Sites

Because you will be injecting insulin on a regular basis for diabetes, you need to know where to inject it and how to rotate (move) your injection sites. By rotating your injection sites, you will make your injections easier, safer, and more comfortable. If the same injection site is used over and over again, you may develop hardened areas under the skin that keep the insulin from being used properly.

Important: Only use the sites on the front of your body for self-injection. Any of the sites may be used if someone else is giving you the injection.

Follow these guidelines:

Ask your doctor, nurse, or health educator which sites you should use.

Move the site of each injection. Inject at least 1 1/2 inches away from the last injection site.

Try to use the same general injection area at the same time of each day (for example, use the abdomen for the injection before lunch). Note: The abdomen absorbs insulin the fastest, followed by the arms, thighs, and buttocks.

Keep a record of which injection sites you have used.

Select and Clean the Injection Site

Choose an injection site for your insulin shot.

Do not inject near joints, the groin area, navel, the middle of the abdomen, or near scars.

Clean the injection site (about 2 inches of your skin) in a circular motion with an alcohol wipe or a cotton ball dampened with rubbing alcohol. Leave the alcohol wipe or cotton ball nearby.

Inject the Insulin

Using the hand you write with, hold the barrel of the syringe (with the needle end down) like a pen, being careful not to put your finger on the plunger.

Remove the needle cap.

With your other hand, gently pinch a two- to three-inch fold of skin on either side of the cleaned injection site.

Insert the needle with a quick motion into the pinched skin at a 90-degree angle (straight up and down). The needle should be all the way into your skin.

Push the plunger of the syringe until all of the insulin is out of the syringe.

Quickly pull the needle out. Do not rub the injection site. You may or may not bleed after the injection. If you are bleeding, apply light pressure with the alcohol wipe. Cover the injection site with a bandage if necessary.

Dispose of the Syringe and Needle

Do not cap the needle. Drop the entire syringe and needle into your container for used "sharps" equipment. When the container is full, put the lid or cover on it and throw it away with the trash.

Do NOT put this container in the recycling bin. Some communities have specific disposal laws. Check with your local health department for specific disposal instructions in your community.

Proper Disposal of Sharps

How do I safely dispose of sharps (pen needles, syringes & lancets)?

To protect your loved ones and waste collectors from injury, it is essential to dispose of used syringes, insulin pen needles, and lancets (small needles used for blood sugar testing) safely and correctly.

Key tips for safe disposal:

Do not reuse used needles or lancets.

Avoid throwing loose used sharps directly into the trash.

Do not place used needles or lancets in the recycling bin.

Immediately place all used sharps into a proper disposal container after use.

What kind of container should I use?

Use a hard plastic or metal container, or purchase a sharps container from the pharmacy.

Ensure the container is puncture-proof with a tight-fitting lid.

The container should be able to stand upright and be leak-proof.

Suitable alternatives include an empty detergent bottle or a sturdy metal tin.

Clearly label the container with "Used Sharps" to prevent confusion.

When should I dispose the container?

Seal the container tightly when it is about three-quarters full.

Use tape to secure the lid if necessary.

Once the container is full, dispose of it in the trash or down the chute (following local guidelines).

What questions should I ask about my diabetes medicines?

Ask your doctor these questions when you get a prescription for a medicine.

You may want to make copies of this list and fill it out for each of your medicines.

What are the names of my medicine?

Brand name: _______________________

Generic name: _____________________

What does my medicine do?

When should I start this medicine?

This medicine is prescribed by:_______________

How long will this medicine take to work?

What is the strength (for example, how many milligrams, written as mg)?

How much should I take for each dose?

How many times a day should I take my medicine?

At what times should I take my medicine?

Should I take it before, with, or after a meal?

Should I avoid any foods or medicines when I take it?

Should I avoid alcoholic beverages when I take it?

Are there any times when I should change the amount of medicine I take?

What should I do if I forget to take it?

If I'm sick and can't keep food down, should I still take my medicine?

Can my diabetes medicine cause low blood glucose?

What should I do if my blood glucose is too low?

What side effects can this medicine cause?

What should I do if I have side effects?

How should I store this medicine?

Insulin Myths and Facts

If you have type 2 diabetes and your A1C is slowly creeping up despite your best efforts, insulin may be the next step in treating your diabetes. Many people struggle with the thought of insulin because of what they have heard about it. Some common myths about insulin and facts that may help you overcome your fears are listed below.

Myth: Insulin means I am a failure.

Fact: Needing insulin does not mean that you have failed to manage you diabetes well. Because type 2 diabetes is a progressive disease,eventually your pancreas is just not able to keep up with your body's need for insulin—no matter what you've done to manage your diabetes. When other medicines no longer keep your blood glucose on target, insulin is often the next logical step for treating diabetes.

Myth: Insulin does not work.

Fact: Although many people think of diabetes as a“sugar” problem, actually diabetes is an insulin problem. The insulins used today are very similar to the insulin that the body naturally makes. In fact, insulin is the best way to lower your blood glucose.

Myth: Insulin causes complications or death.

Fact: The belief that insulin causes complications or death often comes from seeing what happened in the past to family members or friends with diabetes. Although it can be hard to get past your fear, in fact, it is more likely that insulin might have delayed or even prevented these complications if it had been started earlier.

Myth: Insulin causes weight gain.

Fact: It is true that many patients who begin insulin gain weight. Insulin helps your body use food more efficiently. If this is a concern, ask for a referral to a dietitian before you start insulin.

Myth: Insulin injections are painful.

Fact: Although no one likes shots, most people are surprised by how little an insulin injection hurts. Insulin does not “sting” going in, and the needles are very small and thin. Most people find that it is less painful than a finger stick to monitor their blood glucose level.

Myth: Insulin causes hypoglycemia.

Fact: It is true that insulin can cause a low blood glucose reaction. However, with the newer or long-acting insulins, hypoglycemia is less likely to occur. And it is rare for people with type 2 diabetes to pass out from low blood glucose. You can learn how to prevent, recognize, and treat hypoglycemia and thus avoid severe insulin reactions.

Myth: Insulin is addictive.

Fact: You cannot get addicted to insulin. Insulin is a natural substance your body needs. If you are concerned that people who may see you give your insulin shot in a public place will think you are using illegal drugs, ask your provider if an insulin pen would work for you.

Myth: Insulin is too expensive.

Fact: Diabetes is expensive, no question about it. Generally,however, insulin is usually less expensive than using several different types of oral medications. Because prices can vary a great deal at different stores,shop around for the best prices on insulin and other supplies.

Myth: Insulin means that my life will change.

Fact: Many people believe that once they start insulin, they can no longer be independent, live alone, travel, or eat away from home. None of these is true. With planning, there is no reason why you cannot do everything you did before. Ask your provider for a referral to a diabetes educator who can help you fit insulin into your life.

Actually, many people find that their lives do change with insulin—for the better. They have more energy, have more flexibility in their schedule, and feel more positive about themselves. After starting insulin, many people wonder why they waited so long to feel better.

One Final Note..

There are many forms of insulin, which differ by how long it takes them to start working, reach their peak effectiveness, and stop working. Your doctor can help you determine which insulin or combination of the different types of insulin is right for you. There are also different ways to take insulin, so you can choose the option that you find convenient and easiest to use.

Highly Recommended Pen Needles

The most common brand name from Owen Mumford, which has been around since the late 1990s. They’re designed to “lower penetration force to support patient comfort and reduce the sensation of trauma,” with a thin needle wall technology that limits how much thumb force is needed to inject insulin through the pen. These are available in 4, 5, 6, 8, and 12 mm sizes and each has various gauges to choose from.

Highly Avoid These Pen Needles

I do not recommend these needles at all. They are cheaply made, they break very easily, sometimes before you can even use them, during using them and even after you use them. If your prescription is for these ask for different brands.

** Good Luck with your Diabetic Situation **

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Most recent revision July 12, 2025 08:38:07 AM

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