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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)
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.
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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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