Do you often encounter patients complaining that after taking insulin for several years, they have a lot of hard knots in their stomachs and the effect is still not good? Many diabetic patients around the world need to inject insulin to control blood sugar. However, if the operation is not standardized, it may cause injection pain, bleeding, leakage, nodules and other adverse effects. It’s time to remind your patient, adjust the insulin injection, and do it again!
1. First, let’s get to know the commonly used device for injecting insulin: insulin pen
Insulin subcutaneous injection relies on this pen. Common insulin pens on the market include:
2. Preparation before injection
Wash your hands before injecting!
Carefully check the insulin type, dosage, properties, injection time and expiry date.
Take out the insulin 30 minutes in advance and let it warm at room temperature (injecting low-temperature insulin will cause injection pain).
3. Shake the premixed insulin well in advance
Before using premixed insulin, the pen should be inverted and swung several times until a white suspension is produced. The specific method is shown in the above animation: place the insulin pen flat in the palm of your hand, roll it horizontally 10 times, and then swing the elbow joint and forearm up and down 10 times to fully mix the liquid in the bottle until the insulin Transforms into a uniform cloudy white liquid.
Avoid vigorous shaking, which can create air bubbles and reduce the accuracy of dosing.
4. Exhaust
To exhaust air and adjust dosage, remember to drain the air from the refill before each use and after replacing the refill.
Before injection, turn the dose adjustment knob to 2U.
Stand the needle tip upward, flick the refill holder with your finger several times to allow air to collect at the upper part, and then press the injection button until a drop of insulin overflows from the needle. This means that the drive rod has fully contacted the refill and the air bubbles in the refill have been discharged. All.
Note: Check the doctor's order and adjust the dosage to the required scale.
5. Disinfection of injection site
Please avoid injecting into areas such as subcutaneous fat hyperplasia, lipoatrophy, and ecchymosis.
The correct disinfection method is to take the injection point as the center and use alcohol to disinfect the skin from the middle to the surroundings, with a diameter of about 5cm. Do not wipe the area wiped with alcohol again to reduce contamination.
Note: Do not use iodophor for disinfection, because insulin is a protein, and disinfection with iodophor can affect the activity of insulin.
6. Insulin injection site
The suitable parts of the human body for insulin injection are the abdomen, outer thighs, outer upper arms and upper outer buttocks.
Abdomen: Insulin absorption rate reaches 100%;
Outside of upper arm: Insulin absorption rate is 85%;
Outer thigh: Insulin absorption rate is 70%, pinch the skin and inject;
Upper outer side of buttocks: Insulin absorption rate is the slowest, no need to pinch the skin for injection;
Because the abdominal subcutaneous absorption rate is faster, the preferred site for short-acting insulin (recombinant human insulin) injection is the abdomen.
Because insulin is absorbed slowly in the thighs and buttocks, the preferred injection sites for basal insulin (protamine zinc insulin injection, insulin glargine, insulin detemir, etc.) are the thighs and buttocks.
When injecting regular premixed insulin preparations before breakfast, the preferred injection site is abdominal subcutaneous to speed up the absorption of regular (short-acting) insulin and facilitate control of blood sugar fluctuations after breakfast.
When injecting premixed insulin preparations before dinner, the preferred injection site is the buttocks or thigh subcutaneously to delay the absorption of intermediate-acting insulin and reduce the occurrence of nighttime hypoglycemia.
7. Rotation of injection sites
Rotating injection sites can effectively prevent subcutaneous fat hyperplasia. This rotation method includes rotation between different injection sites and rotation within the same injection site.
insulin injection site
The rotation of different injection sites is based on morning, noon, and evening, and different times of the same day, and different sites are selected for injection.
For rotation within the same injection site, take the abdomen as an example. Divide the abdominal injection area into 4 equal areas with a "cross", avoiding the periumbilical area. Use one equal area every week and always rotate in a clockwise direction.
Insulin injection rotation method
8. How to Inject
The goal of injection is to reliably deliver the drug into the subcutaneous tissue to ensure no leakage or discomfort.
The 4mm needle should penetrate the skin vertically and enter the subcutaneous tissue. The risk of intramuscular (or intradermal) injection is minimal. It is the safest injection pen needle for adults and children, regardless of age, gender and body mass index.
When injecting, you should avoid pressing the skin to create depressions to prevent the needle from penetrating too deep into the muscle tissue.
The general injection technology advocates "inserting the needle quickly, withdrawing the needle quickly, and pushing the medicine slowly". This is the unique trick of painless injection technology.
9. When is it necessary to pinch the skin for injection?
Whether the skin needs to be pinched during injection is a question that patients have always been concerned about.
Many patients do not master the injection technique well and easily inject insulin into the muscle layer. This situation not only increases pain and makes patients resistant to insulin injections, but may also cause blood sugar levels to drop too quickly, risking hypoglycemia. Therefore, medical staff should educate patients to use correct techniques and needles of appropriate length for injections.
Generally speaking, overweight patients or patients with a body mass index (BMI) >22kg/m2 do not need to pinch the skin when injecting into the abdomen, but they need to pinch the skin when injecting into the thigh area to ensure that the drug solution is injected subcutaneously. For patients who are thin or have low body fat percentage, the skin needs to be pinched during injection, otherwise it is easy to inject into the muscle layer.
10. Needle replacement
Insulin pen injection needles should be replaced before each use and vented every time they are replaced. Due to economic constraints, most patients in my country use needles repeatedly.
11. Storage of insulin
Insulin is a delicate protein molecule that is easily destroyed by heat, freezing, or vigorous agitation. Below 0 ℃, the activity of insulin will be destroyed, and above 30 ℃, the activity of insulin will be reduced.
Unopened insulin (including bottled insulin, insulin refills, and insulin prefilled injection pens) should be stored at 2 to 8°C and must not be frozen. Avoid freezing and direct sunlight, and prevent repeated shaking.
Insulin that has been opened and is being used should be stored at room temperature (15-30°C) for no more than 30 days, or according to the manufacturer's recommendations, and should not exceed the expiration date.
