adjusting insulin dose pages from DAFNE

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Injection techniques, site & absorption

• general
• injection sites
• needles
• improving the injection experience (Joslin)

 

 

 

 

 

 

 

 

General

Your nurse will have shown you where the suitable injections sites are, on the abdomen, arm, thigh, and buttock. Do try to change you injections sites. Some people say use the same site at the same time of the day, using other sites at other times, but see below. As exercise increases absorption, this may work out well. If you are busy walking at work, the arm may be best.

If you have a phobia and are afraid to injection certain sites, you need to ask your nurse for help and ideas.

Massage of the injection area, exercising muscles in the area of the injection site, and higher temperatures (beware of hot baths!) all increase the rate of absorption. Absorption is quickest in order abdomen>arm>thigh>buttock.

There is more variation in the absorption of the more longer acting insulins (NICE 2004 p85 a large file).

• in the UK virtually all insulin is U100....100 units per ml

• do not inject insulin past its expiry date, stored at the correct temperature in domestic fridges; it must not be frozen as that destroys it

• the best place to inject insulin is into the fatty layer beneath the skin

• inject at a 90 degree angle using a short 6 or 8 mm needle

• Abdomen, thighs, or buttocks are ideal injection areas

• insulin is absorbed more quickly form the abdomen

• vary injections sites to prevent hard lumps forming under the skin..these lumps affect insulin absorption (it may take longer or less time to work...this is unpredictable)

• there is no need to clean the skin first

• Insulin injections should be made into the deep subcutaneous fat; use needles of length appropriate to you.

• The abdominal wall is the best choice for meal-time insulin injections

• Use one anatomical area for the injections given at the same time of day, but to move the precise injection site around in the whole of the available skin within that area.

• If a person with diabetes makes the informed choice to reuse injection needles a small number of times, ask your diabetic nurse how you should do this.

• Use needle disposal containers (disposed of properly).

• Injection site condition should be checked annually, and also if new problems with blood glucose control occur.

• A few people with special visual or psychological problems should be provided with the injection devices or needle-free systems they can use independently for accurate dosing.

• Joslin tips

 

Suggested injection sites

• lower abdomen
• buttocks
• thigh
• not arms: using the upper arms for insulin injections may run the risk of accidentally injecting into the muscle rather than the fat layer see

 

Needle

• Must use a new needle each time. Latest needles are ultrasharp but blunt very easily, after one injection. If you reuse a needle you are much more likely to get injection site problems.
• 4mm length needle for most patients (much shorter needles than previously).
• Don't injecct throught clothing...the insulin will not reach the correct level and will not work, and infections are more likely.