Diabetes is a serious illness that requires close attention and daily treatment. If you're caring for an aging or ill relative or a child who has the disease, diabetes management may be one of your duties. You'll have to check that person's blood sugar levels and make sure he gets a healthy diet. And if he needs insulin shots, you'll have to learn how to use a needle.

Injecting medicine can be a daunting task for anyone who isn't a medical professional, but countless caregivers have discovered that they're up to the job. Your relative's doctor should give you thorough instructions, including what type of insulin to use, how much to inject, and how often to inject it. (Most people who need insulin get at least two shots each day.) Check with your doctor if you have any questions about handling insulin or using a needle. Here's a basic overview to help you stay on track.

Like many other medicines, insulin is sensitive to changes in temperature. Never freeze insulin or allow it to heat up by placing it in direct sunlight. If you buy more than one bottle at a time, check the expiration dates before you leave the pharmacy to make sure that none will expire before you use them up. An open bottle of insulin can be left at room temperature for as long as 30 days. Keep unopened bottles in the refrigerator. Cold shots can be uncomfortable, so before giving one, take the insulin bottle out of the refrigerator and allow the liquid to reach room temperature. Do not use insulin after it has been at room temperature for longer than 30 days. Also, do not use insulin after the expiration date has passed. These are general storage guidelines, but formulations vary, so be sure to read your product's package insert carefully.

Before giving an injection, take a look at the insulin to make sure it appears normal.

There are several types of insulin: rapid-acting, short-acting, intermediate (basal), and long-acting insulin.

•Rapid-acting insulin is the type that starts working in less than 15 minutes and lasts for several hours (usually less than five), such as insulin lispro (Humalog), insulin aspart (Novolog), or insulin glulisine (Apidra). It should be clear and doesn't need to be mixed.

•Short-acting insulin, or regular insulin, starts to work within 30 to 60 minutes and usually lasts about five to eight hours. It is also clear.

•Intermediate insulin -- the type that takes two or more hours to kick in but lasts for about 10 to16 hours (such as NPH) -- should be cloudy, but it shouldn't have any clumps or crystals.

•Lantus (insulin glargine) and Levemir (insulin detemir) are both long-acting insulins. They can last up to 24 hours and are both clear in appearance.

No matter which medication you get, if the insulin doesn't look right, you may want to call a pharmacist to discuss it before using it. If you can't get your questions answered, throw it out.

If you're using intermediate-acting insulin, you'll have to gently mix the product before giving the injection. Simply roll the bottle a few times between your palms. Don't shake the bottle, because shaking can cause clumps.

•Gather everything you'll need: the insulin bottle, a syringe with a new needle, an alcohol wipe (or a cotton ball dipped in alcohol), and an opaque, heavy-duty plastic container with a lid for discarding the syringe and needle when you're finished. It's a good idea to keep the materials together in an "insulin kit."

•Wash your hands thoroughly, and you're ready to start.

•Wipe the rubber cover of the insulin bottle with alcohol.

•Before sticking the needle into the insulin, pull back on the plunger to fill the syringe with air. The amount of air in the syringe should match the amount of insulin you need to inject. If you'll be giving your relative five units of insulin, for example, pull back the plunger until you have five units of air.

•Stick the needle through the rubber cover and into the top of the bottle.

•Press down on the plunger to inject the air into the bottle.

•Turn the bottle upside down, making sure that the tip of the needle is in the insulin.

•Pull back the plunger slowly until you have just a bit more insulin than you need for your dose.

•Check the syringe for air bubbles by holding it straight up and tapping it gently. The bubbles should rise up toward the insulin bottle. (That's why you need to turn the bottle upside down). Push the plunger enough to flush out the bubbles, and you should now have the right amount of insulin in the syringe. Double-check to make sure you have the correct dosage. Take the needle out of the bottle.

•First, choose a site for the injection. The belly, the back of the upper arms, the upper buttocks, and the outer thighs are all good options. However, avoid the 2-inch radius around the belly-button, which doesn't absorb as well. Ask your doctor and your relative if they have any preferences. Also ask your doctor for advice on rotating injection sites, which can help to prevent hard lumps or thickened skin where insulin is injected.

•When you've chosen a site, clean it with alcohol. Allow it to dry thoroughly.

•Pinch about an inch of skin. This will insure you don't inject into a muscle. Hold the needle at 90 degree angle to the skin, and push it in completely. If the person is so thin that you can't get a full inch of skin, you may have to insert the needle at a 45-degree angle. The goal is to keep the needle in the skin, not the muscle.

•Once the needle is in place, slowly push on the plunger to inject the insulin. After the plunger is completely depressed, hold the needle in place for five seconds before pulling it out. This ensures complete delivery of the insulin. Press the injection site gently for a few seconds to prevent the insulin from leaking. If you're giving shots to a child, ask him whether injecting the insulin slower or faster is more comfortable for him.

•Dispose of the needle and syringe in an opaque, heavy-duty plastic box with a tight lid. (Your doctor or hospital may be able to supply you with a "sharps container" for used needles and syringes. You may also be able to purchase one at your pharmacy.)When the box is full, call your local waste company for instructions on disposing of medical waste such as used syringes, as your area may have specific regulations.

All of this can be a lot to remember, so going over injection techniques and the different injection systems with a diabetes educator can be very useful for anyone responsible for insulin shots.

-- Chris Woolston, MS, is a contributing editor to Consumer Health Interactive. A former staff writer for Hippocrates magazine, he has written for Health, WebMD, and other journals. He is also the co-author of Generation Extra Large: Rescuing Our Children from the Epidemic of Obesity (Perseus paperback, 2006).

References

First published November 13, 2007
Last updated October 29, 2008
Copyright © 2007 Consumer Health Interactive

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