TEACHING OBJECTIVES: Insulin 1. Demonstrate …

1 TOPICS:Medications: Insulin MixingandAdministrationTEACHING objectives : 1. Demonstrate technique formixing and drawing up Identify age appropriateinjection Instruct injection Observe family members/selfgiving Insulin OBJECTIVES: Learners (parents, child, relative orself) will be able to:1. Complete accuratedemonstration for mixing anddrawing up Choose two age appropriatesites for Demonstrate correct injectiontechnique using correct injectiontechnique using 9 Drawing Upand GivingInsulinH. Peter Chase, MD Catherine Suffoletta, RNWHERE TO INJECT THE INSULINI nsulin is injected into the fat layer beneath the techniques must be learned so that the Insulin is notinjected too close to the outer skin (which may cause a lump,pain or a red spot) or too deep into the muscle (which maycause pain and Insulin to be absorbed too quickly).

2 If theinjections are given in the recommended areas (see diagram ofthe Pink Panther), it is very unlikely that a large artery or veinwill be entered. The only problem if this were ever to happenwould be that the Insulin would last only a matter of minutesrather than hours. Also, it is not true that injecting a bubble ofair into someone (even into an artery or vein) would harmthem. These are common, but unnecessary SITESThe best places to give Insulin (in order) are the: buttocks (seat): slowest absorbing abdomen (holding pinch of fat): fastest absorbing arms (holding a pinch of fat) thighs (holding a pinch of fat)These are the sites with the most subcutaneous fat (listed inorder).

3 Rotation of injection sites used to be a frequent area of7778 Chapter 9 Drawing Up and Giving Insulinconflict between parents and children. It isnow possible to select two or three of the usualfour areas for injections and to skip areas thatare not well tolerated. Injections should bemoved around within the sites that are used(example: six to nine areas in each buttock site).If there are swollen or lumpy (hypertrophied)areas, injections should not be given into thesesites, as the Insulin may be absorbed at adifferent rate causing high blood is absorbed more rapidly from theabdomen than from the arm, and more rapidlyfrom the arm than from the thigh or , the differences are not great for mostpeople.

4 The buttock should generally be usedfor injections of Lantus Insulin to make certain itis given into the fatty tissue. You may also use anarea where a large pinch of fat can be on recent studies done in Sweden, itis considered necessary to take a pinch of theskin even when using the short needle. Theexceptions may be the buttock area or thecentral abdomen if there is a sufficient amountof fat is some increase in uptake of rapid-acting Insulin when the shot is given in an areathat is then exercised. Injecting into an arm orleg which will be used in an activity may result inlow blood sugars during exercise, due to theincreased blood flow to the area being , if you are to play tennis, don t injectinto the arm that will be used to swing theracquet.

5 A low blood sugar could should also not be injected justprior to a bath, shower or hot tub. Thewarm water will draw more blood to the skin,causing a rapid absorption and resulting in aserious low blood sugar. If the water is warmenough to turn your skin pink then the insulinwill be absorbed more quickly. Wait at least 90minutes after giving rapid acting Insulin to getinto hot SYRINGES(See picture diagram of Insulin syringes andTable 1)There are now several brands of disposableinsulin syringes with varying needle widths(measured in gauges with a larger number for athinner needle) and varying lengths.

6 Theneedles are thin and are sharp for easy money is short, the syringes can be reused. Ifyou are using a mixed Insulin such as NPH, it isnot suggested to reuse your needles as this cancause contamination to your rapid actinginsulin. If you must reuse your needle, pushthe plunger up and down several times toremove as much of the old Insulin as possiblefrom the needle. Then store needles in therefrigerator to prevent growth of bacteria. Theneedle may be dulled as a result of goingthrough the rubber stopper on the Insulin vialmore than one time. If dulled, then it mightcause more tissue damage.

7 There is also thepossibility of infection when reusing 9 Drawing Up and Giving Insulin7949505152535444434645484735 1234568736 37 38 404142392930283132333422 23 24 25 26 27 2115 16 17 18 19 20 9 10 11 12 13 14 InjectionRotationChart80 Chapter 9 Drawing Up and Giving InsulinThe amount of Insulin the syringe will holdvaries. There are 3/10cc and 1/2cc syringesfor people using less than 30 or 50 units ofinsulin per injection, or 1cc syringes for thoseusing more than 50 units per injection (seedrawings). The B-D Ultra-Fine II shortneedles are just 5/16 inch (8mm) in length(compared with the usual 1/2 inch [ ]length) and at 30 gauge are very thin.

8 Thereare also 3/10cc syringes with 1/2 unitmarkings allowing for smaller doses of Insulin tobe measured. This syringe can be helpful foryoung UP THE INSULINYou will be shown how to draw the insulininto the syringe. YOU SHOULD LEARN BYPRACTICE AND FORM GOOD HABITSFROM THE START. When possible, washyour hands first. The picture diagrams showhow to draw up Insulin and give an families often start by doing air shotsinto a doll or mannequin. The next practicestep is drawing up sterile salt water (saline) anddoing the injection into each other. This helpsfamily members to realize how little the pain isfrom the shots.

9 In addition, Table 1 gives achecklist to follow. The nurse will go over thechecklist with you at regular are the steps:Get everything together: alcohol, insulinand a your the plunger of the disposable syringeup and down before drawing in the will help soften the rubber at the endof the plunger and smooth the the top of the Insulin bottle(s) withalcohol and allow to air the needle through the rubber top ofthe bottle of rapid-acting(Humalog/NovoLog/Apidra) or Regularinsulin with the bottle sitting upright on thetable. Turn the bottle (with the needleinserted) upside down.

10 To remove any airbubbles, draw out about five more units ofinsulin than needed and push quickly backinto the bottle. This can be repeated severaltimes as needed until air bubbles arecleared. Flicking the syringe barrel withthe finger is not recommended as it cancause the needle to bend. After the airbubbles are gone, adjust the top edge of therubber plunger to be in line with the exactnumber of units needed. The needle canthen be removed from the vial and held orthe cap put on the needle. Some familiesleave the needle in the rapid-acting insulinbottle until the NPH Insulin is hold the syringe in one hand whilemixing the NPH Insulin (turning up anddown 20 times) with the other lay the syringe down on the tablewith the needle exposed as this may lead tobacteria collecting on the needle and causean also receiving an intermediate-actinginsulin (NPH) or long-lasting Insulin (Lantus) it can be drawn into the samesyringe at this time.