Everything You Ever Wanted To Know About Injecting Insulin…
But Didn’t Know to Ask Just take your shot. What could be easier, right? Well, you’d be surprised how many errors are made by “veteran” insulin users. It turns out there’s nothing basic about the basics of insulin injections. However, you can improve your technique. This article takes a look at the nitty-gritty details behind successful insulin delivery, why they matter, and how to avoid common pitfalls. The gear Realistically, there are two delivery systems when it comes to injecting insulin: syringes and pens. Yes, there are pumps, but that’s a whole other subject. And yes, there are jet injectors, but they are not widely used. Syringes. The first-ever human insulin shot was delivered by syringe in 1922, and here in the United States, more than half of all insulin is still delivered via syringe. Syringes used to be made of glass, had to be sterilized between uses, and had long, thick, steel surgical needles that could be resharpened on a kitchen whetstone. (No kidding.) But syringes have come a long way since then. Syringes are now disposable, the barrels are made of plastic, and the needles are thin, high-tech, multi-beveled, and coated with lubricants to make them enter the skin smoothly. (Bevels are the slanted surfaces on a needle that create a sharp point.) In the old days, the needle and the syringe were separate components. Nowadays most insulin syringes come with the needle attached. People who use syringes almost always purchase insulin in vials. Vials are glass bottles that generally hold 1,000 units of insulin. Pens. Insulin pens date from the mid-1980s, and while syringes still predominate in the United States, much of the rest of the world has traded in syringes for insulin pens. Pens currently come in two varieties: disposable, prefilled pens Continue reading >>
How To Mix Insulin Clear To Cloudy
Learn how to mix insulin clear to cloudy. Drawing up and mixing insulin is a skill that nurses will utilize on the job. Insulin is administered to patients who have diabetes. These type of patients depend on insulin so their body can use glucose. Therefore, nurses must be familiar with how to mix insulin. The goal of this article is to teach you how to mix insulin. Below are a video demonstration and step-by-step instructions on how to do this. How to Mix Insulin Purpose of mixing insulin: To prevent having to give the patient two separate injections (hence better for the patient). Most commonly ordered insulin that are mixed: NPH (intermediate-acting) and Regular insulin (short-acting). Important Points to Keep in Mind: Never mix Insulin Glargine “Lantus” with any other type of insulin. Administer the dose within 5 to 10 minutes after drawing up because the regular insulin binds to the NPH and this decreases its action. Check the patient’s blood sugar and for signs and symptoms of hypoglycemia to ensure they aren’t hypoglycemic …if patient is hypoglycemic hold the dose and notify md for further orders. Key Concept for Mixing Insulin: Draw up CLEAR TO CLOUDY Remember the mnemonic: RN (Regular to Nph) Why? It prevents contaminating the vial of clear insulin with the cloudy insulin because if contaminated it can affect the action of the insulin. Why does this matter because they will be mixed in the syringe? You have 5 to 10 minutes to give the insulin mixed in the syringe before the action of the insulins are affected Demonstration on Drawing Up Clear to Cloudy Insulin Steps on How to Mix Insulin 1. Check the doctor’s order and that you have the correct medication: Doctor’s order says: “10 units of Humulin R and 12 units of Humulin N subcutaneous before b Continue reading >>
Short-acting Insulins
Rapid-Acting Analogues Short-Acting Insulins Intermediate-Acting Insulins Long-Acting Insulins Combination Insulins Onset: 30 minutes Peak: 2.5 - 5 hours Duration: 4 - 12 hours Solution: Clear Comments: Best if administered 30 minutes before a meal. Mixing NPH: If Regular insulin is mixed with NPH human insulin, the Regular insulin should be drawn into the syringe first. Aspart - Novolog ®: Compatible - but NO support clinically for such a mixture. Draw up Novolog first before drawing up Regular Insulin. Lispro - Humalog ®: Compatible - but NO support clinically for such a mixture. Draw up Humalog first before drawing up Regular Insulin. Mixtures should not be administered intravenously. When mixing insulin in a syringe, draw up the quickest acting insulin first (e.g. draw up Humalog or Novolog before drawing up Regular Insulin, or draw up Regular insulin before Novolin N (NPH) or Lente insulin. CLINICAL PHARMACOLOGY Insulin is a polypeptide hormone that controls the storage and metabolism of carbohydrates, proteins, and fats. This activity occurs primarily in the liver, in muscle, and in adipose tissues after binding of the insulin molecules to receptor sites on cellular plasma membranes. Insulin promotes uptake of carbohydrates, proteins, and fats in most tissues. Also, insulin influences carbohydrate, protein, and fat metabolism by stimulating protein and free fatty acid synthesis, and by inhibiting release of free fatty acid from adipose cells. Insulin increases active glucose transport through muscle and adipose cellular membranes, and promotes conversion of intracellular glucose and free fatty acid to the appropriate storage forms (glycogen and triglyceride, respectively). Although the liver does not require active glucose transport, insulin increases hepatic gl Continue reading >>
Mixing Insulin
License Here How Do You Mix Insulin? Your doctor or diabetes educator may ask you to mix a short-acting or clear insulin with an intermediate or long acting cloudy insulin in the same syringe so that both can be given at the same time. Keep in mind: The only insulin that cannot be mixed is insulin Glargine. Mixing Insulin In this example, the doctor has asked you to mix 10 units of regular, clear, insulin with 15 units of NPH cloudy insulin, to a total combined dose of 25 units. Always, draw “clear before cloudy” insulin into the syringe. This is to prevent cloudy insulin from entering the clear insulin bottle. Always do this procedure in the correct order, as shown in the following sequence. Roll the bottle of the cloudy insulin between your hands to mix it. Clean both bottle tops with an alcohol wipe. Pull back the plunger of the syringe to the dose of the long-acting (cloudy) insulin in this example 15 units. You now have 15 units of air in the syringe. Check the insulin bottle to ensure you have the correct cloudy type of insulin. With the insulin bottle held firmly on a counter or tabletop, insert the needle through the rubber cap into the bottle. Push the plunger down so that the air goes from the syringe into the bottle. Remove the needle and syringe. This primes the bottle for when you withdraw the insulin later. Pull back the plunger of the syringe to the dose of the shorter acting clear insulin in this example 10 units. You now have 10 units of air in the syringe. Check the insulin bottle to ensure you have the correct clear type of insulin. With the insulin bottle held firmly on a counter or tabletop, insert the needle through the rubber cap into the bottle. Push the plunger down so that the air goes from the syringe into the bottle. Turn the bottle upsid Continue reading >>
My Doctor Says I Should Learn To Use Insulin...
Drawing and Injecting Insulin BD Getting Started™BD Getting Started™ What Do I Do Next? It is important to know how to draw and inject insulin so that you can give your injection accurately, quickly and with comfort. It will be easy if you follow these steps for using one type of insulin. Check that you have the right syringe size. Match your dose to the syringe size that is just right for you. It is an easy way to assure the accuracy of your dosage. Bottle of Insulin BD Insulin Syringe BD™ Alcohol Swabs gather the supplies you will need: before you inject, gather the supplies you will need: before you inject, Also check that you have the right brand and type of insulin. Make sure that the expiration date on the insulin bottle has not passed. Between 30 and 50 units Between 50 and 100 units Use a 3/10 mL/cc BD Insulin Syringe Use a 1/2 mL/cc BD Insulin Syringe Use a 1 mL/cc BD Insulin Syringe Less than 30 units at one time - - - 1 2 3 if you inject:if you inject: 1 2 3 •If you are taking cloudy insulin, roll the bottle between your hands until it is uniformly cloudy. •Never shake a bottle of insulin. •Wipe the top of the insulin bottle with a BD™ Alcohol Swab step one...step one... step two...step two... step three...step three... •Wash your hands. 5 6 •Push the air into the insulin bottle. •Leave the needle in the insulin bottle . This makes it easier for you to draw the insulin out of the bottle. step five...step five... step two...step six... •Push the needle through the center of the rubber top of the insulin bottle. 4 •Pull the plunger down to let _____ units of air in your syringe. •You need air in the syringe equal to the amount of insulin you will take. step four...step four... 9 step Continue reading >>
A Simple Analogy To Remember For Mixing Insulin
There are a few different types of insulin that are normally given to people with diabetes. Some people are prescribed different types of insulin that are sometimes required to be administered at the same time. Different methods of preparation are required when mixing two types of insulin as opposed to taking just one. Here is a breakdown of how to properly mix two different types of insulin. Mixing insulin is normally done with people who are administered a short acting insulin along with an intermediate or long acting insulin. The fast acting insulin is normally clear and the other is usually cloudy. The first step in the process is to remove both vials of insulin from the fridge and roll each of them in your hand. This prevents clumps of insulin from forming on the side or in the vial. Never shake the vials since this can cause disrupt the composition of some insulin and cause bubbles in the vials. After rolling the vials in your hand, take an alcohol pad and wipe the top of both vials. The next few steps are the most important part in mixing the two types of insulin. The first thing to keep in mind when mixing is that the faster acting insulin is the one that is always drawn up first. With that being said let’s take a look at the process of withdrawing each insulin. A simple analogy can be made between mixing insulin and jump starting a car. When connecting two cars together you first connect the red terminal to the bad car then the other red to the good car. Then you connect the black terminal to the good car and finally the other black terminal to the bad car. When mixing insulin, similar rules may apply. Think of the cloudy insulin (intermediate) as the good car and the clear insulin (fast acting) as the bad car (note there is nothing bad about this insulin it Continue reading >>
How To Mix Nph And Regular Insulin For A Patient
This how to video demonstrates how to mix two different types of insulin for a patient. Watch and learn how to properly prepare a mixture of regular insulin and neutral protamine hagedorn (NPH) insulin. Make sure you do the proper order of draw. Note that this instructional video is intended for medical students and professionals. Change a gown on a patient with an IV pump in nursing Prepare an insulin syringe to inject a diabetic cat Perform fundoscopy or opthalmoscopy on a patient Administer a subcutaneous injection on a patient Draw medication up from a vial for an injection Administer an intramuscular Z-track injection Administer an intradermal injection on a patient Give your diabetic cat an insulin injection Insert a proper PICC line into your patient Administer medication through a running IV Administer medication through a saline lock Perform a general eye exam on a patient Intubate a patient (endotracheal intubation procedure) Evaluate a patient with knee pain Draw blood with a standard venepuncture procedure Administer an intramuscular injection Use proper suture technique with your patient Place an abductor pillow on a THR patient in nursing Do passive range of motion on a patient in nursing Perform a HEENT exam (head, ears, eyes, nose & throat) Perform a cardiovascular exam on a patient Examine a patient for vital signs Perform a saline sinus flush Assess thyroid status & perform a thyroid gland exam Perform a full chest exam on a patient Put sterile gloves on properly Listen to a patient's lungs Take someone's blood pressure Use subdermal interrupted suturing on a patient Inject local anesthetic into a wound Communicate with children through play in nursing Access a port-a-cath in nursing Do open heart surgery on a patient simulator safely Become an Anesthe Continue reading >>
Diabetes: Drawing Up And Giving Insulin
Learning to draw up and give insulin takes practice. Families often start by doing "air" shots into a doll for practice. Next they practice drawing up sterile salt water (saline) and injecting each other. This helps family members realize that the shot is not very painful. Children below age 10 usually do not draw up insulin by themselves as they do not have the fine motor abilities and concern for accuracy. Your child will need your help. What kind of syringe should we use? There are now several brands of disposable insulin syringes with varying needle widths. Needle thickness is measured in gauges. A larger number means it has a thinner needle (for example, a 30 gauge needle is a thin needle). Needles also come in varying lengths. The standard length is 1/2 inch. Insulin syringes should have thin, short, sharp needles so they are easy to insert. The amount of insulin a syringe will hold varies. Insulin is measured in units. Example of common syringes: 3/10cc (holds 30 units) 1/2cc (holds 50 units) 1cc (holds 100 units) Syringes have markings on the side that measure the units. A 3/10cc syringe has a larger distance between the unit lines and is easier to use if you need to measure small doses. There are even some syringes that have markings for half units. If you do not want to throw away the syringe after each use, you can reuse it. However, the needle may get dulled from going through the rubber stopper on the insulin bottle over and over. A dull needle may cause more damage to your child's skin and tissues. There is also a possibility of infection when reusing syringes. How do I draw up the insulin into the syringe? Your healthcare provider will show you how to draw the insulin into the syringe. These are the steps: Get your supplies (syringe, insulin, alcohol) and Continue reading >>
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Insulin Therapy
Why do I need to take insulin? When you digest food, your body changes most of the food you eat into glucose (a form of sugar). Insulin allows this glucose to enter all the cells of your body and be used as energy. When you have diabetes, your body doesn’t make enough insulin or can’t use it properly, so the glucose builds up in your blood instead of moving into the cells. Too much glucose in the blood can lead to serious health problems. All people who have type 1 diabetes and some people who have type 2 diabetes need to take insulin to help control their blood sugar levels. The goal of taking insulin is to keep your blood sugar level in a normal range as much as possible so you’ll stay healthy. Insulin can’t be taken by mouth. It is usually taken with injections (shots). It can also be taken with an insulin pen or an insulin pump. How often will I need to take insulin? You and your doctor will develop a schedule that is right for you. Most people who have diabetes and take insulin need at least 2 insulin shots a day for good blood sugar control. Some people need 3 or 4 shots a day. Do I need to monitor my blood sugar level? Yes. Monitoring and controlling your blood sugar is key to preventing the complications of diabetes. If you don’t already monitor your blood sugar level, you will need to learn how. Checking your blood sugar involves pricking your finger to get a small drop of blood that you put on a test strip. You can read the results yourself or insert the strip into a machine called an electronic glucose meter. The results will tell you whether or not your blood sugar is in a healthy range. Your doctor will give you additional information about monitoring your blood sugar. When should I take insulin? You and your doctor should discuss when and how you Continue reading >>
Steps For Preparing A Mixed Dose Of Insulin
XIAFLEX® is a prescription medicine used to treat adults with Dupuytren's contracture when a "cord" can be felt. It is not known if XIAFLEX® is safe and effective in children under the age of 18. Do not receive XIAFLEX® if you have had an allergic reaction to collagenase clostridium histolyticum or any of the ingredients in XIAFLEX®, or to any other collagenase product. See the end of the Medication Guide for a complete list of ingredients in XIAFLEX®. XIAFLEX® can cause serious side effects, including: Tendon rupture or ligament damage. Receiving an injection of XIAFLEX® may cause damage to a tendon or ligament in your hand and cause it to break or weaken. This could require surgery to fix the damaged tendon or ligament. Call your healthcare provider right away if you have trouble bending your injected finger (towards the wrist) after the swelling goes down or you have problems using your treated hand after your follow-up visit Nerve injury or other serious injury of the hand. Call your healthcare provider right away if you get numbness, tingling, increased pain, or tears in the skin (laceration) in your treated finger or hand after your injection or after your follow-up visit Hypersensitivity reactions, including anaphylaxis. Severe allergic reactions can happen in people who receive XIAFLEX® because it contains foreign proteins. Call your healthcare provider right away if you have any of these symptoms of an allergic reaction after an injection of XIAFLEX®: hives swollen face breathing trouble chest pain low blood pressure Increased chance of bleeding. Bleeding or bruising at the injection site can happen in people who receive XIAFLEX®. Talk to your healthcare provider if you have a problem with your blood clotting. XIAFLEX® may not be right for you. Befor Continue reading >>
Insulin: How To Give A Mixed Dose
Many people with diabetes need to take insulin to keep their blood glucose in a good range. This can be scary for some people, especially for the first time. The truth is that insulin shots are not painful because the needles are short and thin and the insulin shots are placed into fatty tissue below the skin. This is called a subcutaneous (sub-kyu-TAY-nee-us) injection. In some cases, the doctor prescribes a mixed dose of insulin. This means taking more than one type of insulin at the same time. A mixed dose allows you to have the benefits of both short-acting insulin along with a longer acting insulin — without having to give 2 separate shots. Usually, one of the insulins will be cloudy and the other clear. Some insulins cannot be mixed in the same syringe. For instance, never mix Lantus or Levemir with any other solution. Be sure to check with your doctor, pharmacist, or diabetes educator before mixing. These instructions explain how to mix two different types of insulin into one shot. If you are giving or getting just one type of insulin, refer to the patient education sheet Insulin: How to Give a Shot. What You Will Need Bottles of insulin Alcohol swab, or cotton ball moistened with alcohol Syringe with needle (You will need a prescription to buy syringes from a pharmacy. Check with your pharmacist to be sure the syringe size you are using is correct for your total dose of insulin.) Hard plastic or metal container with a screw-on or tightly-secured lid Parts of a Syringe and Needle You will use a syringe and needle to give the shot. The parts are labeled below. Wash the work area (where you will set the insulin and syringe) well with soap and water. Wash your hands. Check the drug labels to be sure they are what your doctor prescribed. Check the expiration date o Continue reading >>
Insulin Injection: Two Bottle Injection Instructions
Wash your hands. Pick up the CLOUDY bottle and turn it upside down. Roll the bottle gently between your hands to mix the insulin. Wipe the top of both (clear and cloudy) bottles with alcohol. Remove the caps from the top and bottom of the syringe. Pull the plunger down to the correct unit mark for your CLOUDY insulin dose as ordered. Insert the needle into the CLOUDY bottle. Push the plunger down to inject air into the CLOUDY bottle. Withdraw the empty syringe from the bottle. Set the bottle aside. Pull the plunger down to the correct unit mark for the CLEAR insulin dose as ordered. Insert the needle into the CLEAR bottle. Push the plunger down to inject air into the CLEAR bottle. Leave the needle in the bottle. Turn the bottle upside down with the needle in it. Pull the plunger down to the correct unit mark for the CLEAR insulin dose. Look for air bubbles in the syringe. If you see air bubbles in the syringe, push the insulin back into the bottle, and repeat steps 17 and 18. Pull the bottle away from the needle, and set aside the CLEAR bottle. Pick up the CLOUDY bottle of insulin. Turn the CLOUDY bottle upside down and push the needle into the bottle. Be very careful not to move the plunger. Pull the plunger down and withdraw the correct number of units for the CLOUDY insulin. The plunger should now be on the unit mark showing the total units of both the CLEAR and CLOUDY types of insulin. For example, 6 units of CLEAR insulin are already in the syringe. Add 14 units of CLOUDY insulin for a total of 20 units in the syringe. Pull the bottle away from the needle. Set both bottles on the table. Look for air bubbles in the syringe. If you see air bubbles, discard the dose and begin again. Set the syringe down. Do not let the needle touch anything. Pinch or spread the skin a Continue reading >>
Stability Of U-500 Regular Insulin In Prefilled Syringes.
Abstract OBJECTIVE: To evaluate the stability of U-500 regular insulin in prefilled syringes stored under refrigeration for up to 28 days. METHODS: U-500 regular insulin was drawn up in 1 mL insulin syringes in a clean, nonsterile environment to emulate conditions of a patient's home. Samples were assayed using a stability-indicating reverse-phase high-performance liquid chromatography method immediately after preparation (day 0) and after 7, 14, 21, and 28 days under refrigeration. Before evaluation, all samples were diluted to a concentration of 40 units/mL in the starting mobile phase. Stability was determined by evaluating the percentage of the initial concentration remaining at each time point. RESULTS: At least 93.3% of the initial U-500 insulin concentration remained throughout the 28-day study period, with no statistically significant changes in the amount remaining. The percent of initial concentration remained above 97% for the first 21 days of the study. CONCLUSION: A prefilled syringe with U-500 regular insulin is stable for at least 28 days when stored under refrigeration. These data are similar to those reported for U-100 regular insulin, indicating that prefilling syringes with U-500 insulin is a safe and effective practice for patients who are unable to accurately draw up their own point-of-care doses. Continue reading >>
Using Insulin Lispro
What is insulin lispro, and how can it help control my blood sugar levels? Insulin lispro (brand name: Humalog) is the newest type of insulin on the market. It's a fast-acting insulin that starts working sooner than other insulins. It also reaches peak activity faster and goes away sooner. Insulin lispro helps keep your blood sugar levels from going too high after you eat. Studies show that insulin lispro may do this better than regular insulin. In fact, insulin lispro may replace regular insulin for many patients with diabetes mellitus. The medicines your doctor has prescribed are very important in keeping your diabetes under control. To keep your blood sugar level steady, your doctor will probably prescribe either a longer-acting insulin or another drug for you to take each day in addition to the insulin lispro. When and how do I take insulin lispro? Insulin lispro should be injected under the skin within 15 minutes before you eat. Your doctor will tell you how much insulin lispro to inject. Remember, you must eat 15 minutes after you take this insulin shot. Insulin lispro is a little easier to take than regular insulin. If you've been using regular insulin, you've had to inject the insulin and then wait 30 to 45 minutes before eating. Many people find it hard to time regular insulin injections and mealtimes. Sometimes they end up eating too early or too late. Then they don't get the best blood sugar control. Since insulin lispro is taken so close to meals, it may help you get the best possible blood sugar control. Can I mix insulin lispro with other insulins? It's best that you mix insulin lispro only with Humulin U or Humulin N, which are brand names for certain longer-acting insulins. Insulin lispro should always be drawn into the syringe first. This will keep the Continue reading >>
Insulin Administration
Insulin is necessary for normal carbohydrate, protein, and fat metabolism. People with type 1 diabetes mellitus do not produce enough of this hormone to sustain life and therefore depend on exogenous insulin for survival. In contrast, individuals with type 2 diabetes are not dependent on exogenous insulin for survival. However, over time, many of these individuals will show decreased insulin production, therefore requiring supplemental insulin for adequate blood glucose control, especially during times of stress or illness. An insulin regimen is often required in the treatment of gestational diabetes and diabetes associated with certain conditions or syndromes (e.g., pancreatic diseases, drug- or chemical-induced diabetes, endocrinopathies, insulin-receptor disorders, certain genetic syndromes). In all instances of insulin use, the insulin dosage must be individualized and balanced with medical nutrition therapy and exercise. This position statement addresses issues regarding the use of conventional insulin administration (i.e., via syringe or pen with needle and cartridge) in the self-care of the individual with diabetes. It does not address the use of insulin pumps. (See the American Diabetes Association’s position statement “Continuous Subcutaneous Insulin Infusion” for further discussion on this subject.) INSULIN Insulin is obtained from pork pancreas or is made chemically identical to human insulin by recombinant DNA technology or chemical modification of pork insulin. Insulin analogs have been developed by modifying the amino acid sequence of the insulin molecule. Insulin is available in rapid-, short-, intermediate-, and long-acting types that may be injected separately or mixed in the same syringe. Rapid-acting insulin analogs (insulin lispro and insulin a Continue reading >>
