Recommendations for correct insulin injection

INSULIN STORAGE TIPS

Keep opened containers (pens or ampoules) at room temperature; once opened, they should not be refrigerated.
Discard opened containers after one month.
Refrigerate unopened containers (not in use) between 2 and 8°C. The expiration date corresponds to unopened, refrigerated insulin.

RECOMMENDATIONS TO PREVENT TISSUE INJURY

Change the injection site for each injection. Each injection should be approximately 2 cm away from the previous injection sites.
The recommended insulin administration sites are:
- Abdomen: central and lateral areas, leaving approximately 1-2 cm free around the navel.
- Thighs: the anterolateral area, leaving approximately 4 finger widths above the knee and 4 finger widths below the hip.
- Buttocks: The upper and outer lateral areas of the buttocks.
- Arms: Leave approximately 4 finger widths below the shoulder and 4 finger widths above the elbow on the back.
Keep track of injection sites to rotate.
Since skin thickness varies between approximately 1.25 and 3.25 mm in 90% of individuals and insulin must be injected into the subcutaneous tissue (since there are no large blood vessels or nerves there), it is recommended not to use needles larger than 8 mm in adults and larger than 6 mm in children to avoid injecting insulin into intramuscular tissue and causing repeated and unexpected hypoglycemia.
Needles are for single use. Once used, they are no longer sterile. Due to the problems many patients report in obtaining needles, a recommendation of a maximum of 3 needle punctures may be heard.
Always avoid injecting near skin folds, the groin area, the navel, the midline of the abdomen, as well as near wounds, scars, and/or moles.
Frequently inspect and palpate the areas where insulin is administered to assess the possible development of lipodystrophy. If there are lumps or deformities, rest the area and avoid re-injecting insulin until they have disappeared (they may take weeks or even months to disappear).
It is important to systematically rotate injection sites along with proper needle replacement.
A healthcare professional should assess the injection sites at least once a year.
Cartridges or pens should not be shared between patients.

CAUSES THAT PREVENT PROPER INSULIN ABSORPTION

Loss of insulin activity due to improper storage.
Poor suspension of mixed or NPH insulins.
If a needle that is too long is used, the injection will be made into a muscle, or if it is too short, intradermal.
Poor rotation at the injection sites (leading to the formation of subcutaneous tissue calluses or lipodystrophy).
If the injection site has been exposed to higher temperatures (due to sun exposure, local heat, sauna, etc.), greater vasodilation occurs, increasing the rate of absorption and rapid action. The same occurs if we massage the injection site, or if we exercise, vigorously mobilizing the insulin injection site (if you are playing soccer, do not inject insulin into your legs).

PREPARING THE PEN FOR INJECTION

It is recommended to wash your hands with soap and water before handling the pen.
Check that the insulin corresponds to the amount to be administered at that time if the patient is to inject more than one type of insulin.
Remove the protective cap and check the appearance of the insulin. Some insulins should have clear, colorless, and particle-free contents, such as rapid-acting insulins or slow-acting insulin analogs (Levemir or Lantus). However, other insulins, such as NPH insulin or insulin mixtures, have a cloudy appearance and must be suspended (i.e., obtained as a homogeneous solution).
To do this, rotate the pen between the palms of your hands without shaking.
Then, attach the needle to the insulin pen. Remove the protective seal from the outer needle cap and insert the needle into the pen, screwing it on tightly. Finally, remove the outer needle cap and set it aside (you will need it to remove the needle later).
Remove the inner cover and prime the pen before injecting. This way, the insulin pen is fully ready for injection.

HOW TO INJECT INSULIN

Wash your hands with soap and water.
Load the pen with the insulin dose to be administered. Prime the needle with 1-2 IU to ensure proper permeability.
Disinfection with alcohol is not necessary if the area is well-hygienic.
Your dose can be injected into any of the areas indicated above; however, you should follow your healthcare professional’s recommendations on where to inject.
Hold the pen in one hand and, with the other, pinch with your index, middle, and thumb fingers, grasping the dermis and subcutaneous tissue without touching the muscle.
Once you have pinched the pen, hold the injection system with all your fingers with your other hand as if it were a dagger and stab firmly to reduce pain. Generally, it is recommended to use a 90° angle for injections, unless the needle is longer, when it should be a 45° angle. Once the needle is inserted into your body, press the injection button all the way in and then release the pinch. After completing the insulin injection, hold the needle against your skin for 10 seconds without removing it, to ensure proper insulin delivery and avoid dripping. If you remove the needle too quickly, insulin will leak, affecting the dose received. If blood oozes from the needle after removing it from your skin, press gently but do not rub.
Remove, recap, and dispose of the needle after each injection as directed by your healthcare professional to avoid accidental needle sticks. Never leave the needle in the pen between doses.
Replace the protective cap on the pen and store it in a safe place.

LITERATURE

Frid AH, et al. New Insulin Delivery Recommendations. Mayo Clin Proc. 2016 Sep;91(9):1231-55. doi: 10.1016/j.mayocp.2016.06.010. Review.
Frid AH, et al. Worldwide Injection Technique Questionnaire Study: Injecting Complications and the Role of the Professional. Mayo Clin Proc. 2016 Sep;91(9):1224-30. doi: 10.1016/j.mayocp.2016.06.012. Review.
Frid AH, et al Worldwide Injection Technique Questionnaire Study: Population Parameters and Injection Practices. Mayo Clin Proc. 2016 Sep;91(9):1212-23. doi: 10.1016/j.mayocp.2016.06.011.
Blanco M, et al. Prevalence and risk factor of lipohypertrophy in insulin-injecting patients with diabetes. Diabetes Metab. 2013:39(5):445-453.
Daria Roca. Enfermera Educadora en diabetes, Hospital Clinic de Barcelona.
Universidad de California, San Francisco
Socialdiabetes
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