Josefina E Florendo, Rn, Man

Josefina E. Florendo, RN, MAN Insulin Injection Certification Workshop:Insulin Injection Techniques INSULIN TECHNIQUES

Objectives At the end of the presentation, the participants will be able to: 1 . State ways to administer insulin safely; 2. Identify interventions to prevent problems associated with

insulin administration; 3. Demonstrate the competencies expected in the

administration of insulin.

Josefina E. Florendo, RN, MAN

INSULIN  Most powerful and effective pharmacologic tool available

to treat diabetes.

Insulin Preparations Class

Agents

Human insulin

Regular, NPH, lente

Insulin analogues

Aspart, Glulisine, Lispro, Glargine, Detemir

Premixed insulin

Human 70/30, 50/50 Humalog mix 75/25 Novomix 70/30

 Its potential to lower plasma glucose levels is limited only

by hypoglycemia.  Sustained near-normal blood sugar to prevent the onset

and progression of long-term complications is the major treatment goal of insulin therapy.

INSULIN ADMINISTRATION

 Insulin therapy is used to achieve

and sustain target-level glycemic  Delivered using various devices

Insulin Administration Devices

Josefina E. Florendo, RN, MAN Insulin Injection Certification Workshop:Insulin Injection Techniques Insulin Administration Devices Insulin pens Faster and easier than syringes

Insulin Pen

reusable pen

Improve patient attitude and adherence Have accurate dosing mechanisms, but inadequate mixing may be a problem

Hides needle to reduce anxiety disposable pens

Insulin Pump

Insulin Pump

Continuous subcutaneous insulin infusion (CSII) External, programmable pump connected to an indwelling subcutaneous catheter to deliver rapidacting insulin

External, programmable pump connected to an indwelling subcutaneous catheter to deliver rapidacting insulin

INSULIN ADMINISTRATION

Insulin Administration Devices Inhaler 

Designed for people with: Poor eyesight Dexterity problems Learning difficulties

No longer available

Technique employed in administration may affect absorption rate and eventually the blood glucose levels.

Josefina E. Florendo, RN, MAN Insulin Injection Certification Workshop:Insulin Injection Techniques Injection Tips



Insulin Tips

Do NOT wipe the needle with alcohol as it removes the protective coating.

 Absorption differs in various areas of the human

The coating makes injection easier and less painful

 The new shot can be given in the area with the

body.

distance of 1 to 2 fingers from the site where the last shot was given.

Insulin Tips

Site Selection/ Rotation

Injecting any insulin at the same site repeatedly over time or blunting a needle with re-use can cause a lipodystrophy: either lipoatrophy or lipohypertrophy. Either makes absorption unreliable.



Varying the injection site can cause variability in action profile.

Lipodystrophy

Insulin Tips 

Eliminate bubbles     

Keep vial upright Draw insulin slowly Re-inject insulin into vial when air bubble get into the syringe Tap the syringe with a finger or two to remove air bubbles while holding it upright

Josefina E. Florendo, RN, MAN Insulin Injection Certification Workshop:Insulin Injection Techniques Insulin Tips 

In mixing clear and cloudy insulin, bubbles can be removed from the clear insulin, which is drawn first. but can't remove bubbles after both insulins are in the syringe.

Insulin can’ t be pushed back into the bottle of cloudy insulin, from the syringe which already contains clear insulin. This would cause two problems: * Y ou won't get the full amount of clear insulin *

Insulin Tips

Cold Insulin Bring to room temperature to prevent sting * Remove from fridge before administration * Warm capped syringe with hands * Do not warm insulin using stove or microwave

that you need It will change the insulin in the cloudy insulin bottle (because some clear insulin has been mixed into it)

Insulin Tips  Do Not Use Insulin If:  



bottle appear to be frosted clear insulin that looks discolored, turned cloudy, or hazy cloudy insulin that is appears yellowish or remains lumpy or clotted after mixing

Preventing leakage Release pinch or squeeze Count to 10 before removing the needle

Injection Tips

Injection leakage  Cause

holding pinch too long when shot is given forces some of the insulin back from the newly created hole in the  Short needle can cause insulin leakage  Pinch

Bleeding at Site of Injection  usually caused when the syringe punctures a tiny blood vessel  can be stopped by putting pressure on the injection site with finger or a cotton ball. Be sure that you:  Don't

rub the spot. light pressure with your finger to prevent bruising.  If a bruise does appear, don't use that injection site again until the bruise is gone.  Maintain

Josefina E. Florendo, RN, MAN Insulin Injection Certification Workshop:Insulin Injection Techniques

To keep your blood glucose on target follow these two rules for proper site rotation:  

Same general location at the same time each day. Rotate within each injection site.

Injection Site  Do not inject close to the belly button. Do not inject close to moles or

scars. The tissue there is tougher  insulin absorption will not be as consistent.  Injecting in the upper arm, use only the outer back area (where the most fat is). It is hard to pinch the upper arm when doing self injection. Try pressing upper arm against a wall or door.  When injecting in the thigh, stay away from the inner thighs. If thighs rub together when walking, if might make the injection site sore.  Do not inject in an area that will be exercised soon. Exercising increases blood flow, which causes long-acting insulin to be absorbed at a rate that’ s faster needed.

Insulin Absorption 

Insulin is absorbed fastest when injected into the subcutaneous tissue in the abdomen (stomach), and somewhat less quickly in the upper arms, thighs, and buttocks/hips.

The difference in absorption rates can be used to plan where to inject insulin. For example:  Rapid-onset insulin can be injected into the abdomen just before or right after you eat a meal to take advantage of the abdomen's fast absorption rate.  NPH insulin can be injected into a different site (arms, thighs, or buttocks), to take advantage of the slower absorption rate while you sleep.

Insulin Absorption  Inject breakfast and lunch bolus doses into the abdomen

because Insulin is absorbed fastest when injected into this area. Fast absorption is needed at mealtimes to cover the carbohydrates you are about to eat.  The supper or bedtime dose of long-acting insulin could

be injected into the thigh, buttocks, or upper arm so the long-acting insulin can take effect gradually and cover needs throughout the night.

Insulin Absorption

   

Fastest from the abdomen A little slower from the arms Even slower from the legs Slowest from the buttocks

Exercise can affect the absorption rate  playing basketball after injecting choose a site other

than the shooting/dribbling arm, since injecting there can increase the absorption rate.  If it is preferred to inject near a part of body used when exercising  wait at least 45 minutes after injecting before starting activity.