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Guide to Diabetes

Injecting and adjusting doses 

Injecting insulin

 

Unfortunately insulin can only be injected because if swallowed it will be destroyed.

 

How to inject


When starting on insulin your diabetes specialist nurse/practice nurse will show you how to use your insulin device and help with the injecting technique.
They will show you the correct techniques on how to prepare your injection according to the delivery method you have decided with your diabetes team.

 

Injecting with pens/syringes

You can download pictures showing how to inject for the following by clicking on the link:

 

 

Injection techniques


Lift and fold technique

Lifted Skin Fold Technique - In order to avoid injecting insulin into the muscle you can do what is called a “Lifted Skin Fold” a correct skin fold is done with the thumb, index finger and middle finger, taking up the skin but not the muscle. (picture form GOSH NHS)

The grip on the skin fold should be kept throughout the injection and released once the needle has been removed.Inserting the needle
The full length of the needle should be inserted into the skin fold at 90 o (NOT at an angle).
 




Injection sites: Where do I inject and do I need to change the area that I inject? 

injection sites


The main insulin injection sites are into the fat of the:

  • Thighs

  • Buttocks
  • Stomach
  • Do not inject into the upper arm (muscle) or top layer of the skin.

 

These parts of your body absorb insulin at different rates, plan where to inject and ask your diabetes specialist nurse for advice. This is however different for each person and depends on the persons body. Your diabetes team will recommend a specific length of needle. This will help with maximum absorption. 
 

Rotating between injection sites

Rotating sites


Each injection site has different absorption pattern, you should keep a consistent site for each time of the day. DO NOT mix the site of injection and time.

For example
If it is recommended that you inject your morning insulin in the abdomen, you should not at times give morning injections in the thigh or else where, always in the abdomen.
 

Change where you inject regulary


Repeated insulin injections at the same place have been shown to be one of the causes of fatty lumps or “lipodystrophy”. This can cause unpredictable insulin absorption and affect your blood glucose readings. Sometimes bruising or bleeding may occur when injecting.

It is essential to prevent local skin tissue irritation and to prevent inconsistent absorption of insulin and to prevent fatty lumps appearing.

  • Check the injection sites every three months.
  • Change sides alternating from the right side to the left and vice versa.
  • Move about a fingers length away from the last injection site
  • No injections within 3cm of the belly button
  • Do not inject into hardened tissue, scars, moles bruises or tattoos.


Contact your diabetes specialist nurse/practice nurse if you are unsure or are still having problems with injecting insulin.
 

REMEMBER  NEW Injection - NEW needle!
 

Adjusting Insulin doses


It is important to realise that your insulin dose will change continually throughout your life and this depends on what you eat, how much you exercise, illness, climate, work, social activity and other circumstances. Your diabetes team will help you with this.
 

  • If your blood glucose levels are too high or low, changes of insulin dose may be needed and it is advisable to either increase or decrease by 10-20% of your insulin dose. Changes should not be made more than 2 times during the week. 
  • Sometimes blood glucose may go high or low for no reason. If this happens DO NOT adjust your insulin. 
  • If a pattern of highs and lows emerge you should adjust your insulin accordingly speak to your diabetes specialist nurse/practice nurse if in doubt.
  • Adjusting insulin doses when you are unwell See our sick day rules 
  • “How to adjust insulin using blood glucose results”for different insulin therapy regimes. See guidelines below
  • If you forget to take your insulin, a plan should be agreed to with your GP or diabetes specialist nurse, to deal with such a situation. If you are unsure contact your diabetes team.
  • You may be interested in joining our Insulin Management Group which is an educational session on dose adjustment.

 

Download information leaflets


Documents

Adjusting insulin- 2x daily premixed (PDF 41KB)

 Download Document

Adjusting Insulin-2x Non- premixed 09 (PDF 41KB)

 Download Document

Adjusting Insulin-Basul Bolus Humulin (PDF 41KB)

Information about adjusting doses Download Document

Adjusting Insulin-Basul Bolus Lantus (PDF 41KB)

Information about adjusting doses Download Document

Injecting with a Pre-loaded Pen (PDF 344KB)

Illustrated example Download Document

Injecting with a Reusable Insulin Pen (PDF 340KB)

Illustrated example Download Document

Lifted Skin Fold Technique (PDF 135KB)

Illustrated example Download Document

Mixing insulins in a Syringe (PDF)

Illustrated example Download Document

The Skin Structure (PDF 156KB)

Information about the skin and correct and safe injection technique Download Document