Patient Education Pharmacy Services
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- Charleen Jackson
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1 Patient Education This handout details the types of insulin. It also covers how to store, mix and inject insulin. What is insulin? Insulin is made by the pancreas and acts as a key to move glucose (sugar) from the blood into cells where it is used for energy. People with Type 1 diabetes make little or no insulin, and thus must give insulin injections (shots) every day to survive. Sometimes people with Type 2 diabetes also need to take insulin injections to control their blood glucose. Insulin cannot be taken as a pill because the acids in the stomach would destroy it. What types of insulin are there? There are several types of insulin. All insulin used today is human insulin. They differ in onset (how soon they start to work), peak (maximum effect) and duration (how long they last). Basal insulin is long acting and controls blood glucose when you are not eating. Prandial or food insulin works more quickly, but does not last as long as basal insulin. Many people need both a basal and a prandial insulin. Basal Insulin: Type of Basal Insulin How it looks Onset Peak Duration # Injections per day* NPH Cloudy to 3 Lente Cloudy Ultralente Cloudy Glargine (Lantus ) Clear 2 None >24 1 *Most patients take this number of injections per day of that type of insulin. Your provider may have you give your basal insulin more or less often. All basal insulin except Glargine (Lantus ) can be mixed in a syringe with prandial insulin.
2 Page 2 Prandial Insulin: Type of Prandial Insulin Onset (min.) Peak Duration Regular Lispro < (Humalog ) Aspart (Novolog ) < <5 3-4 # Injections per day Prandial insulin must be injected before eating so that it is ready to do its job when you eat. The onset of your prandial insulin will determine how soon before you eat you should inject your insulin. Ask your diabetes educator for details. How do I store insulin? Unopened insulin should be kept in the refrigerator, (do not freeze) and is good until the expiration date marked on the bottle. Open bottles of insulin can be stored at room temperature (<85 o F) for 30 days. Each time you use your insulin you should inspect it to make sure that clear insulin remains clear, and that cloudy insulin is uniformly cloudy. If your insulin has clumps or is supposed to be clear and appears cloudy, you should throw it away and get a fresh bottle. Always keep a spare bottle of each kind of insulin on hand for emergencies. Giving an Insulin Injection What types of insulin syringes are there? Insulin syringes come in 3 sizes. You will use 3/10 cc (holds 30 units), ½ cc (holds 50 units) or 1cc (holds 100 units) depending on how much insulin you take per injection. Insulin syringes come with needles attached. The diameter or thickness of the needle is called its gauge. The smaller the diameter of the needle, the larger the gauge of the needle. Needles come in short or standard length. Short needles should only be used for children or very thin adults. Insulin syringes and needles should be used only once. The needles are very thin and can be damaged with repeated use. Insulin syringes and needles must be discarded in an appropriate sharps container. Ask your diabetes educator for advice about containers.
3 Page 3 Where do I inject insulin? Insulin is injected into the subcutaneous tissue (fat layer just under the skin) in the stomach, outside of the upper arm, front/sides of the thighs, buttocks, or hip areas. Your diabetes educator will teach you the correct way to give an insulin injection. How do I draw up the insulin into a syringe? 1. Gather your supplies (insulin, syringe, alcohol pads). 2. Wash your hands with soap and water. Dry your hands well. 3. If using cloudy insulin, make sure it is uniformly cloudy (mixed) by rubbing the bottle between the palms of your hands and by turning it end to end. Do not shake insulin. 4. If using a new bottle, remove the colored plastic cap. For both new and previously opened bottles, clean the rubber stopper on the top with an alcohol pad. 5. Remove the cap from the needle and pull the plunger on the syringe back to the number of units you will be using. 6. With the insulin vial on a table put the needle straight into the rubber stopper. Push the plunger down to inject air into the vial. 7. With the needle still in the vial, turn the vial and syringe upside down. Pull the plunger to fill the syringe past your dose of insulin. 8. Slowly push the plunger back to your dose of insulin. 9. Check for air bubbles. If bubbles are present, inject the insulin back into the vial and repeat steps 7 & Remove the needle from the bottle and inject as told by your diabetes educator.
4 Page 4 How do I mix more than one type of insulin in a syringe? Warning: Glargine (Lantus ) Insulin cannot be mixed with any other insulin. 1. Gather your supplies (insulin, syringe, alcohol pads). 2. Wash your hands with soap and water. Dry your hands well. 3. Know your dose for each type of insulin you will be injecting. + = Units of 1 st Insulin (Lispro, Aspart, Regular) Units of 2 nd Insulin (NPH, Lente, Ultralente) Warning: Insulin Glargine cannot be mixed with any other insulin Total units of insulin 4. If using cloudy insulin make sure it is uniformly cloudy (mixed) by rubbing the between the palms of your hands and by turning it end to end. Do not shake insulin. 5. If using a new bottle, remove the colored plastic cap. For both new and previously opened bottles, clean the rubber stopper on the top with an alcohol pad. 6. Remove the cap from the needle and pull plunger back to the number of units of 1 st insulin you will be using. Inject this into the insulin bottle with the bottle upright on a table. Repeat process for the 2 nd insulin. Do not touch needle to the insulin in the bottle. 7. Remove the needle from the 2 nd insulin bottle. Insert the needle into the 1 st insulin bottle. Tip the bottle and syringe upside down, and draw the plunger down to the number of units you will need. Pull the needle straight out of the bottle. 8. Insert the needle into the 2 nd type of insulin and draw the plunger to the total number of units you will need of both types of insulin. 9. Remove the needle and inject as told by your diabetes educator.
5 Page 5 When Mixing Insulin Always Go from Fastest Onset to Slowest Lispro/Aspart Regular NPH/Lente Ultralente How do I inject insulin? Choose your injection site. Pinch the skin and fat tissue between your thumb and first finger. Put the needle into the pinched tissue at a 90 o angle. Push the needle all the way in. Let go of the pinched tissue. Inject the insulin by using a slow and steady push on the plunger. Count slowly to 5 and then remove the needle. This will prevent insulin from leaking out of the injection site. Dispose of your used needles and syringes in a sharps container. Tips To Help Lessen Injection Pain Inject insulin at room temperature. Remove all air bubbles from the syringe before injection. Avoid changing the direction of the needle during insertion or removal. Do not reuse needles. Do not pinch too tightly.
6 Page 4 Questions? Your questions are important. Call your doctor or health care provider if you have questions or concerns. UWMC Clinic staff are also available to help at any time. Notes Your Provider s Name: Your Provider s Phone Number: Box N.E. Pacific St. Seattle, WA University of Washington Medical Center 10/2002
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