Patient Education Insulin Basic facts Insulin is a protein made by the pancreas that allows your cells to use glucose for energy. There are different types of insulin: Basal long-acting insulin that controls blood glucose when not eating. Prandial short-acting insulin that controls blood glucose after eating. What is insulin? Insulin is made by the pancreas and helps 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 so must take 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. The types of insulin differ in onset (how soon they start to work), peak (greatest effect), and duration (how long they work). 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 basal and prandial insulin to control their blood glucose. Basal Insulin Type of Insulin Appearance Onset Peak Duration Injections per Day* NPH Cloudy 2 to 3 4 to 5 8 to 12 2 to 3 Glargine (Lantus ) Detemir (Levemir ) Clear 1 to 2 None About 24 1 to 2 Clear 1 to 2 None Up to 24 1 to 2 * 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.
Page 2 Insulin syringes and pen needles should be used only one time. The needles are very thin and can be damaged with repeat use. Syringes and needles must be thrown away in a sharps container. Ask your diabetes educator for advice. Prandial Insulin All prandial insulin should be clear. Check your insulin before using it to make sure it is clear (not cloudy). Type of Insulin Onset (minutes) Peak Duration Injections per Day Regular 30 to 60 2 to 3 6 to 8 2 to 3 Lispro (Humalog ) Aspart (Novolog ) Glulisine (Apidra ) less than 15 1 to 1.5 4 3 to 4 less than 15 1 to 1.5 less than 5 3 to 4 less than 20 1.5 5 3 to 4 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 give your insulin. Ask your diabetes educator for details. How do I store insulin? Unopened insulin bottles and disposable pen devices should be kept in the refrigerator, (do not freeze) and are good until the expiration date marked on the bottle or pen. Open bottles or pens should be stored at room temperature (less than 85 F). Check with your pharmacist or diabetes educator about how long you should use an open bottle or pen. Each time you use your insulin, make sure clear insulin is still clear, and cloudy insulin is uniformly cloudy. Throw away any insulin that doesn t look right, and use a fresh bottle or pen. Always keep a spare bottle or pen of each kind of insulin you use on hand for emergencies. What types of insulin syringes are there? Insulin syringes come in 3 sizes. You will use 3/10 ml (holds 30 units), ½ ml (holds 50 units), or 1 ml (holds 100 units), depending on how much insulin you take per injection. Insulin syringes come with needles attached. Insulin pen devices do NOT come with needles attached. You will need to put a new needle on each time you use your insulin pen. What types of needles are there? The diameter or thickness of the needle is called its gauge. The smaller the diameter of the needle, the larger the gauge is. Needles come in short or standard lengths. Short needles should only be used for children or very thin adults.
Page 3 Can I mix more than one type of insulin in a syringe? NPH insulin can be mixed with regular, Lispro (Humalog ), Aspart (Novolog ), and Glulisine (Apidra ) just before injection. Ask your diabetes educator for details. Glargine (Lantus ) and Detemir (Levemir ) CANNOT be mixed with any other insulin. When mixing insulin, always go from fastest onset to slowest. For example: Lispro/Aspart/Glulisine then Regular then NPH. Glargine (Lantus ) and Detemir (Levemir ) CANNOT be mixed with any other insulin. Giving 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 (Figure 1). Dry your hands well. 3. If using NPH 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. Clean the rubber stopper on the top with an alcohol pad. 5. Remove the cap from the needle (Figure 2) 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. (This prevents a vacuum forming in the vial, which can make it difficult for you to draw up your insulin.) 7. With the needle still in the vial, turn the vial and syringe upside down. 8. Slowly pull the plunger to your dose of insulin. 9. Check for air bubbles. If bubbles are present, inject the insulin back into the vial and repeat step 8. 10. Remove the needle from the bottle and inject as described on the next page. Figure 1: Wash hands with soap and water. Figure 2: Remove the cap from the needle.
Page 4 Figure 3: Gently pinch the skin and fat tissue between your thumb and middle finger. How 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. 1. Gently pinch the skin and fat tissue between your thumb and middle finger (Figure 3). 2. Put the needle straight into the pinched tissue (90 angle). Push the needle all the way in (Figure 4). 3. Let go of the pinched tissue, and inject the insulin by slowly pushing the plunger down (Figure 5). 4. Count slowly to 5 and then remove the needle. This prevents insulin from leaking out of the injection site (Figure 6). 5. Dispose of needles and/or syringes in a sharps container (Figure 7). Figure 4: Put the needle straight into the pinched tissue at a 90 angle. Push the needle all the way in. Figure 6: Remove the needle after counting to 5 slowly. DO NOT insert the needle like this. Figure 5: Let go of the pinched tissue and inject the insulin by slowly pushing the plunger down. Figure 7: Put needles and/or syringes in a sharps container.
Questions? Your questions are important. Call your doctor or health care provider if you have questions or concerns. Tips to Reduce Injection Pain Inject insulin at room temperature. Remove air bubbles from the syringe before injecting. Avoid changing the direction of the needle during insertion/removal. Do not reuse needles. Do not pinch too tightly. 1959 N.E. Pacific St. Seattle, WA 98195 University of Washington Medical Center 02/2008 Reprints: Health Online