Diabetes – Insulin injection techniques

Injecting insulin isn’t difficult, but takes some practice. Correct insulin injection technique isn’t uncomfortable, and allows your medication to work effectively.

Your doctor will show you how to inject insulin initially, but you can also follow these steps for successful self-injection.

Set out your medication equipment
Wash your hands.

Choose a suitable injection site:

Stomach/abdomen: inject at least two fingers’ width from your navel, as there are many veins in this area.
Upper and outer thighs: avoid injecting too near the bony area above the knee;
Upper arms: choose the outer, back area, which has more fatty tissue

Don’t always choose the same place, as this can damage the tissue and cause lipohypertrophy (lumps under the skin). Using multiple injection sites, and rotating these, allows them time to heal.

Try dividing each area into zones: abdomen – 4 zones, thighs – 2 zones, arms – 2 zones, buttocks – 2 zones. Use one zone each week, before moving to the next. Inject at least one finger’s width away from the previous injection.
Don’t inject through clothing: needles are designed to enter skin only. It can also cause bruising, blood-stained clothing and needle contamination (clothes aren’t sterile).

If using a syringe, use a new sterile needle every time. Needle tips become blunt, hooked or broken off with repeat use. This can cause painful injections and skin damage, leading to lipohypertrophy at injection sites, which can block the needle and interfere with insulin absorption.

Wipe the top of the vial with alcohol first; let it dry. Draw up the correct amount of insulin in the syringe. Expel the air from syringe and needle.

If using a pen, attach a new needle and turn the knob to the correct dosage.

Pinch and lift 2.5cm of skin and fat with your thumb and forefinger. Insulin injections are subcutaneous i.e into the fatty layer just under the skin. Injecting too deep may reach the underlying muscle, which has more blood vessels, causing faster absorption of the insulin and making blood glucose levels drop too quickly. Using a shorter needle can help prevent injection into muscle.

Insert the needle straight down, not at an angle.
Inject the insulin or press the knob.
Count slowly to 10 before removing the needle. Insulin may take slightly longer to come out of a pen than from a syringe.

Insulin shouldn’t drip from the needle: if it does, leave the needle in slightly longer next time.

Dispose of the needle in a sharps container or use a needle cutter – never in a dustbin or toilet.

Insulin storage tips:

Store unused pens in the fridge (2-8°C).
Don’t freeze insulin.
After opening an insulin vial, keep it at room temperature (15-25°C).
If insulin overheats, discard it.
When traveling, keep insulin in a cooler box with an icepack, covered with a towel to prevent it from getting too cold. Keep insulin in your hand luggage if traveling by bus or plane.

Suitable injection sites on the body:

Stomach: inject at least two fingers’ width from your navel
Upper, outer thighs: avoid injecting too near the bony area above the knee
Upper arms: choose the outer area, which has more fatty tissue
Buttocks

WHY IT’S IMPORTANT TO CHANGE YOUR NEEDLES

How often do you change your needles? We asked the Diabetic South Africans community that recently, and we were surprised by the answers. Most people only change their needles when they can feel they’re blunt, or when they change pens. But needles are actually supposed to be changed with every injection! We asked BD why.

WHY IS IT IMPORTANT TO CHANGE NEEDLES AT ALL?

There is increasing evidence that reusing a needle can cause micro-trauma and lead to lipohypertrophy (bumps and lumps under the skin) at injection sites. Changing your needle offers benefits such as: Less painful injections Less damage to the skin at the injection site Reduced contamination of the needle Take a look at this research article on the risk of repeated use of insulin pen needles.

WHAT HAPPENS TO NEEDLES IF THEY ARE OLD?

Needles become blunt as soon as they are used. Look at this frightening close-up of a needle that has been used – see how blunt it is!

How many times should you use a needle? Needles are for single use only, so a needle should only be used once.

DOES INJECTION TECHNIQUE MATTER?

Because pen and insulin syringe needles are designed with the thickness of the skin in mind, it’s not a good idea to inject through clothing. It can also lead to bruising, blood-stained clothing and contamination of the needle because clothes aren’t sterile. So it’s not a good idea!

DO YOU ROTATE YOUR INJECTION SITES?

For those of us who inject insulin, it can become very much part of our everyday lives – just one more thing we have to do before we eat. (Dish up, calculate the carb count, inject, and then eat!) It’s easy to fall into a bad habit of injecting into the same area every time we eat, but rotating injection sites is really important. Do you know how often you should rotate your injection sites? Here’s all you need to know.

Why rotating injection sites is important

It’s important to inject into different places in your body so that the injection sites have time to heal. If you inject into the same area over and over, it can lead to lumps and mounds under the skin known as lipohypertrophy. By rotating where you inject, you can inject into the same spot as little as possible.

Where to inject

The most common places to inject are in the stomach (abdomen) area, upper thighs, arms and top of the butt. Whichever you choose, divide the area into sections and inject into one section per week – but always one finger width away from the last injection. If you use the Zone System, you can divide the abdomen into 4 zones, the thighs into 2 zones, the butt into 2 zones and the arm into 2 zones. One zone can be used for one week, before moving on to the next zone.

Rotation rules

It’s important to use large, multiple injection areas so that you don’t repeatedly inject into the same spot. If you rotate zones, there will be plenty of time for your body to heal before the next round of injections into that zone. The end goal, of course, is for insulin to be absorbed properly and blood glucose to be as stable as possible. The right injection technique can be a big help in this regard, as it ensures you’re not developing lipohypertrophy.