2015-11-20
We all grew up with some dread about those occasional visits to the doctor — and usually it was that fear of getting a shot.
Now that you’re the one commissioned to give the shot, we know you may have reservations and a heightened fear at pricking your loved one. Remember though, that insulin injections are subcutaneous, meaning the area between the skin and the muscle, so the needles are usually smaller and shorter than you’re imagining.
We also know that you want it to be as pain-free as possible, so it’s important to keep in mind that confidence (while gained with practice) may also be faked in order to help put your loved one at ease. If you are cringing every time you give a shot, this will also increase anxiety and fear in the person receiving the injection. So try to relax!
Talking to your loved one and asking them questions may also help reduce anxiety. This communication (that isn’t about the injection) helps to distract the person receiving it. Before you both know it, it’ll all be over for both of you.
Speed is another key way to decrease discomfort. And the more you do it, the faster you’ll become. You aren’t going to be a pro at the start, so don’t expect to be. With a little bit of practice though, you’ll be able to administer insulin in your sleep (although we don’t recommend this).
Note: This information is for educational purposes only and is not medical advice. For specific guidance on giving an insulin injection, please talk with your doctor.
CHECK YOUR INSULIN
Insulin has an expiration date, so be mindful of this and don’t use expired insulin. Seriously — just toss it. Insulin also can’t be stored in the freezer, or left in direct sunlight. If you were keeping it cool in a bag or the refrigerator, give it time (30 minutes) to warm up to room temperature. Once you open a vial you can keep it room temperature for around 28 days. There are several different brands of insulin, so know which one you’re using and its dosage.
You’ll want to make sure there are no “clumps” inside the bottle of insulin. Sometimes this can happen when a bottle is shaken around too much, so if you spot any, don’t use that bottle and get another.
Depending on the type of insulin, you may need to gently mix it. “Short-acting” insulin is clear and does not need to be mixed. “Intermediate” or “long-acting” insulin does need to be mixed and usually appears cloudy. Gently rolling the bottle between your palms for a few moments will do the trick, but remember not to shake it.
GET EVERYTHING YOU NEED
- Syringe, with needle.
- Alcohol swabs – You’ll want to wipe off the top of the bottle as well as the skin around the injection spot.
- A “sharps” container, which is basically any sturdy box with a lid where you can keep the used needles and syringes. There are rules about how and where you can dispose of these, so check in your area for what is most convenient for you. Keep in mind that you may need a specific type of container depending on which disposal option you choose.
WASH YOUR HANDS
Don’t get lazy and skip this … who knows what invisible bacteria or viruses have collected on your apparently clean fingers, and minimizing germs before puncturing your loved one is the best way to reduce the chance of skin irritation or infection.
PICK AN INJECTION SPOT
You want to inject an area of fat, not muscle, and there are several common areas for injections (the abdomen, upper legs or thighs, or the back of the arms). It’s important to rotate your injection spots — always at least 1 inch from your last, 1 inch from any scars, and 2 inches from the navel. Some doctors will even provide a chart to help you keep track.
Avoid any spots that are swollen or bruised. Make sure the skin is clean, and you can wipe this area with alcohol to make sure. Remember to let the alcohol dry before you inject, but don’t try to speed it up by blowing on it. (You want less germs, not more.)
FILL THE SYRINGE
After you pop the cap off and give the top a quick wipe with the alcohol, set the bottle on a flat surface. Grab your syringe and then pull back the plunger (filling it with air) to the amount you plan to inject. Then insert it down into the bottle and press the plunger down. This will push air into the bottle, which will add pressure and make drawing the insulin a bit easier.
Turn the bottle upside down and draw the plunger on your syringe back until you have the proper amount. You do not want any air bubbles in your syringe, so give it a little tap or push some back up into the bottle to make sure. Double-check that you still have the correct dosage in your syringe afterward.
Pull out the syringe; set it down with the bottle. And please — don’t touch anything with the needle and contaminate it. Now you’re ready …
INJECT
The key to minimizing the pain of an injection is speed. You want to make quick, decisive motions and stick your loved one at a straight angle — no waggling the syringe after you make contact. Some other tips include making sure your insulin is at room temperature (there’s more discomfort when it’s cold) and encourage your loved one to relax his or her muscles before injecting.
Pinch a hunk of flesh around where you want to give the shot. This should give you an area with enough fatty tissue underneath, so you’ll want to aim straight down (at a 90-degree angle) into the skin, but if your patient is lean and there’s not much flab there, keep the needle at a slight (45 degree) angle instead. Remember, you want to avoid muscle, and doing so will also be less painful.
Hold the syringe firmly — like a dart — a few inches away from your loved one’s skin … and then bring it down with a quick motion. Don’t overthink it — just jab the needle all the way in. Now let go of the skin, push down the plunger on the syringe smoothly to inject the insulin, and then wait 5-10 seconds before pulling the needle out (at the same angle you poked it in).
Ditch the needle and syringe in your sharps container. Never reuse either.
If there’s a little insulin leak or a bit of blood from the injection site, press down on the area but avoid rubbing it. You can use a cotton ball or a wipe, and even a small bandage if you like. If this happens consistently or if your loved one repeatedly develops redness or swelling after an injection, then mention it to your doctor for further advice.
CONGRATULATIONS
Kudos to you both! To reward yourself and your loved one, you might keep some (sugar-free) lollipops on hand. A fist bump, “in the house” chant or a traditional high-five would also do.
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Read More
Some people with diabetes need to take insulin every day. Insulin is a hormone that helps the body manage blood sugar when a person injects it. The area of skin through which the injection occurs can change its effects.
A person cannot take insulin as a pill or oral medication. The enzymes in the stomach would break down the insulin before it reaches the bloodstream.
People use insulin injections to treat and manage diabetes alongside dietary and lifestyle changes, and oral medications.
For people who require insulin injections, different types of insulin are available. In this article, we explain how to follow the doctor’s instructions on how and where to inject insulin.
Image credit: Stephen Kelly, 2019
A person needs to inject insulin into the layer of fat directly under the skin, known as subcutaneous tissue, with a small needle or a device that looks like a pen.
Several different sites can support an insulin injection.
Abdomen
The abdomen is a common site for insulin injections that many people with diabetes choose. It is easy to access and often less painful than other sites due to protection by fat, greater surface area, and less muscle.
To give an injection into the abdomen, pinch a section of fatty abdominal tissue, with fingers either side.
The site should be between the waist and the hipbones about 2 inches away from the belly button.
Avoid injecting near any scar tissue on the abdomen.
Upper Arms
The upper arm is another possible site for insulin injection.
Place the needle into the tricep area at the back of the arm, about halfway between the elbow and the shoulder.
Difficult self-administration is the main disadvantage of this site. Getting enough of a pinch to administer the insulin can be tricky. A person might need assistance for an injection into the upper arm. They might also experience greater comfort while injecting into the non-dominant arm.
This means injecting into the left arm of a right-handed person or the right arm of a left-handed person.
Thighs
The thigh is a simple area for self-injection.
When choosing the thigh as an injection site, insert the needle into the front of the thigh, halfway between the knee and the hip. It should be slightly off center towards the outside of the leg.
The injection should take place around 4 inches, or about the width of a hand, above the knee and the same distance from the top of the leg. Avoid the inner thigh due to the denser network of blood vessels in that area.
Inject the medicine into a pinch of at least 1–2 inches of skin.
Though easy to access, regular injections in the thigh can sometimes cause discomfort when walking or running afterward.
Lower back, hips, or buttocks
The final site for administering an insulin injection is the lower back or hip.
To administer an injection here, draw an imaginary line across the top of the buttocks between the hips.
Place the needle above this line but below the waist, about halfway between the spine and the side.
As with the upper arm, this site is very difficult to use for self-injection and may require another person for administration. When injecting into the buttocks, avoid the lower part.
The body absorbs insulin at different speeds from each of the sites. This information can be useful when planning insulin injections:
- Abdomen: Insulin enters the bloodstream most quickly after an abdominal injection.
- Upper arms: The body absorbs insulin with moderate speed but slower than an injection in the abdomen.
- Lower back and thighs: Insulin enters the bloodstream most slowly from these sites.
- Administer rapid-acting insulin into the abdomen right after a meal for the fastest results.
Inject long-acting and intermediate-acting insulin into the other sites, as rapid absorption would reduce the effectiveness of these types. Insulin works more efficiently over the entire time it needs to because of the slower absorption rate.
Exercise can increase the absorption rate of insulin. If planning a workout or physical activity, account for these when planning injections.
For example, a baseball pitcher should avoid injecting into their throwing arm. The physical activity can affect the absorption of insulin into the body.
Wait to for at least 45 minutes after the injection to exercise a part of the body that is near the injection site.
Avoid injecting into the same site over and over. This can irritate the skin and underlying fatty tissue.
If this happens, it may increase discomfort and cause other complications. Puncturing the same point every time can lead to hard lumps or fatty deposits developing. This can be uncomfortable and even reduce the body’s effectiveness in absorbing the medication.
When rotating injections, move around within the area to ensure that the injection does not always take place in exactly the same spot.
For example, when taking a night time dose of long-acting insulin, a person might always feel more comfortable injecting it into the thigh. However, they should switch between the right and left thigh each night.
If a person always administers a morning dose of rapid-acting insulin into their abdomen, they should alternate between different areas of the abdomen to avoid repeated injections into the same site.
Ask the doctor any questions about insulin injection, site selection and rotation, and other injection techniques.
In addition, people with diabetes should monitor their blood sugar routinely, as the doctor will advise.
It is important to keep track of blood sugar levels in a diary or notebook for sharing with the doctor. Share any unusual values so that the doctor can adjust insulin dosage and delivery as is necessary.
Read more on self-monitoring glucose levels here.
A person can administer insulin injections into the abdomen, upper arm, thigh, lower back, hips, or buttocks.
Take into account comfort, as injections into some sites can cause pain. Be sure to inject into a pinch of tissue and consider the different methods for injection at each site.
Each site delivers insulin to the bloodstream at different speeds, so consider these depending on the time of day and how fast the body needs insulin.
Avoid repeatedly administering injections to the same spot. Speak to a doctor for advice on switching sites and self-administering.