Considerations for Self-Administered Insulin Injections

Patient A: Needles are expensive; each one costs several yuan. The nurse told me to change the needle every time I inject insulin. I don’t listen; isn’t it the same if I use it for a few times before changing? The hospital just wants to make money; who would change it every time?

Patient B: The nurse said you can inject insulin in the stomach, arms, thighs, and buttocks. But injecting elsewhere is inconvenient and painful. I prefer injecting in the stomach; it has more flesh, and it’s less painful. I’ll stick to injecting in the stomach.

Patient C: Insulin pens require disinfecting the needle every time—so troublesome. After each injection, I put on a new needle, so I don’t waste time disinfecting for the next time. The nurse didn’t even tell me about this easy method; I’m really clever.

Patient D: The nurse said to use alcohol for disinfection. I used a big bottle of alcohol at home for three months, just finished it. Isn’t iodine also a disinfectant? Why waste money buying it? I’m really a frugal expert.

Patient E: The nurse said insulin can be stored at room temperature after opening. I’ll place it next to the TV so that I can always see it, and I won’t forget to inject insulin.

People with diabetes, do these situations sound familiar? Perhaps you’ve had similar experiences or thoughts, but these are not correct.

Non-standard insulin injections can lead to bleeding, pain at the injection site, increased subcutaneous fat, and nodules. Subcutaneous nodules and hyperplasia can slow down insulin absorption and action at the injection site, resulting in poor blood sugar control, increased blood sugar fluctuations, and a higher risk of hypoglycemia. Due to poor skin absorption, the daily total dose of insulin is often higher, increasing healthcare costs. Therefore, standardized insulin injection is crucial!

Next, please see the standard steps for insulin injection.

Standardized Insulin Injection Procedure

1. Wash hands before injection.
2. Check insulin: Unopened insulin or insulin stored in the refrigerator should be taken out 30 minutes in advance and allowed to warm up at room temperature. (Opened insulin placed at room temperature, temperature <30°C, avoid heat sources such as appliances and heaters, effective for 28 days). Check the type: Check if the liquid is within the expiration date, sufficient amount, and if the drug is damaged or leaking.
3. Install the insulin pen cartridge: Remove the pen cap, unscrew the cartridge holder; insert the cartridge into the cartridge holder and tighten it; install the pen needle, reset the plunger. One-piece pens do not require cartridge installation; just disinfect and attach the needle for use.
4. Thoroughly mix pre-mixed insulin. Place the insulin pen flat in your hand, hold the insulin pen with both hands, flip it up and down 10 times, and roll it horizontally 10 times. For non-premixed insulin such as lente insulin, isophane insulin, and protamine insulin, there is no need to shake it.
5. Correctly install the pen needle and expel the air from the cartridge: Disinfect the front rubber membrane of the pen cartridge with 75% alcohol. Remove the special insulin injection needle, open the outer packaging, screw the needle clockwise, remove the outer needle cap, and set aside. Turn the dose adjustment knob to 1-2 IU, with the needle tip upright, gently tap the cartridge holder several times with your fingers to collect the air at the top. Press the injection button until a drop of insulin overflows from the needle, indicating that the plunger has completely contacted the pen cartridge, and the air bubble in the pen cartridge has been expelled. Turn the dose knob to the desired scale.
6. Check and disinfect the injection site. The human body has four suitable injection sites: ① 1 cm above the pubic symphysis, about 1 cm below the lower rib, and 2.5 cm away from the navel on both sides of the abdomen; ② The upper 1/3 of the front outer thigh on both sides; ③ The upper outer side of both buttocks; ④ The middle 1/3 of the outer side of the upper arm. It is crucial to rotate the injection site: Divide the abdomen into four quadrants, and rotate the injection site on the legs and buttocks in a different order each week. Then rotate clockwise, and the distance between injection points should be more than 1 cm.

Correct disinfection method: Use 75% medical alcohol for disinfection, do not use iodine, as insulin is a protein, and iodine may affect its activity. With the injection point as the center, disinfect the skin with alcohol from the center to the periphery, with a diameter of about 5 cm. Do not repeat wiping areas that have been wiped with alcohol to reduce contamination. Wait for the alcohol to dry before injecting.

7. Correct injection method: When injecting into the abdomen, overweight and obese children use a 90° angle for vertical injection without pinching the skin. For children with a slender physique or injections in limb areas, to avoid injecting the drug into the muscle tissue and increasing the risk of hypoglycemia, a pinching injection or a 45° angle should be used. When pinching the skin, use the thumb and forefinger to pinch up the skin, avoiding using multiple fingers to pinch up the skin.
8. After injection, leave the needle in place for at least 10-15 seconds before pulling it out. This ensures that the drug is completely injected into the body and prevents liquid leakage. When the injection volume is large, delay pulling out the needle. Maintain the same angle of the needle during the injection process and when pulling out the needle to prevent bending.
9. Handling insulin needle: After removing the needle, put the needle cap on and throw it into a hard-shell container with a lid, such as a mineral water bottle or a cardboard box, to bring it back to the hospital for disposal by medical staff during the follow-up visit.
10. After injection, the needle should not be left on the pen to avoid air entering the cartridge, liquid leakage, needle clogging, and the risk of misuse by children. Reusing injection needles is harmful; one needle should be used for each injection.