Drawing up insulin

Drawing insulin into a syringe to the correct dose with no air requires dexterity, concentration, good vision, and a steady hand. The bottle of insulin should be in date and the top should be clean (to clean use 70 per cent alcohol). Bottles of cloudy insulin should be rotated gently between two hands to mix the insulin. The insulin bottle is held vertically bung-down and the needle is inserted vertically so that insulin, not air, is drawn up. It is easier to withdraw insulin if air is injected into the bottle first. Air in the syringe can be expelled by tapping or by re-injecting insulin into the bottle to expel air bubbles. The dose is then checked and the needle withdrawn from the bung.

If insulins are to be mixed in the syringe it is important that the clear, short-acting insulin is not contaminated with cloudy, slower-acting insulin. Therefore the clear insulin is drawn up first. However, once the clear insulin has been drawn up the correct dose of cloudy insulin and no more must be drawn up. This technique is fraught with error. Some advisers suggest drawing up each insulin separately and injecting each through a detachable needle left in the skin or completely separately. Isophane

Drawing Insulin Syringe

(a) Attach needle to syringe if necessary

(b) Gently rotate bottle to mix insulin

(c) Draw up air and inject into the insulin bottle

(d) Draw up insulin

(e) Clear air bubbles

(f) Check syringe contains correct insulin dose

(g) Inject insulin into fatty layer under skin

(h) Withdraw needle

(i) Press on the hole

Fig. 9.3 Drawing up and injecting insulin

(a) Attach needle to syringe if necessary

(b) Gently rotate bottle to mix insulin

(c) Draw up air and inject into the insulin bottle

(d) Draw up insulin

(e) Clear air bubbles

(f) Check syringe contains correct insulin dose

(g) Inject insulin into fatty layer under skin

(h) Withdraw needle

(i) Press on the hole

Fig. 9.3 Drawing up and injecting insulin

(NPH) insulins make stable mixtures with short-acting insulins, but all the others are not stable and should be injected immediately.

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