Injecting insulin

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Insulin is injected subcutaneously. If the injection is too shallow, a painful intradermal blister may be raised. Insulin absorption will be unpredictable. If the injection is too deep the insulin will enter the muscles where it will be absorbed more rapidly than anticipated. It is important that patients understand what is meant by subcutaneous. It is not enough to say 'under the skin'. The patient should take a thick pinch of skin

(a) Gently rotate bottle to mix insulin

(c) Inject air into cloudy insulin bottle

(d) Put cloudy insulin down

(f) Inject air into clear insulin bottle. Draw up clear insulin

(g) Express air bubbles and check you have drawn up correct dose of clear insulin

(h) Draw up correct dose of cloudy insulin

(i) Ready for injection

(a) Gently rotate bottle to mix insulin

(c) Inject air into cloudy insulin bottle

(d) Put cloudy insulin down

(f) Inject air into clear insulin bottle. Draw up clear insulin

(g) Express air bubbles and check you have drawn up correct dose of clear insulin

(h) Draw up correct dose of cloudy insulin

(i) Ready for injection

Fig. 9.4 Mixing insulin and subcutaneous tissue and insert the needle at an angle of 45°. The insulin is then injected, the needle left in situ for a few seconds, and then withdrawn. Some patients press a clean tissue, cotton wool swab, or finger over the hole for a few moments.

If the skin is dirty it should be washed and dried. There is no need to use alcohol or other spirit swabs unless the person cannot wash. These may cause the injection to sting and surgical spirit hardens the skin. Bruising occurs occasionally as does a tiny trickle of blood. Patients need to be reassured that this is most unlikely to mean that the insulin has been injected intravenously. Some doctors advocate withdrawing the plunger before injection to ensure that a vein has not been entered, but many no longer consider this useful.

Pinch

Fig. 9.5 Injecting insulin

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