Syringes and needles

More and more, people are using insulin pens to administer their insulin (I discuss these devices later in this chapter). Compared to a syringe and needle, the pen is just more convenient and easier to determine the correct dose. However, you and your child still need to know how to measure and deliver insulin with a syringe and needle (the oldest and still most common method for delivering insulin) in case you run out of pens or pen refills.

Numerous different brands of syringes and needles are available. Here are some of their common features:

i Syringes come in sizes of 1 ml (100 units), 0.5 ml (50 units), and 0.3 ml (30 units). Disposable syringes may be reused as long as the needle remains sharp.

If you're using less than 30 units of insulin for all shots, the 0.3 ml syringe is easiest to use. If you use more than 30 but less than 50 units, the 0.5 ml syringe is best.

i Needle size is either >2 inch or Ke inch. Children usually use the shorter needle.

i Needle gauge is 28, 29, 30, or 31. The higher the number, the thinner the needle. The thinner needles are less painful and are preferred for children and adults alike.

i Packages contain 100 needles and syringes already connected.

The syringe shown in Figure 10-2 is a 1-ml syringe that can hold a maximum of 100 units of any insulin. There are ten longer lines along the barrel that mark the syringe each time ten more units of insulin are added and that read 10, 20, 30, and so forth. Between the longer ten lines are ten shorter lines representing 1 unit each. At the fifth unit, the line is longer than the 1-unit line but shorter than the 10-unit line.

Figure 10-2:

An insulin syringe and bottle.

The bottle in Figure 10-2 is a typical bottle of insulin. When it's new, the top is covered by an aluminum cap that you break off and discard when using the insulin. Under the cap is a rubber stopper through which you push the needle to obtain the insulin. The stopper neatly seals itself when the needle is removed.

Every bottle of insulin has an expiration date on it. You can keep it in the refrigerator until that expiration date, and then discard it. You can have it at room temperature for four weeks before the expiration date, but then you must obtain new insulin. Insulin that has been stored at temperatures above 86 degrees F loses its potency; you can still use it, but discard it as soon as you can get new insulin. Insulin that has been frozen should be discarded.

Taking (or giving) a shot

If the insulin is rapid-acting or regular, it should be clear, and you don't have to roll the bottle. Intermediate-acting insulin (NPH) is cloudy, and you need to roll the bottle a few times to suspend the tiny particles in the liquid. A new bottle has a cap on the top, which you break off and discard. When you're ready to give insulin to your child (or take it yourself), wipe the rubber stopper in the top of the bottle with an alcohol wipe.

Make sure that you've selected the correct type of insulin before you draw it up into the syringe. Suppose that you need to give (or take) 25 units. Follow these steps to load the syringe with insulin:

1. Pull the plunger of the syringe out, pulling in air, until the end of the plunger is at the 25-unit mark, the line exactly between 20 and 30 units.

2. Turn the insulin bottle upside down, and insert the needle into the soft rubber stopper until it's in the liquid insulin.

3. Push the plunger so that the air in the syringe goes into the insulin bottle, and then pull the plunger out to the 25-unit mark. Leave the needle inside the bottle.

4. Make sure there's no air in the syringe; you can tell by looking for air bubbles. If there is air, push the plunger back in to discard the insulin.

5. Pull the plunger out again to the 25-unit mark, and repeat Step 4 if necessary.

6. Pull the syringe and needle out of the insulin bottle.

After you select an injection site (refer to the earlier section "Before you begin: Selecting an injection site"), push the needle into the skin until it goes no further. Push the plunger down to zero. You've successfully given insulin.

If you're giving your child an insulin shot, he's probably had many shots in the hospital. He should know that they're just about painless, and he shouldn't put up much of a fuss about receiving them.

Mixing two types of insulin

You can mix two different kinds of insulin in one syringe with the exception of long-acting insulin glargine and detemir insulin. You may need to mix insulins if you're giving NPH insulin combined with a rapid-acting insulin, for example. Here are the steps to follow to mix insulin:

1. Wipe both bottles with alcohol wipes.

2. Pull out the plunger on the syringe to draw up the total units of air corresponding to the total insulin you need, both rapid- and long-acting.

3. Turn the long-acting insulin bottle upside down, and insert the needle into the soft rubber stopper until it's in the liquid insulin.

4. Push the units of air into the long-acting insulin bottle that correspond to the number of units of long-acting insulin you need, and withdraw the needle.

5. Turn the rapid-acting insulin bottle upside down, and insert the needle into the soft rubber stopper until it's in the liquid insulin.

6. Push the rest of the units of air into the rapid-acting insulin bottle, and then pull the plunger out to withdraw the correct number of units of rapid-acting insulin.

7. Insert the needle into the upside-down long-acting insulin bottle, and pull out the plunger to withdraw the correct number of units of long-acting insulin.

It's important to follow these steps to mix rapid- and long-acting insulin so that you don't contaminate the rapid-acting insulin with the additive in the long-acting insulin.

Aiding the use of syringes and needles

Many people are a bit squeamish and have difficulty looking at the syringe and needle they're about to use. The following injection aids either hide the tools or turn inserting the needle into pushing a spring-loaded button that pushes in the needle and then pushes in the plunger to give the insulin. Some of the injection aids on the market are

1 Autoject and Autoject 2: A spring-loaded plastic syringe holder

1 BD Inject-Ease Automatic Injector: A spring-loaded plastic syringe holder i Inject-Ease: A spring-loaded plastic syringe holder

1 Instaject: A syringe injector and blood lancet device i NeedleAid: A device that hides the needle of the syringe or insulin pen (which I discuss later in this chapter)

1 NovoPen 3 PenMate: A device that conceals the needle of an insulin pen

Some devices magnify the syringe so that a visually impaired patient can easily see the dose he's taking while holding the syringe and needle firmly. Some of them include:

i BD Magni-Guide: A magnifying device i Count-a-Dose: A device that converts pulling up the plunger of the syringe into audible clicks so that you can hear the dose i Syringe Magnifier: A magnifying device

1 Tru-Hand: A magnifying device

Some devices hold a syringe and needle firmly so that a physically handicapped patient can easily pull up the correct amount of insulin. The best of these include:

1 Holdease: A device that holds the needle and syringe together 1 Inject Assist: A device that holds the needle and syringe together 1 Inject Safety Guard: A device to protect the hand

1 NeedleAid: A device that stabilizes an insulin syringe or pen at the time of the injection

Many of these injection aids are available at pharmacies, and you can also find most of them on the Internet at diabetes supply Web sites. Two such sites are

1 www.diabeticexpress.com 1 www.diabeticsupplies.com

Disposing of syringes and needles

It's essential that you dispose of needles, syringes, and disposable pens (see the next section) in proper containers so that others don't reuse the syringes or stick themselves on the needles. Several companies make containers or other items to accomplish this important safety precaution (you can find them at the Web sites mentioned in the preceding section).

1 BD Home Sharps Container holds 70 to 100 syringes or 300 pen needles.

1 BD Safe-Clip clips and stores up to 1,500 needles.

1 BD Sharps Disposal by Mail allows you to mail in 70 to 100 syringes or 300 pen needles.

i UltiGuard Syringes and Disposable Container Unit is a combination of syringes in various sizes and needle gauges with a disposal unit.

Firmly close any disposal unit you use. When the unit is full, dispose of it according to your local waste disposal rules.

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