Insulin injection

What is insulin injection?

INSULIN ( Iletin II®,Humulin®, Humalog®, Novolin®, Novolog™, etc.) is a hormone produced naturally by the pancreas. Insulin regulates the amount of sugar in your blood and prevents or reduces long-term complications including damage to the blood vessels, eyes, kidneys, or nerves

There are different types of insulin available. Each type has a different onset of action and a different duration of action in the body. You should learn which types you take and how you should administer them, and how each type acts in your body. Insulin is labeled with a large, black letter (example: R for regular, L for lente) to help you easily identify the type, or with the name of the type you take (examples: Humalog®, NovoLog™, Humalog®Mix™, Lantus®, Novolog™Mix™). Only certain types of insulin may be used in insulin pumps.

Insulin is obtained from beef, pork or human sources. Beef insulin is no longer being produced in the US due to concerns of transmission of certain infections through cow tissues. Talk to your prescriber if you take beef insulin currently

Once you are stabilized, do not change the type of insulin you use unless directed to do so by your health care professional. If you must switch the type of insulin you use, you should realize that you may need to monitor your blood sugar more frequently and that dosage adjustments may be needed before you are stabilized on the new type. Take care to learn and recognize the symptoms of hypoglycemia (low blood sugar) and know how you should treat these reactions.

Insulin is available from several manufacturers. Some types of insulin can only be obtained by prescription; your prescriber or health care professional will probably write one. A prescription to obtain insulin syringes may or may not be required in the state where you live

What does my health care professional need to know before I receive insulin?

They need to know if you have any of these conditions:

• adrenal or pituitary gland problems

• diarrhea

• fever or infection

• injury or trauma

• kidney disease

• nausea, vomiting

• recent surgery

• thyroid disease

• an unusual or allergic reaction to insulin, beef or pork products, other medicines, foods, dyes, or preservatives

How should I use this medicine?

Insulin is for injection under the skin. Use daily exactly as directed. Do not use more insulin than prescribed. Do not use more or less often than prescribed

To prepare a dose: Clean the rubber stopper of the vial with an alcohol wipe. Roll the bottle gently between the palms of your hands to mix and warm the solution (not necessary for regular insulin, insulin aspart, or insulin lispro). Be sure to mix the solution well, but do not shake vigorously. Pull back the plunger of a disposable syringe to fill the syringe with an amount of air equal to your dose of insulin (if your dose is 30 units, pull the plunger to the 30 unit mark). Insert the needle into the rubber stopper of the vial, and inject the air into the vial (this will make the insulin easier to remove). Turn the vial upside down, and pull back on the plunger to fill the syringe with prescribed number of units of insulin. Remove any air bubbles trapped in the syringe. If you are mixing two types of insulin in the syringe, measure the regular, aspart, or lispro insulin first

To inject a dose: Select an injection site on the stomach, arm, buttocks, or thigh, and clean with an alcohol wipe. Pinch the skin up with your fingers about three inches apart, and insert the needle at an angle of 45—90 degrees. Pull back on the plunger to make sure the needle is not in a blood vessel before injecting the insulin. If blood appears, remove the needle, reinsert it in a different (nearby) location, and repeat the process. If no blood appears, press the plunger to deliver the insulin. Remove the needle from the skin and press gently on the injection site for a moment (but do not rub or massage). Rotate your injection site such that each site is not used more than once every 1—2 months

If you utilize a insulin injector device, you will be taught how to use it and how to refill the device with the insulin cartridges. Depending on the type of insulin and the type of injector device you use, you should gently roll the injector device between your hands or gently tip it up-side down then right-side up, until the insulin appears uniformly white and cloudy. You will be taught how to administer doses for meals or adjust doses for activities. Your health care prescriber and diabetic educators will teach you

If you utilize an insulin pump, you will be taught how to program the pump; refill the pump cartridges; and how to administer doses for meals or adjust doses for activities. Your health care prescriber and diabetic educators will teach you

What if I miss a dose?

It is important not to miss a dose. If you do miss a dose, use it as soon as you can. If it is almost time for your next dose, use only that dose, do not take double doses. Know the signs of low and high blood sugar and make sure a close family contact or friend can also recognize these signs. Contact your prescriber or health care professional at once if you have any problems

What drug(s) may interact with insulin?

• diazoxide

• epinephrine

• glucagon

• guanethidine

• other medicines for diabetes

Many medications may cause changes (increase or decrease) in blood sugar, these include:

• alcohol containing beverages

• aspirin and aspirin-like drugs

• beta-blockers, often used for high blood pressure or heart problems (examples include atenolol, metoprolol, propranolol)

• chromium

• female hormones, such as estrogens, progestins, or contraceptive pills

• isoniazid

• male hormones or anabolic steroids

• medications to suppress appetite or for weight loss

• medicines for allergies, asthma, cold, or cough

• niacin

• pentamidine

• phenytoin

• some herbal dietary supplements

• steroid medicines such as prednisone or cortisone

• thyroid hormones

• water pills (diuretics)

Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines

What should I watch for while taking insulin?

Visit your prescriber or health care professional for regular checks on your progress. To control your diabetes properly you must use insulin regularly, follow a regular diet and exercise schedule. Diabetes cannot be cured. Careful, daily control of blood sugar can postpone or prevent many of the long-term complications of diabetes

Dangerously high or low blood sugar can occur when meals and insulin are not spaced properly. Checking and recording your blood glucose and urine ketone levels regularly is important. It is sometimes hard to tell the difference between low and high blood sugar on the basis of symptoms (see side effects). Use a glucometer (blood glucose or sugar measuring device), whenever possible, before treating a suspected increase or decrease in blood sugar

Make sure that you have the right kind of syringe for the type of insulin you use. Try not to change the brand and type of insulin syringe unless told to switch by your prescriber. Use a syringe only once and throw away syringe and needle in a closed container to prevent accidental needle sticks

Do not switch brands or types of insulin without consulting your prescriber or health care professional; this can result in dangerously high or low blood sugar

Wear a Medic Alert bracelet or necklace and/or carry an identification card with your name and address, condition, medication, and prescriber's name and address

If you develop a cold, diarrhea, vomiting or other acute infection or illness, you should contact your health care prescriber. "Sick-days" may require adjustments to your insulin dosage or your illness may need to be evaluated. Ask your prescriber what you should do if you become ill. Do not stop taking your insulin; check with your prescriber for advice

If you are a long time smoker and suddenly stop, you may need a change in insulin dose. Talk to your prescriber or health care professional first

Many nonprescription cough and cold products contain sugar or alcohol. These can affect diabetes control or can alter the results of tests used to monitor blood sugar control. Avoid alcohol and products that contain alcohol or sugar

If you are going to have surgery, make sure you tell the health care professionals that you take insulin

What side effects may I notice from receiving insulin?

Learn how and when you should monitor your blood sugar, and what you should do if high or low blood sugar occurs. Side effects that you should report to your prescriber or health care professional as soon as possible:

Symptoms of hypoglycemia (low blood glucose). Contact your health care professional if you experience symptoms of low blood sugar, which may include:

• anxiety or nervousness, confusion, difficulty concentrating, hunger, pale skin, nausea, fatigue, sweating, headache, palpitations, numbness of the mouth, tingling in the fingers, tremors, muscle weakness, blurred vision, cold sensations, uncontrolled yawning, irritability, rapid heartbeat, shallow breathing, and loss of consciousness. Hypoglycemia may cause you to not be aware of your actions or surroundings if it is severe, so you should let others know what to do if you cannot help yourself in a severe reaction

Symptoms of high blood sugar (hyperglycemia) include:

• dizziness, dry mouth, flushed dry-skin, fruit-like breath odor, loss of appetite, nausea, stomach ache, unusual thirst, frequent passing of urine

Insulin also can cause rare but serious allergic reactions in some patients, including:

• severe skin rash and itching (hives)

• difficulty breathing

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):

• increase or decrease in fatty tissue under the skin, through overuse of a particular injection site

• itching, burning, swelling, or rash at the injection site

Where can I keep my medicine?

Keep out of the reach of children

Store unopened insulin vials or pen-injector cartridges in a refrigerator between 2—8 degrees C (36—46 degrees F). Do not freeze. Return to room temperature before use. Opened vials (vials currently in use) may be safely stored at room temperature, at approximately 25 degrees C (77 degrees F) or cooler for up to 28 days. Pen-injector cartridges in use may be kept at room temperature, approximately 25 degrees C (77 degrees F or cooler) for up to 10 days. Protect from light and excessive heat. Throw away any unused medicine after the expiration date or after the specified time for room temperature storage has passed