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Diabetes: Insulin Treatment, Type 1

Type 1 Diabetes: Insulin Treatment

Diabetes

Your child has Type I Insulin Dependent Diabetes. This type of diabetes happens when the body does not make enough insulin. Because the body needs insulin to stay healthy, your child must take insulin each day by injection to meet the body's needs to control blood sugars.

Supplies you will need:

  • Insulin
  • Insulin syringe
  • Alcohol swab or 70% alcohol and cotten ball

Note:Insulin syringes come in four types - 25, 30, 50 and 100 units. On a 25-unit syringe, each line equals ½ unit. On the 30 and 50-unit syringe, each line equals 1 unit. On the 100-unit syringe, each line equals 2 units.

Opened vials of insulin, cartridges or pens in current use do not need to be refrigerated if used within 30 days of their first use. Refrigerated and unopened vials or pens can last up to the expiration date on the box or vial. The injection hurts less if the insulin is allowed to come to room temperature before injecting. You may warm the insulin syringe by rolling the syringe between your hands before injecting.

  • Label the bottle with the date when it is opened.
  • The bottle or pen must be thrown away once it has been opened for 30 days (whether it has been refrigerated or is at room temperature).
  • Levemir should be thrown away after 42 days.

    Drawing up your insulin

    Single Dose:
    1. Wash your hands.
    2. Check the insulin bottle before using it. Make sure that the expiration date has not passed and that the top of the bottle is not damaged. Make sure clear insulin stays clear and cloudy insulin is white, not clumpy.
    3. Lantus and Levemir are clear, long-acting insulins. Your doctor may give permission/orders allowing you to mix Lantus or Levemir with your short or rapid-acting insulin. Do not mix either of these insulins with any other insulin without first discussing this with your doctor.
    4. If using "cloudy" insulin (NPH, 70/30) tip the insulin bottle up and down and side to side. DO NOT SHAKE.
    5. Clean the top of the insulin bottle with an alcohol swab or a cotton ball dipped in alcohol.
    6. Remove the needle cover from the syringe by pulling it straight off. Lay the cover on a flat surface.
    7. Draw air into the syringe by pulling back on the plunger to the amount of insulin to be given. (Picture A)
    8.  With the bottle standing upright, insert the needle into the rubber stopper on the bottle and push the plunger in. (Picture B)
    9. Leaving the syringe in the bottle, invert the bottle. Slowly pull the plunger down about 5 units past the dose of insulin you need. If there are no air bubbles, push the top of the plunger tip up to the line, which marks your exact dose. If there are air bubbles in your syringe, flick or tap the syringe at the bubble with your finger (see Picture C). When the air bubble goes to the top of the syringe, push the plunger tip up to your exact dose.
    10. Remove the syringe from the bottle.
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    Mixed Dose:

    Note:  A mixed insulin dose means mixing two kinds of insulin, clear (Regular, Humalogstrong

    1. Wash your hands.
    2. Check the insulin bottles before using them. Make sure the expiration dates have not passed. Make sure the clear insulin (Regular, Humalogâ or Novolog) is clear.
    3. Gently tip the cloudy insulin bottle up and down and side-to-side mixing well. DO NOT SHAKE THE BOTTLE.
    4. Clean the tops of both bottles using an alcohol swab or a cotton ball dipped in alcohol.
    5. Remove the needle cover from the syringe by pulling it straight off. Lay the cover on a flat surface.
    6. Diabetes
    7. Draw air into the syringe by pulling out on the plunger to the amount of cloudy insulin to be given.
    8. With the bottle standing upright, insert the needle into the rubber stopper of the cloudy insulin and push in the plunger (Picture D). Remove the syringe from the cloudy bottle of insulin. You are not going to draw up any of the cloudy insulin yet.  
    9. Draw air into the syringe equal to the amount of clear insulin to be given.
    10. Insert the needle into the rubber stopper of the clear insulin bottle and push air into the bottle (Picture E). Do not remove the syringe from the insulin bottle this time.
    11. Leaving the syringe in the bottle, invert the bottle. Slowly pull the plunger down about 5 units past the dose of insulin you need.
      Diabetes
      Diabetes
      (Picture F) To remove any air bubbles, flick the top of the syringe at the site of the bubbles with your fingers. This will push the bubbles to the top of the syringe. Push on the plunger to push the air bubbles back into the bottle. Make sure you have the exact number of units of clear insulin you need.
    12. Keeping the bottle upside down, remove the syringe from the bottle.
    13. Remember the total number of units that you need. Clear insulin + cloudy insulin = total units.
    14. Turn the cloudy insulin bottle upside down. Insert the needle into the rubber stopper of the cloudy insulin.
    15. Slowly pull the cloudy insulin into the syringe to the total number of units.
      NOTE: If you draw up too much insulin, do not push the insulin back into the bottle. Remove the syringe from the bottle, discard insulin and start again.
    16. Check the syringe to make sure you have the right number of units of insulin. Remove the syringe from the bottle.
    17. Follow the directions "How to Give an Insulin Injection".  

    Site Selection:

    Insulin should be injected into subcutaneous tissue. This is the tissue between the fat layer just under the skin and the muscles that are under the fat. Subcutaneous tissue is all over your body, but the most common areas for insulin injections are:
    • the upper outer area of the arm
    • the front and outer sides of the thighs
    • the abdomen, except for a 2 inch area around the navel
    • the upper outer area of the buttocks
    • the upper hips
    Diabetes

    Site Rotation:

    Site rotation is a system of changing injection sites in a pattern that will help you choose different sites each time you inject. This helps prevent problems that could come from giving injections in the same area. Giving injections in the same place each day may cause your skin to become sunken (atrophy) or lumpy (hypertrophy).

    Choose a pattern that is easy for you to remember - one that best suits the number of injections you need and your body size. Most people should inject in one area until all the sites in that area are used. You should move to a different site within the area for each injection. The injections should be about 1 and 2 inches apart. When all of the previous sites are used, move to a new area of the body and choose a new site in that area for each injection.

    Keep a record of when and where you give each injection. You can mark the date or place an "X" on the body maps as you use a site.

    How to give an insulin injection:

    Diabetes
    1. Choose injection site.
    2. Clean the skin with soap and water or alcohol.
    3. Remove the needle cover by pulling it straight off. Hold the syringe like a pencil.
    4. Pinch the skin between your thumb and index finger.
    5. With one quick motion, quickly push the needle into the skin. (The faster the needle goes in, the less it will hurt.)
    6. Inject the insulin by pushing the plunger down. This should take 3-5 seconds.
    7. Release the skin pinch and remove the needle from the skin.
    8. Gently hold an alcohol swab or cotton ball on the injection site. Do not rub the area.

    If you are unable to inject the needle, ask your physician, pharmacist or nurse educator about devices to help you.

    How to discard the syringe:

    1. Do not recap the syringe. (You may injure yourself.)
    2. Drop the used syringe in a disposal container, such as a hard plastic or metal container with a lid. A coffee can with a slit in the plastic lid may be used. Choose a container that you cannot see through.
    3. When the container is full, tape the top closed, and discard it in the trash. You may want to call your local trash collection service for other disposal suggestions. DO NOT bring the container with the used syringes to the hospital or to your physician’s office.
    4. If you are using a sharps container from a medical company or from a pharmacy, DO NOT return it to the hospital or your physician’s office.
    If you have any questions, ask your physician, pharmacist or nurse educator.

  • Disclaimer: This information is not intended to substitute or replace the professional medical advice you receive from your child's physician. The content provided on this page is for informational purposes only, and was not designed to diagnose or treat a health problem or disease. Please consult your child's physician with any questions or concerns you may have regarding a medical condition.

    Reviewed: 07/2008