Learning to draw up and give insulin takes practice. Families often start by doing "air" shots into a doll for practice. Next they practice drawing up sterile salt water (saline) and injecting each other. This helps family members realize that the shot is not very painful. Children below age 10 usually do not draw up insulin by themselves as they do not have the fine motor abilities and concern for accuracy. Your child will need your help.
There are now several brands of disposable insulin syringes with varying needle widths. Needle thickness is measured in gauges. A larger number means it has a thinner needle (for example, a 30 gauge needle is a thin needle). Needles also come in varying lengths. The standard length is 1/2 inch. Insulin syringes should have thin, short, sharp needles so they are easy to insert.
The amount of insulin a syringe will hold varies. Insulin is measured in units. Example of common syringes:
Syringes have markings on the side that measure the units. A 3/10cc syringe has a larger distance between the unit lines and is easier to use if you need to measure small doses. There are even some syringes that have markings for half units. If you do not want to throw away the syringe after each use, you can reuse it. However, the needle may get dulled from going through the rubber stopper on the insulin bottle over and over. A dull needle may cause more damage to your child's skin and tissues. There is also a possibility of infection when reusing syringes.
Your healthcare provider will show you how to draw the insulin into the syringe.
These are the steps:
Continue with steps 8 and 9 if you need to add an intermediate-acting insulin to the same syringe. If you want to have both hands free, you can leave the syringe stuck in the rapid-acting insulin bottle until you have mixed the intermediate-acting insulin.
One problem with insulin bottles is that a vacuum can develop which will draw the insulin in the syringe back into the bottle. To avoid this problem, you can do one of two things:
Venting the bottles
To vent the bottles:
Pick one consistent day of the week to vent the bottles.
The rapid-acting insulins (Humalog, NovoLog, Apidra) peak in 90 to 100 minutes. The blood sugar from food peaks in 60 minutes. It is best to inject the insulin 15 to 30 minutes before eating, if the blood sugar is above 80 mg/dl (4.4 mmol/L). If the blood sugar is below that level, the insulin dose can be given right before or right after eating.
Insulin is injected into the fat layer beneath the skin. The best places to give insulin are the abdomen, arms, thighs, and buttocks. You should rotate injection sites. If your child doesn't like to have shots in one of these areas, then you should rotate the shots between the other areas and skip the area that bothers your child. Shots should not only be rotated from site to site but also within the site itself. For example, there might be 6 different places on the thigh that you can use. This way your child can have a shot in over 50 different spots, before having to have a shot in the same place again. For example, see injection rotation chart.
It is important to learn the proper technique. If you give the shot too close to the outer skin it can cause a lump, pain, or a red spot. If you give the shot too deep into the muscle it may be more painful and cause the insulin to be absorbed too quickly. You want to avoid injecting insulin into a large vein or artery. This is very unlikely if you are giving shots in the recommended areas. If you did inject insulin into a large vein or artery, the insulin would last only a matter of minutes rather than hours. Do not worry about accidentally injecting a bubble of air into your child (even into an artery or vein). It will not harm your child.
To inject the insulin:
Ideally, insulin should be stored in the refrigerator and warmed to room temperature before using. You can warm it up by holding your filled syringe between your hands for a minute or two. If you warm the insulin to room temperature, it is less likely to sting or cause red spots on the skin.
Some people store the bottles they are using at room temperature (except during very hot summer months). Research has shown that insulin stored at room temperature loses a small percentage of its potency every month. For most people, this small change will not make a difference. Watch your child's blood sugar levels carefully when the insulin bottle is almost empty. If the blood sugars start to be unusually high or low, the last bit of insulin should be thrown out.
Insulin will spoil if it gets above 90°F (32.2°C) or if it freezes. Insulin bottles (or pens) should not be left in a car in the hot summer or the cold winter.
Throw away insulin if:
The plastic syringes are recommended for one time use only. If you need to reuse the syringe, after giving the injection, push the plunger up and down to get rid of any insulin left in the needle. Wipe the needle off with an alcohol swab. Put the cap over the needle and store the syringe and needle in the refrigerator until ready for the next use.